Treating Depression Flashcards
(9 cards)
What are the 2 strands of CBT?
1) Beck’s Cognitive Therapy
2) Ellis’s Rational Emotive Behaviour Therapy (REBT)
Treating depression
- Cognitive Behavioural Therapy (CBT) involves both cognitive and behavioural elements.
- The cognitive element aims to identify negative and irrational thoughts, which lead to depression with the aim of replacing them with more positive ones. This element of CBT is built upon from Beck’s cognitive therapy and Ellis’s rational emotive behaviour therapy as they encourage cognitive restructuring.
- The behavioural element of CBT stimulates patients to test their beliefs through engaging in experiments and homework.
- There are various components of CBT, including:
1) Initial assessment
2) Goal setting
3) Identifying negative/irrational thoughts and challenging these: either using Beck’s Cognitive Therapy or Ellis’s REBT
4) Homework
- All CBT starts with an initial assessment in which the patient and therapist identify the patient’s problems. Thereafter, the patient and therapist agree on a set of goals, and plan of action to achieve these goals. Both strands of CBT (Beck’s and Ellis’s) then aim to identify the negative and irrational thoughts, however their approaches are slightly different.
Beck’s Cognitive Therapy
- 16-20 week program that focuses on present experiences and issues.
- Therapist trains thought-catching, which is a process of identifying irrational thoughts coming from the negative triad.
- The patient acts as a scientist - hypothesis/reality-testing the validity of their irrational thoughts. When they realise that their thoughts don’t match reality, this will change their schemas, and the irrational thoughts can be discarded.
- The patient and therapist will then work together to challenge these irrational thoughts, by discussing evidence for and against them.
- The patient may be set homework, including keeping a diary, which is used to record negative thoughts and identify situations that cause negative thinking.
- Encouraged to partake in behavioural activation which improves emotions and challenges thoughts. It involves engaging in activities that the sufferer used to enjoy, e.g., sports, travelling or socialising.
Ellis’s Rational Emotive Behaviour Therapy (REBT)
- Ellis developed his ABC model to include D (dispute) and E (effect).
- The therapist will dispute the patient’s irrational beliefs, to replace them with effective beliefs and attitudes. There are different types of dispute which can be used, including: logical dispute – where the therapist questions the logic of a person’s thoughts, for example: ‘does the way you think about that situation make any sense?’ Or empirical dispute – where the therapist seeks evidence for a person’s thoughts, for example: ‘where is the evidence that your beliefs are true?’.
- The effect of this is a reduction of irrational thoughts (restructured beliefs B) leading to better consequences (C) in the future.
- Following a session, the therapist may set their patient homework. The idea is that the patient identifies their own irrational beliefs and then proves them wrong. As a result, their beliefs begin to change. For example, someone who is anxious in social situations may be set a homework assignment to meet a friend for a drink.
Difference
In Beck’s cognitive therapy, the client is helped to figure out the irrationality of their thoughts themselves by acting as a scientist. In Ellis’s REBT, the therapist explains the irrationality of their thoughts directly to their patients through disputation.
Strength
Point: A major strength of cognitive behavioural therapy (CBT) is its strong practical application in the treatment of depression.
Evidence: CBT is widely used in clinical settings and recommended by organisations such as the NHS as a first-line treatment for mild to moderate depression. It is relatively short-term, cost-effective and structured, making it easier to deliver in a standardised format whilst simultaneously equipping patients with skills to identify and challenge negative thinking patterns and replace them with more balanced thoughts.
Justification: This practical approach not only reduces symptoms in the short term but also provides individuals with coping strategies that can be used long after therapy ends. This makes CBT a sustainable and empowering form of treatment that encourages self-reliance and long-term mental health improvement.
Implication: The broad application and long-term benefits of CBT increase its value in mental health services. Its structured, goal-oriented nature makes it suitable for wide use, particularly in public healthcare systems where cost-effectiveness and time efficiency are important.
Counterargument: However, a limitation of CBT as a treatment for depression is that it requires high levels of motivation from the patient.
Evidence: Individuals with severe depression often struggle with low energy, reduced concentration, and lack of interest, which can prevent them from attending sessions or engaging actively with the therapeutic process.
Justification: This can make CBT ineffective for the very people who may need treatment the most. In contrast, alternative treatments such as antidepressants do not require the same level of motivation and may therefore be more suitable for these individuals.
Implication: This limits the practical application of CBT, suggesting it may not be appropriate as a sole treatment for all cases of depression, particularly those that are more severe.
Strength
Point: A strength of CBT is that it focuses on the present rather than exploring a person’s past.
Evidence: CBT is concerned with identifying and challenging current negative thought patterns and behaviours, which are seen as maintaining the symptoms of depression. This makes the therapy more structured, goal-oriented, and time-limited.
Justification: This present-focused approach can be appealing to patients who prefer practical solutions over delving into past traumas. It also allows therapists and clients to track progress more clearly, contributing to its effectiveness and popularity as a treatment.
Implication: As a result, CBT is more accessible and efficient for many patients, making it a widely used therapy in clinical settings, especially in public health systems where the volume of patients suffering from depression need to be taken into account.
Counterargument: On the other hand, CBT’s present-focused nature may not be suitable for all patients, particularly those who wish to explore the root causes of their depression.
Evidence: Some individuals with depression have unresolved childhood trauma or significant past experiences that contribute to their current mental health issues. These patients may find CBT’s avoidance of the past unhelpful or frustrating.
Justification: By not addressing the underlying causes rooted in early life experiences, CBT may only provide short-term relief and not resolve deeper emotional issues. This can reduce its long-term effectiveness for certain individuals.
Implication: This suggests that while CBT is useful for many, a more integrative approach that combines present-focused strategies with exploration of past experiences may be more beneficial for some patients.
Weakness
Point: A limitation of CBT is that its effectiveness may be more influenced by the quality of the therapist-patient relationship than the specific techniques used.
Evidence: Rosenzweig (1936) suggested that all forms of psychotherapy share a common factor: the strength of the therapeutic relationship. This implies that the success of CBT may be largely due to how well the therapist and patient work together, rather than the cognitive techniques themselves.
Justification: If the therapeutic alliance is a key factor in recovery, then the specific elements of CBT may not be solely responsible for improvement. This challenges the idea that CBT is uniquely effective and suggests that similar outcomes could be achieved through other talking therapies with strong relational support.
Implication: This reduces the internal validity of CBT research because improvements in symptoms may not be due to the cognitive components of the therapy itself, but rather to the quality of the therapist-patient relationship — a confounding variable that is difficult to control for.
Strength
Point: One strength of cognitive behavioural therapy (CBT) is that there is strong research evidence supporting its effectiveness in treating depression.
Evidence: Research by March et al. (2007) investigated the effectiveness of CBT compared to antidepressants. They studied 327 adolescents diagnosed with depression and found that after 36 weeks, 81% of those in the CBT group and 81% in the antidepressant group had shown significant improvement. Furthermore, 86% of participants receiving a combination of CBT and antidepressants had improved.
Justification: This demonstrates that CBT is just as effective as medication in treating depression, and even more effective when used alongside antidepressants. The findings support the idea that CBT can successfully reduce depressive symptoms, particularly when integrated with other treatments.
Implication: These results enhance the practical value of CBT as a treatment option for depression and suggest that a combined approach may be the most effective strategy, offering flexibility in tailoring treatment to individual patient needs.
