Cognitive Approach To Treating Depression

Question 1

CBT:

Answer 1

1. A method for treating mental disorders based on both cognitive and behavioural techniques.
2. Deals with thinking like challenging negative thoughts and behavioural activation.

Question 2

How does CBT work?

Answer 2

1. An assessment, therapist and patient work together to clarify the patient’s problems.
2. Jointly identify goals for therapy and put together a plan to achieve them.

Question 3

CBT: Beck

Answer 3

1. The idea is to identify automatic thoughts about the world, self and future (negative triad).
2. Must challenge their thoughts and helps patients test the reality of their beliefs. Might be given HW to recall an event they enjoyed.
3. Investigate their negative beliefs in the way a scientist would.
4. In future, if they say there is no point in going to events, the therapist can produce this as evidence to prove they are incorrect.

Question 4

CBT: Ellis’s Rational Emotive Behaviour Therapy (REBT)

Answer 4

1. REBT extends the ABC model to an ABCDE (D for dispute and E for effect). Identify and dispute irrational thoughts.
2. A patient may talk about how unfair things seem, a REBT therapist would identify these as examples of utopianism and challenge this as an irrational belief.
3. This would involve a vigorous argument, change the irrational belief and so break the link between negative life events and depression.
4. Empirical argument involves disputing whether actual evidence to support the negative belief. Logical argument involves disputing whether the negative thought logically follows from the facts.

Question 5

Behavioural Activation:

Answer 5

1. Encourage a depressed patient to be more active and engage in enjoyable activities.
2. Behavioural activation will provide more evidence for the irrational nature of beliefs.

Question 6

E: Effective

Answer 6

1. March et al. (2007) compared the effects of CBT with antidepressant drugs and a combination of the 2 in 327 adolescents with a main diagnosis of depression.
2. After 36 weeks, 81% of the CBT group and 81% of the antidepressants group and 86% of the CBT plus AD group were significantly improved.
3. CBT just as effective as mediaction and helpful alongside medication.
4. Good case for making CBT the first choice of treatment in public health care systems like the NHS.

Question 7

E: CBT may not work for the most severe cases

Answer 7

1. May be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT. May not even be able to pay attention to what is happening in a session.
2. It is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated.
3. Possible to work around this by using medication, this is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression.

Question 8

E: Success May Be Due to The Therapist Patient Relationship

Answer 8

1. Rosenzweig suggested that the differences between different methods of psychotherapy, such as between CBT and systematic desensitisation, might actually quite small.
2. All therapies share one essential ingredient (patient-therapist relationship).
3. May be the quality of this relationship that determines success rather than any particular technique that is used.
4. Comparative reviews (Luborsky et al. 2002) find very small differences, which supports the view that simply having an opportunity to talk to someone who will listen could be what matters most.

Question 9

E: Overemphasis on Cognition

Answer 9

1. Risk of minimising the importance of circumstances in which a patient is living (McCusker) and focusing on what is happening in the individual’s mind.
2. A patient living in poverty or suffering abuse needs to change their circumstances, and any approaches to therapy that emphasises what is happening in the patient’s mind rather than their environment can prevent this.
3. CBT techniques used inappropriately can demotivate people to change their situation.

Question 10

E: Some patients want to explore their past

Answer 10

1. One of the basic principles of CBT is that the focus in therapy is on the present and future, not the patient’s past.
2. Contrasts to some other forms of psychological therapy. Some patients are aware of the link between their childhood experiences and current depression and wan to talk about their experiences.
3. They can find this ‘present-focus’ very frustrating.