Psypath: CBT/cog. approach to treating depression AO1 + 3

Question 1

What is the cognitive element of CBT?

Answer 1

Identify irrational/negative thoughts, replace them w/positive ones

Question 2

What is the behaviour element of CBT?

Answer 2

Encourages pts to test beliefs through behavioral experiments + homework

Question 3

What is the central premise of CBT?

Answer 3

Thoughts/feelings/behaviour impact each other- if an irrational thought can be identified it can change other ppl’s emotions + behaviour

Question 4

How CBT is administered?

Answer 4

Initial assessment- CBT therapist works w/pt to identify problems
Goal setting- pt + therapist agree on set of goals + plan of action to achieve them
Identify automatic negative/irrational thoughts in relation to themselves/their world/their future (Beck’s negative triad) or Ellis’ ABCs model

Question 5

What is meant by patient as scientist?

Answer 5

Generalising + testing hypotheses abt validity of irrational thoughts; realise thoughts don’t match reality, schemas change- irrational thoughts= discarded

Question 6

What is cognitive restructuring?

Answer 6

Perspectives reframed- change in feelings/behaviours

Question 7

What is thought catching?

Answer 7

Identifying irrational thoughts coming from negative triad of schemas

Question 8

What is behavioural activation?

Answer 8

Engage in more active + enjoyable activities (e.g. sports/socializing/travelling).
Important to combat depressive symptoms of isolation and loss of interest.

Question 9

What is Ellis’ ABCDE model?

Answer 9

Dispute- therapist asks client to dispute/challenge irrational thoughts + beliefs as utopianism- involves vigorous argument (hallmark of REBT- Rational Emotive Behaviour Therapy)
Effective new responses- therapist asks client to think of more rational responses

Question 10

What are the types of disputing?

Answer 10

Empirical- assessing if there is evidence for the thought
Logical- assessing whether the thoughts follow from the facts.
Pragmatic- assessing if thought is helpful

Question 11

strength CBT- large body of evidence to support its effectiveness- esp w/ antidepressant treatment.

Answer 11

E- March et al (2007)- 327 adolescents w/a depression diagnosis + looked at effectiveness of CBT, antidepressants, and a combo- 36 wks, 81% of antidepressant group + 81% of CBT group improved. 86% of combo group improved.
E- shows CBT is effective- 81% of pts symptoms improved, but research suggests that a combo of both is effective.
L- therefore, cognitive treatment of depression is effective, but not comprehensive + physiology also needs to be considered, which can be addressed w/ drug therapy

Question 12

limitation CBT- unsuitable for all patients, e.g. those with learning disabilities

Answer 12

E- Sturney (2005) pts w/learning disabilities can’t access complex rational thinking of ‘talking therapy’. Also, pts whose depression is so severe can’t motivate themselves to engage w/cognitive work of CBT.
E- suggests CBT no appropriate for all pts w/depression.
E- however, recent ev. conflicts w/this- Lewis & Lewis (2016) efficacy of CBT for severe depression = antidepressants, Taylor et al (2008) found CBT w/appropriate adjustments used w/pts w/learning difficulties.
L- CBT may be more broadly applicable than prev. considered, but application may need modification

Question 13

limitation CBT- high relapse rates

Answer 13

E- Ali et al (2017) assessed depression in 439 clients for 123 months after a course of CBT. 42% of pts relapsed within 6 months, 53% in 1 yr.
E-suggests few earlier studies had looked at l-t effect- not be as high as assumed. 1 reason=CBT needs motivation- pts w/severe depression may not engage w/CBT/attend sessions. Drug therapy doesn’t need motivation, more effective
L- ev. supports concern that CBT lacks prolonged efficacy, may limit application to pts of moderate severity, whereby motivation can be maintained for longer

Question 14

limitation CBT- efficacy may not depend on the specific techniques of Beck or Ellis, but on patient and therapist relationship

Answer 14

E- Resenzweig et al. (1936) relationship is v. important in determining success of psychological therapy.
E- having someone to talk to might be crucial component in pos. result not specific techniques used. Supported by Luborsky et al. (2002) little diff. w/diff. methods of psychotherapy, suggesting underlying principles don’t differentiate their efficacy.
L- supports concern that efficacy of CBT may be non-specific + unrelated to its cognitive principles, but relies on opportunity for pts to build a trusted relationship which they can confide their concerns

Question 15

March et al. (2007)

Answer 15

327 adolescents w/a depression diagnosis + looked at effectiveness of CBT, antidepressants, and a combo- 81%, 81%, 86%

Question 16

Sturney (2005)

Answer 16

Proposed that pts w/learning disabilities can’t access complex rational thinking of ‘talking therapy’

Question 17

Lewis & Lewis (2016)

Answer 17

Found efficacy of CBT for severe depression was equal to antidepressants

Question 18

Taylor et al. (2008)

Answer 18

Found CBT w/appropriate adjustments used w/pts w/learning difficulties

Question 19

Ali et al. (2017)

Answer 19

Assessed depression in 439 clients every month for 123 months after a course of CBT. 42% relapsed within 6 months, 53% in 1 yr

Question 20

Rosenweig et al. (1936)

Answer 20

Argued the relationship is v. important in determining success of psychological therapy.

Question 21

Luborksy et al. (2002)

Answer 21

Showed little diff. w/diff. methods of psychotherapy, suggesting underlying principles don’t differentiate their efficacy

Question 22

CBT

Answer 22

Most commonly used NHS treatment, based on Beck’s Negative Triad, involves cognitive and behavioral elements.

Question 23

CBT homework

Answer 23

Challenges negative thoughts against reality, puts new rational beliefs into practice (e.g. thought diaries).

Question 24

Patient as scientist

Answer 24

Generating/testing hypotheses about validity of irrational thoughts- mismatched changes schemas.

Question 25

cog. restructuring

Answer 25

perspectives= reframed, change in feelings/behaviours

Question 26

REBT

Answer 26

Ellis’ ABCDE model of expl. (adverse event/behaviour/conseq/dispute/effective new responses)

Question 27

empirical disputing

Answer 27

evidence for thought

Question 28

logical disputing

Answer 28

thought follows facts

Question 29

pragmatic disputing

Answer 29

if thought is helpful