Treating depression

• what type of therapy is CBT?

  a psychological talking treatment for depression and many other disorders.
• What techniques is CBT based on?

  behavioural and cognitive
• what is CBT based on the belief of?

  - our thoughts affect our feelings and our behaviour, but also how we behave affects our thoughts.

  they are all interconnected.
• What is CBT?


  it is a way of talking (psychotherapy) about how you think about:

  - yourself

  - the world

  - other people

  and how this affects behaviour and how what you do affects your thoughts and feelings.
• What is challenged by the therapist in CBT?

  negative thoughts and irrational beliefs.
• What is behavioural activation?


  a type of behavioural technique which encourages patients to enage in those activities they are avoiding.
• What can CBT help to do?

  break the vicious cycle of maladaptive thinking, feelings and behaviour.
• What time period does CBT focus on?


  here and now ( not about post trauma or childhood for example)
• How does CBT work?

  - When unhelpful thoughts and behaviours are identified and understood, they can be changed, this in turn will help improve emotions.

  - Aim : DIY - patients are given the tools to be able to help themselves in the future.
• how many sessions in CBT?

  It is short term, usually 5-20 weekly or fortnightly. Between 30-60 minutes.
• what does CBT involve?

  Assessment --> Identify goals --> treatment (homework and monitoring progress --> treatment complete.
• Beck developed a therapy to..

  challenge the negative triad (beliefs of the client.)
• What is Beck's assumption for his therapy?

  To feel better you must think positively.
• What is the client asked in Beck's therapy?

  How they perceive themselves, the future and the world and made aware of their automatic negative thoughts.
• How does the therapist challenge the automatic negative thoughts in Beck's therpy?

  The therapist will use a process called reality testing. This is cognitive.
• What might the therapist ask the client to do in Beck's therapy?

  do something to demonstrate their ability to succeed (behavioural activation)
• What are negative and irrational ideas replaced with?

  more optimistic and rational beliefs, which allow healthy behaviour and emotions to follow.
• What is Ellis's CBT therapy called?

  Rational Emotive Behaviour Therapy. (REBT)
• What did REBT extend the ABC model to?


  the ABCDE model
• what does D stand for in the ABCDE model?

  Dispute (challenge the irrational beliefs)
• What does E stand for in the ABCDE model?

  Effect (to see a more beneficial effect on our thoughts and behaviour)
• What is the central technique of REBT?

  To identify and dispute the patient's irrational thoughts.
• What does REBT challenge the client with?

  Vigorous argument against the irrational beliefs.
• What can the arguments in REBT be?

  - Empirical (scientific - what evidence is there?)

  - Logical (does the belief follow logically from the event?)
• What is the same between both Beck and Ellis's CBT?

  - challenges thoughts and beliefs

  - 'thought catching' - stops a thought becoming an emotional response.

  - Hypothesis testing - looking for evidence to disprove negative thoughts and beliefs.

  - Homework

  - behavioural activation

  - restructuring thoughts and beliefs by replacing with positive / rational ones.
• What is different of Beck's CBT? (compared to Ellis's)

  - no presumption of activating event

  - does not argue but will still challenge thoughts

  - patient-led

  - warm therapeutic relationship
• What is different of Ellis's CBT? (compared to Beck's)

  - presumption of activating event

  - argues vigorously with the client

  - therapist-led

  - business like relationship
• what research support shows CBT is effective, especially for moderate depression?

  March et al (2007) -

  groups:

  - CBT only, Antidepressants only, both

  after 36 weeks improvement rate:

  CBT - 81%

  Antidepressants - 81%

  Both - 86%
• What does March et al research show?

  CBT is as effective as antidepressants and even more when in combination.
• What research support looks at combination treatment with drugs and CBT in adults with chronic depression?

  Keller et al (2000)

  Recovery rates (from depression)

  - 55% drugs alone

  - 52% CBT alone

  - 85% combination
• What does Keller et al research show?

  CBT is almost as effective as drugs when used alone, but is most effective when used as a combination.
• Why may CBT not work for the most severe cases?

  - People with severe depression may lack any motivation to engage with therapy, they may need to be treated with antidepressants before CBT is possible.
• Why may some people not prefer CBT as their choice of talking therapy?

  it focuses on the here and now. Some people may want to explore their past such as childhood experiences, this will not happen in CBT.