CA Treating Depression- Beck's Cognitive Therapy+Ellis' REBT

• The therapist will ask the client to identify negative thoughts, challenge them with evidence, and replace them with more positive ones.
• Beck's Cognitive Therapy(1)

  Beck developed one type of CBT to treat depression. The patient learns how to spot their negative automatic thoughts and their negative triad, which are negative thoughts about themselves, the world and the future. This is called 'Thought Catching'. The patient then learns how to logically dispute these thoughts by coming up with evidence for and against them (Reality Testing)
• Beck's Cognitive Therapy (2)

  Patients then use actives such as using diaries to monitor events and identify situations in which negative thinking occurs so it can be challenged. They may be set homework such as to keep record of an event they enjoyed or when someone was nice to them. In future sessions, if the patient says no one is nice to them, the therapist can provide this evidence to show how their statement is incorrect, thus challenging their thoughts.
• Beck's Cognitive Therapy (3)

  The therapist may also ask the patient to make small changes to their behaviour, such as 'Activity raising or 'Behavioural activation', where patients build up their daily social activities and therefore test their fears.
• Beck's Cognitive Therapy

  CBT often involves a specific focus on encouraging patients to become more active and engage in pleasurable activities as a common characteristic of depressed people is that they no longer participate in activities they previously enjoyed. In CBT, the therapist and client identify potential pleasurable activities and anticipate and deal with any cognitive obstacles
• Ellis' Rational Emotive Behavioural Therapy (REBT) (1) 


  Another form of CBT based upon his ABC model which focuses on challenging or disputing the individuals irrational thoughts about an event and replacing them with effective, rational beliefs. The central idea in REBT is logically disputing whether the negative thoughts about REBT extends the ABC model to ABCDEF model.

  D- Disputing irrational beliefs and thoughts, E- effects of disputing, F new feelings produced.
• REBT (2)

  It is not the activating event that causes unproductive consequences, it's the belief that lead to the self defeating consequences. It is not the activating event that causes unproductive consequences, it's the belief that lead to the self defeating consequences.
• REBT (3)

  Examples of REBT

  Logically Disputing- Involves disputing whether the negative thought logically follows the fact.

  Empirical Disputing- Involves disputing whether there is actual evidence to support the negative belief

  Pragmatic Disputing- This emphasises the lack of usefulness of self-defeating beliefs.

  Effective Disputing- Whether the activating events are actually realistic or not
• (+) Effective compared to Drug treatment

  A strength of CBT as a treatment for depression is that there is evidence to suggest it is effective. For example, Holon found that fewer depressed patients relapsed after 12 weeks of CBT (40%) than those taking drugs (45%). This is a strength because it suggests that the research works
• (+) Supporting Evidence- Large body of evidence to suggest effectiveness (1)

  March compared the effects of CBT with antidepressant drugs and a combination of the two in 329 adolescents with depression. After 36 weeks, 81% of the CBT group, 81% of the antidepressant group and 86% of the combination group had significantly improved. Strength because CBT emerged just as effective as medication and helpful alongside it, this suggests that there is some good in making it the first choice of treatment in the NHS.
• (+) Supporting Evidence (2)

  (-) However, the success may depend on the Therapist-Client relationship. Therapist competence appears to explain a significant amount of variation in CBT outcomes. Kuyken lends support to this claim, concluding that as much as 15% variance in outcome may be attributable to the therapist competence.
• (-) Takes effort compared to Biological therapies

  Patients may not be able to follow the activities of CBT and some people may give up before it has had chance to work because it takes too long to work. This may be the case with patients with severe depression who may not be able to motivate themselves to follow the activities. This is a limitation because if a depressed patient can't do these things, CBT can't be effective for them.
• (-) Time consuming

  Because CBT can take over a year to be effective, it is not appropriate for patients at high risk of suicide. This is a limitation of CBT because the treatment is not appropriate for individuals who are suffering from severe symptoms of depression and might be at risk of committing suicide and therefore need faster relief/treatment such as anti-depressants
• (-) Overemphasis on Cognitions

  Because the focus is on irrational cognitions, the patients may end up minimising or ignoring the importance of their environment and social factors. For example, a patient living in poverty or suffering abuse needs to change their circumstances. This is a limitation because CBT techniques used inappropriately can demotivate people to change their situations. Therefore it is not always an effective treatment for all cases of depression.
• (-) Over simplistic

  The diathesis stress model suggests that depression isn't caused by one factors but is caused by the individual having a genetic predisposition to depression that is triggered by an environmental stimuli. If this theory is correct, then it would logically follow that the most effective way to treat depression is to use a combination of therapies. Limitation as some psychologists would criticise the approach for not using a multi-treatment approach