depression

• Cognitive Behavioural Therapy (CBT) is the most commonly used psychological treatment for depression and a range of other mental health issues
• Cognitive element of CBT

  1. Assessment to clarify problems

  2. Jointly clarify goals and put a plan to achieve them

  3. Identify negative irrational thoughts that will benefit from challenge
• Behavioural element of CBT


  Change negative irrational thoughts and replace with more effective behaviours
• Cognitive Therapy


  Application of Beck's theory of depression - the most logical and effective way to change maladaptive behaviour is to change the irrational thinking which underlies it
• Beck's cognitive therapy


  1. Identify automatic thoughts about the world, the self and the future (Negative Triad)

  2. Challenge these thoughts

  3. Client acts as a scientist to test the reality of their negative beliefs

  4. Clients may be asked to record positive events to challenge irrational thoughts
• Once clients identified their irrational thoughts, CBT helps them change them by challenging the thoughts directly
• Homework completed by the client, recording positive events, can be used in sessions to help challenge irrational thoughts
• Ellis's Rational Emotive Behaviour Therapy (REBT) extends the ABC model to ABCDE (D is for Dispute and E is for Effect)
• REBT


  1. Identify irrational thoughts

  2. Challenge irrational thoughts through empirical, logical and pragmatic arguments
• The goal of behavioural activation is to work with individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood
• The World Health Organisation (WHO) states that in 2020, depression was the biggest single disease burden, costly to individuals, families, communities and the economy as a whole through lowered productivity, absenteeism and unemployment
• Even though cognitive therapy might initially be more expensive than drug therapy, in the long-term it might be more economically sound to offer cognitive therapy as people would have less time off work
• Ellis claimed a 90% success rate for REBT after 27 sessions, but recognised therapy was not always effective when clients did not put revised beliefs into action
• REBT may be less suitable for clients who have high irrational beliefs that are resistant to change, and for the most severe cases as the patients can't motivate themselves to engage with the hard cognitive work of CBT
• Relapse rates for cognitive treatments are high, with 42% of patients relapsing within 6 months and 53% within a year
• What's depression?


  A mental disorder characterised by low mood and low energy levels
• What are behavioural, emotional, & cognitive characteristics?

  • Ways in which people act
  • Ways in which people feel
  • Refers to the process of thinking – knowing, perceiving, believing.
• What are the behavioural characterisics of depression?

  • Activity levels
  • Disruption to sleep and eating behavior
  • Agression & self-harm
• What are the emotional characteristics of depression?

  • Lowered mood
  • Anger
  • Lowered self-esteem
• What are the cognitive characteristics of depression

  • Poor concentration
  • Attending to & dwelling on the negative
  • Absolutist thinking
• Expand on the behavioural characteristics(a,se,as)

  • ↓ energy=lethargy & withdrawal (work, education & social life)/↑ energy(psychomotor agitation), may struggle to relax/may pace up and down rooms
  • Insomnia, particularly premature waking, or an increased need for sleep (hypersomnia).Appetite and eating may increase/decrease, leading to weight gain/loss.
  • irritable,become verbally/physically aggressive. e.g. effects (verbal) ending a relationship/quitting a job. May display physical aggression directed against the self (self-harm(cutting/suicide attempts))
• Expand on the emotional characteristics (mal)

  • Feeling sad, desccribe themselves as 'worthless' & 'empty'. Lowered mood is still a defining emotional element of depression but it is more pronounced than in the daily kind of experience of feeling lethargic and sad.
  • Frequently experience anger, sometimes extreme directed at the self/others.Can lead to aggressive/self-harming behaviour.
  • (The emotional experience of how much we like ourselves)- reduced self-esteem, liking themselves less than usual.May be extreme-some describing it as self-loathing,e.g. hating themselves
• Expand on the cognitive characteristics (cnt)

  • Unable to stick with a task they usually would/make decisions normally straightforward. Poor concentration and poor decision making likely to interfere with the individual’s work.
  • In depressive episode, likely to pay attention to - aspects of a situation & ignore the + ones, see a glass as 1/2 empty rather than 1/2 full. Can have a bias towards recalling - events rather than + ones, the opposite bias that people have when not depressed.
  • ‘Black & white thinking’, When a situation is unfortunate they tend to see it as an absolute disaster
• Define the negative triad

  Beck proposed that there were three kinds of negative thinking that contributed to becoming depressed: negative views of the world, the future and the self. Such negative views lead a person to interpret their experiences in a negative way and so make them more vulnerable to depression.
• Define the ABC model

  Ellis proposed that depression occurs when an activating event (A) triggers an irrational belief (B) which in turn produces a consequence (C), i.e. an emotional response like depression. The key to this process is the irrational belief.
• Explain faulty information processing

  When depressed we attend to the negatives aspects of a situation and ignore positives. For example, if I was depressed and won £1 million on the Lottery, I might focus on the fact that the previous week someone had won £10 million rather than focus on the positive of all I could do with £1 million. We also tend to blow small problems out of proportion and think in ‘black and white’ terms.
• Explain negative self-schemas


  A schema is a ‘package’ of ideas and information developed through experience. They act as a mental framework for the interpretation of sensory information. A self-schema is the package of information we have about ourselves. We use schemas to interpret the world, so if we have a negative self-schema we interpret all information about ourselves in a negative way.
• Explain the negative triad

  Dysfunctional thinking due to - triad,(automatic), regardless of reality .When we are depressed, these 3 types of thoughts often come to us.

  • - view of the world,e.g. ‘the world is a cold hard place’. This creates the impression that there is no hope anywhere.
  • - view of the future,e.g. ‘Isn’t much chance that economy will get better’, reducing any hopefulness & enhancing depression.
  • - view of the self,‘I am a failure’, Enhancing any existing depressive feelings as they confirm the existing emotions of low self-esteem.