Cognitive treatment of depression

• Cognitive behavioural therapy (CBT)


  CBT is an example of the cognitive approach to treatment though it also includes behavioural aspects :

  • Cognitive - challenge negative, irrational thoughts
  • Behaviour - change behaviour so it is more effective

  Client and therapist work together

  The aim is to identify negative thoughts about the self, the world, the future (negative triad). Thee thoughts must be challenged by the client taking an active role in their treatment
• CBT - client as a scientist

  Clients are encouraged to test the reality of their irrational beliefs. They might set homework like record when you enjoyed an event. This is referred to as the client as a scientist. In future sessions, if the client says no one is nice to them, the therapist can produce this evidence to prove the client's beliefs are incorrect.
• REBT = Rational emotive behavioural therapy


  REBT extends Ellis' ABC model to ABCDE model :

  • D = dispute irrational beliefs
  • E = effect

  Empirical argument - disputing whether there is evidence to support the irrational belief

  Logical argument - disputing whether the negative thought actually follows from fact
• Behavioural activation


  As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms.

  The goal of behavioural activation is to work with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood.
• Evaluation

  One strength of CBT is evidence of its effectiveness. March compared the effects of CBT with antidepressant drugs and a combination of the two in 27 depressed adolescence. After 36 weeks, 81% of CBT group, 81% of antidepressants group and 86% of CBT and antidepressants group were significantly improved. This means there is a good case for making CBT the first choice of treatment in public health care systems lie the NHS.
• Evaluation

  One limitation is suitability for diverse clients. In severe cases, depressed clients may not be able to motivate themselves to engage with the cognitive work of CBT. They may not be able to pay attention in sessions. Sturmey suggests that any form of psychotherapy is not suitable for people with learning difficulties. This means that CBT may only be appropriate for a specific range of clients.
• Evaluation

  One limitation is high relapse rates. Few early studies looked at long term effectiveness and recent studies suggest that relapse is common. Ali assessed depression for 12 months following a course of CBT. 42% relapsed within six months of ending treatment and 53% within a year. This means that CBT may need to be repeated periodically