The cognitive approach to treating depression

• Cognitive behaviour therapy (CBT)


  The most commonly used psychological treatment for depression and a range of other mental health problems
• Cognitive behaviour therapy (CBT)


  • An example of the cognitive approach to treatment, though it also includes behavioural elements
• Cognitive element of CBT


  1. Assessment to clarify the client's problems

  2. Jointly identify goals for the therapy

  3. Put together a plan to achieve them

  4. Identify negative or irrational thoughts that will benefit from challenge
• Behaviour element of CBT


  1. Work to change negative and irrational thoughts

  2. Put more effective behaviours into place
• Beck's cognitive therapy


  The application of Beck's cognitive theory of depression to identify and challenge automatic negative thoughts
• Beck's cognitive therapy


  1. Identify automatic thoughts about the world, the self and the future (the negative triad)

  2. Challenge these thoughts directly

  3. Help clients test the reality of their negative beliefs
• Ellis's rational emotive behaviour therapy (REBT)


  Extends the ABC model to an ABCDE model, where D stands for dispute and E for effect
• REBT


  1. Identify irrational thoughts

  2. Dispute (challenge) the irrational thoughts

  3. Intended effect is to change the irrational belief and break the link between negative life events and depression
• Behavioural activation


  As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms. The goal 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.
• Strength of cognitive behaviour therapy


  • evidence supporting its effectiveness

  • John March compares CBT to antidepressant drugs and to a combination of both when treating 327 depressed adolescent.

  • after 36 weeks, 81% of the CBT group 81% of the antidepressant group and 86% of both were improved. So CBT was just as effective on his own and more so when use alongside antidepressants.

  • Means that CBT is seen as a first choice of treatment in public healthcare systems.
• Limitation of CBT


  • High relapse rates

  • Some studies suggest that long-term outcomes are not as good as has been assumed.

  • For example, Shehzad, Ali assessed depression in 439 clients every month for 12 months following a course of CBT.

  • 42% of the class relapsed into depression within six months of ending treatment and 53% within a year

  • Means that CBT may need to be repeated periodically