cognitive approach to treating depression

Question 1

what is the most commonly used psychological treatment for depression

Answer 1

• CBT
• Cognitive behaviour therapy

Question 2

What is the cognitive element of CBT

Answer 2

• begin with an assessment in which the client and the cognitive behavioural therapist work together to clarify the clients problems
• jointly identify goals for the therapy and put together a plan to achieve them
• one of the central tasks is to identify where there may be negative or irrational thoughts that will benefit from the challenge

Question 3

what is the behavioural element to CBT

Answer 3

• working to change the negative and irrational thoughts and put more effective behaviours in place

Question 4

strength of CBT

Answer 4

1. evidence for effectiveness
   - many studies show that CBT work
   - March et al (2007) compared CBT to antidepressant drugs and a combination of both when treating 327 depressed adolescents
   - after 36 weeks 81% of the CBT group, 81% of the antidepressant group and 86% of both were significantly improved
   - CBT was just as effective when used on its own and more so effective when used alongside antidepressants
   - CBT requires 6 - 12 sessions so is also cost effective
   - widely seen as the first choice of treatment in the NHS

Question 5

limitation of CBT

Answer 5

1. suitability for diverse clients
   - lack of effectiveness for severe cases and for clients with learning disabilities
   - depression can be severe that clients cannot motivate themselves to engage with the cognitive work of CBT
   - seems likely that the complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disability
   - suggest that CBT may only be appropriate for a specific range of people with depression
2. relapse rates
   - has high relapse rates
   - although CBT is effective there are concerns over how long the benefits last
   - study by Ali et al (2017) assessed depression in 439 clients every month for 12 months following a course of CBT
   - 42% of the clients relapsed into depression with 6 months of ending treatment
   - 53% relapsed within a year
   - CBT may need to be repeated periodically

Question 6

behavioural activation in CBT

Answer 6

• as individuals become depressed they tend to increasingly avoid difficult situations and become isolated which worsens symptoms
• the goal of behavioral activation is to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that improve mood eg exercise
• the therapist aims to reinforce such behavoiur

Question 7

ellis rational emotive behavoiur therapy (REBT)

Answer 7

• extends the ABC model to an ABCDE model
• D for dispute and E for effort
• central technique of REBT is to identify and dispute irrational thoughts
• REBT identifies the irrational thoughts and challenges them through vigorous argument
• intended effect is to change the irrational belief and break the link between negative life events and depression

Question 8

what are Ellis methods of disputing

Answer 8

• empirical argument = disputing whether there is actual evidence to support the negative belief
• logical argument = disputing whether the negative thought logically follows from fact

Question 9

Becks cognitive therapy

Answer 9

• the application of Becks cognitive theory of depression
• identify automatic thoughts about the world, self and future (negative triad)
• once identified these thoughts must be challenged
• as well as challenging these thoughts directly cognitive therapy aims to help clients test the reality of their negative beliefs
• they might be set homework to record when they enjoyed an event
• so in future if clients say that no there is no point in going to events the therapist can they produce this evidence and use it to prove the clients statements are incorrect