PATH 08 - Depression treatments 1

Question 1

What does CBT stand for?

Answer 1

Cognitive behaviour therapy

Question 2

What is CBT?

Answer 2

• A method for treating mental disorders based on both cognitive and behavioural techniques
• From the cognitive viewpoint the therapy aims to deal with thinking such as challenging negative thoughts
• The therapy also includes behavioural techniques such as behavioural activation

Question 3

What are irrational thoughts?

Answer 3

• Also called dysfunctional thoughts
• In Ellis’s model and therapy, these are defined as thoughts that are likely to interfere with a person’s happiness
• Such dysfunctional thoughts lead to mental disorders such as depression

Question 4

What is behavioural activation?

Answer 4

• It is a treatment approach, often used for depression, that focuses on increasing engagement in activities that are rewarding and meaningful to improve mood and reduce avoidance behaviour
• The therapist aims to reinforce such activity

Question 5

How does Beck’s cognitive therapy work?

Answer 5

• Cognitive therapy is the application of Beck’s cognitive theory of depression
• The idea behind cognitive therapy is to identify automatic thoughts about the world, the self and the future (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

Question 6

What does Ellis’s REBT stand for?

Answer 6

Ellis’s rational emotive behaviour therapy

Question 7

How does Ellis’s REBT work?

Answer 7

• REBT extends the ABC model (the theory => explanation) to an ABCDE model
• The D stands for dispute and E for effect (the DE is the actual therapy)
• The central technique of REBT is to identify and dispute irrational thoughts. Irrational thoughts are defined as thoughts that are likely to interfere with a person’s happiness
• Such dysfunctional thoughts lead to mental disorders such as depression
• The REBT therapist would identify and challenge these irrational thoughts (e.g. utopianism)
• This would involve a vigorous argument which intends to change the irrational belief and break the connection between negative life events and depression
• These arguments are the central component of REBT
• The effect (the outcome of the therapy) is that they will have more healthy, rational thinking patterns

Question 8

What are the methods of disputing in Ellis’s REBT?

Answer 8

• Logical argument => involves disputing whether the negative thought logically follows from the facts
• Empirical argument => involves disputing whether there is actual evidence to support the negative belief

Question 9

What are the strengths of CBT?

Answer 9

Large body of evidence supporting its effectiveness

Question 10

What evidence supports the effectiveness of CBT?

Answer 10

• One strength of CBT is the large body of evidence supporting its effectiveness for treating depression
• Many studies show that CBT works
• For example, John March et al. (2007) compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents
• After 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved
• So, CBT was just as effective when used on its own and more so when used alongside antidepressants
• CBT is usually a fairly brief therapy requiring six to 12 sessions, so it is also cost-effective
• This means that CBT is widely seen as the first choice of treatment in public health care systems such as the National Health Service

Question 11

What are the limitations of CBT?

Answer 11

• Lack of effectiveness for severe cases and for clients with learning disabilities
• High relapse rates
• Client preference

Question 12

How does CBT lack effectiveness in severe cases and for clients with learning disabilities?

Answer 12

• One limitation of CBT for depression is the lack of effectiveness for severe cases and for clients with learning disabilities
• In some cases, depression can be so severe that clients cannot motivate themselves to engage with the cognitive work of CBT
• They may not even be able to pay attention to what is happening in a session
• It also seems likely that the complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities
• Peter Sturmey (2005) suggests that, in general, any form of psychotherapy (i.e. any ‘talking’ therapy) is not suitable for people with learning disabilities, and this includes CBT
• This suggests that CBT may only be appropriate for a specific range of people with depression

Question 13

What evidence is there for CBT having high relapse rates?

Answer 13

• One limitation of CBT for the treatment of depression is its high relapse rates
• Although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last
• Relatively few early studies of CBT for depression looked at long-term effectiveness
• Some more recent studies suggest that long-term outcomes are not as good as had been assumed
• For example, in one study, Shehzad 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 within six months of ending treatment and 53% relapsed within a year
• This means that CBT may need to be repeated periodically

Question 14

Why is client preference a limitation of CBT?

Answer 14

• CBT for depression focuses on identifying and changing unhelpful patterns of thinking and behaviour
• There is a large body of evidence to show that, when used with appropriate clients, this is highly effective, at least in the short term, in tackling symptoms of depression
• However, not all clients want to tackle their depression this way
• Some people just want their symptoms gone as quickly and easily as possible and prefer medication
• Others, for example survivors of trauma, wish to explore the origins of their symptoms
• In a study of client preference, Antoine Yrondi et al. (2015) found that depressed people rated CBT as their least preferred psychological therapy