cognitive treatments for depression Flashcards
(8 cards)
introduction
Cognitive behaviour therapy (CBT) is the most commonly used psychological treatment for depression and a range of other mental health issues. It is an example of the cognitive approach to treatment, though it also includes behavioural elements.
Cognitive element CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the client’s problems. They jointly identify goals for the therapy and put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge.
Behaviour element CBT then involves working to change negative and irrational thoughts and finally put more effective behaviours into place.
Becks cognitive therapy
Cognitive therapy is the application of Beck’s cognitive theory of depression (see previous spread). The idea behind cognitive therapy is to identify automatic thoughts about the world, the self and the future - this is the negative triad. Once identified these thoughts must be challenged. This is the central component of the therapy.
As well as challenging these thoughts directly, cognitive therapy aims to help clients test the reality of their negative beliefs. They might therefore be set homework, such as to record when they enjoyed an event or when people were nice to them. This is sometimes referred to as the client as scientist, investigating the reality of their negative beliefs in the way a scientist would. In future sessions if clients say that no one is nice to them or there is no point in going to events, the therapist can then produce this evidence and use it to prove the client’s statements are incorrect.
Ellis’ rational emotive behaviour therapy
Rational emotive behaviour therapy (REBT) extends the ABC model (see previous spread) to an ABCDE model - D stands for dispute and E for effect. The central technique of REBT is to identify and dispute (challenge) irrational thoughts.
For example, a client might talk about how unlucky they have been or how unfair things seem. An REBT therapist would identify these as examples of utopianism and challenge this as an irrational belief. This would involve a vigorous argument. The intended effect is to change the irrational belief and so break the link between negative life events and depression.
This vigorous argument is the hallmark of REBT. Ellis identified different methods of disputing. For example, empirical argument involves disputing whether there is actual evidence to support the negative belief. Logical argument involves disputing whether the negative thought logically follows from the facts.
Empirical Argument
This is about evidence.
You ask: “Where’s the proof?”
Logical Argument
This is about reasoning.
You ask: “Does that actually make sense?
Ellis-behavioural activation
As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms.
The goal of behavioural activation 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, e.g. exercising, going out to dinner, etc. The therapist aims to reinforce such activity.
strength-research support CBT
Research by March et al. (2007) found that CBT was as effective as antidepressants in treating depression.
• 327 adolescents with a diagnosis of depression
• Compared the effectiveness of CBT, antidepressants, and a combination of CBT and antidepressants.
• After 36 weeks, 81% of the antidepressant group, 81% of the CBT and 86% of the combination group had significantly improved.
• This demonstrates the effectiveness of CBT in treating depression and also suggests that it works well alongside medication as a combination therapy and may even be more effective than just one or the other. CBT is usually a fairly brief therapy requiring six to 12 sessions so it is also cost effective.
limitation-suitability for diverse clients
CBT could be ineffective for more severe cases and people with learning difficulties.
• CBT requires motivation
• Motivation may not be present in the more severe cases of depression → won’t be able to engage with the work or pay attention to what is happening in the session.
• It is also possible that the hard cognitive work associated with CBT could make it unsuitable for people with learning disabilities.
• Sturmey (2005) even suggests that psychotherapy of any kind is unsuitable for people with learning difficulties.
Suggests that CBT may only be appropriate for a specific range of clients.
counterpoint-suitability
More recent evidence challenges the idea that CBT is unsuitable for severe depression and for people with learning difficulties.
• Lewis and Lewis (2016) concluded that CBT was as effective as antidepressants and behavioural therapy for severe depression.
• Taylor et al. (2008) concluded that when used appropriate CBT is effective for people with learning disabilities.
This means that CBT may in fact be suitable for a wider range of people than was initially thought.
limitation-relapse rates
Although CBT seems to be quite effective in tackling the symptoms of depression there are some concerns over how long the benefits last.
• Some recent study suggest that the long-term outcomes are infact not as good was once thought.
• E.g. Ali et al. (2017) assessed depression in 439 clients every month for 12 months following a course of CBT.
• 42% relapsed within 6 months of ending treatment.
• 53% relapsed within a year.
This means that CBT may need a to be repeated periodically.
