Cognitive approach to treating depression

• Cognitive behaviour therapy

  = Based on both cognitive and behavioural techniques.

  • Aims to deal with thinking, such as challenging negative thoughts.
  • Cognitive element=begins with assessment to clarify the clients problems- identify goals for the therapy and put together a plan- identify where there might be negative or irrational thoughts.
  • Behavioural element= working to change negative and irrational thoughts and put more effective behaviours in place.
• Beck's cognitive therapy

  -Identify automatic thoughts about the world, self and future.

  -Then challenge these thoughts.

  -Helps clients test the reality of their negative beliefs.

  -Sometimes told to record any event they enjoyed so they can use this to prove their negative statements wrong.
• Ellis's rational emotive behaviour therapy

  = Technique of REBT is to identify and challenge irrational thoughts.

  • Involves a vigorous argument.
  • The intended effect is to change the irrational belief and so break the link between negative life events and depression.
  • Empirical argument= involves disputing whether there is actual evidence to support the negative beliefs.
  • Logical argument= involves disputing whether the negative thought logically follows from the facts.
• Behavioural activation

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

  • Behavioural activation= gradually decrease their avoidance and isolation, and increase engagement in activities that improve mood. Reinforce this activity.
• Evaluation- evidence for effectiveness

  March et al compared CBT to antidepressant drugs and also to a combination of both treatments.

  • After 36 weeks, 81% of CBT group, 81% of antidepressant group and 86% of CBT and antidepressant group significantly improved.
  • So CBT is just as effective when used on its own and more so when alongside antidepressants.
  • So CBT is fairly brief therapy so cost effective and widely seen as as first choice.
• Evaluation- suitability for diverse clients

  Limitation= lack of effectiveness for severe cases for clients with learning difficulties.

  • In severe cases, clients can't motivate themselves to engage with the cognitive work of CBT- may not pay attention.
  • Likely that the hard cognitive work involved in CBT makes it unsuitable for treating depression in clients with learning disabilities.
  • Sturmey suggests any form of psychotherapy isn't suitable for people with learning disabilities, so CBT is not suitable.
• Evaluation- counterpoint

  Recent evidence to challenge suitability of CBT for people with learning disabilities.

  Lewis and Lewis concluded CBT was as effective as antidepressants drugs and behavioural therapies for severe depression.

  Taylor concluded that when used appropriately, CBT is effective for people with learning disabilities so suitable for a wider range of people.
• Evaluation- relapse rates

  Limitation= high relapse rates for CBT treatment.

  • CBT effective in tackling symptoms but concerns over lasting benefits.
  • Few early studies look at long lasting effectiveness.
  • Shehzad assessed depression in 439 clients every month for 12 months following a course of CBT- 42% of clients relapse into depression within 6 months of ending treatment, 53% relapsed within a year.
  • So CBT needs to be repeated periodically