Download cognitive treatment of depression

Unit 1 - Psychopathology
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What have we studied as a key cause of
depression?
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Therefore, how might depression be treated?
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Is it likely to be successful?
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This approach links depression to irrational and
dysfunctional thoughts.
Negative events occur that can trigger negative schemata
that may have been acquired in childhood e.g. “I will never
succeed at anything”.
This leads to the negative automatic thoughts that you are
indeed a failure at everything.
The aim of CBT is to challenge these irrational and
dysfunctional thought processes.
Two examples of the Cognitive approach are Beck’s
therapy for depression and Ellis's RET which both follow
the same assumptions and share many similarities.
Summary Clip
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Beck (1976) believed that negative schemata lead to pessimistic
thoughts about the self, the world and the future. These sort of cognitive
biases maintain negative thoughts. The aim of Beck’s approach is to
challenge these irrational cognitions and replace them with more
realistic appraisals.
The therapist helps the client identify specific negative thoughts e.g. “I
always fail exams in that subject” or “I will never have a successful
relationship”. They will often advocate keeping a diary record.
The therapist challenges these records by pointing out positive incidents
and drawing their focus onto these. This is a form of reality testing.
Beck also uses behavioural techniques to encourage more positive
behaviour e.g. setting someone who is depressed a list of small goals to
achieve such as getting up by a certain time. This is to give them a sense
of personal effectiveness.
Training in problem solving skills is another aspect along with relaxation
techniques to reduce anxiety in stressful situations.
• Remember: Ellis’s ABC Model…
ACTIVATING EVENT
Getting a bad mark for
an essay.
SELF-DEFEATING BELIEFS
I’m hopeless and will
never get the grade I
need.
CONSEQUENCES
No longer trying and
just accepting my lot.
• RET (renamed REBT) helps clients substitute more effective problem solving
methods.
• This treatment has been used in a variety of situations and can be helpful for
conditions such as anxiety disorders, depression and addictions.
• The therapist and client work together to identify situations and negative
reactions they produce.
• The therapist then helps the client rationalise the situation, giving the client a
more realistic perspective.
• Ellis developed a more confrontational approach to therapy than Beck,
challenging the client’s self-defeating beliefs in intense debates.
From the video clips, write down specific
examples for the following aspects of CBT:
 Identifying automatic negative thoughts about
the self/world/future
 Identifying the activating event and the negative
irrational belief that has resulted from it
 Effort to challenge maladaptive thoughts
 Engagement in empirical and logical dispute
(attempts to get the client to consider if their
interpretations are based on sound evidence or
if they are logical)
 Clip 1
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Greta suffers from depression. She often experiences feelings of
hopelessness and worries constantly that she is a burden to
others; she feels guilty for having depression. This has affected her
work, as she believes she cannot cope; some days she finds it
difficult to even get up let alone travel to work. She reports losing
interest in food and finds sleeping difficult. Previously, Greta was
in a relationship which she describes as very controlling. Following
the breakdown of this relationship, Greta found herself staying
home more, avoiding friends and losing enthusiasm for life in
general. Although she now realises her partner was very
manipulative, she blames herself for how she was treated.
Following a discussion with her GP, Greta has been referred to a
psychologist for cognitive behavioural therapy.
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In pairs, read the scenario above
Design 5 questions which a therapist might ask Greta
Is this thought realistic?
What is the evidence for and against this idea?
Might this belief be a habit, rather than something based on facts?
How long have I been thinking this?
What possible misinterpretations might I be making?
Am I thinking in all-or-none/black-and-white terms?
Is there any room for “grey” with this thought?
Am I using words or phrases that are extreme or exaggerated (i.e., always, forever, never,
need, should, must, can’t, ever time, etc.)?
Is extreme and/or exaggerated language implied in this thought?
In what way might I be focusing only on one aspect of the event (possibly negative)?
Who has given me this message before?
o Other people in my life?
o A younger version of myself?
o Is that person a reliable source of information when it comes to this thought?
What are the odds that this thought is true? Am I overestimating the likelihood that this
thought is true? Am I overestimating the odds that something bad will happen?
Are my judgments based on feelings rather than facts?
In what way might I be focused on irrelevant factors?
What are the costs and benefits of this thought?
o How might I arrive at similar benefits with different thoughts?
Here are some key aspects of CBT below:
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Identifying automatic negative thoughts about the self/world/future
(thought catching)
Identifying the activating event and the negative irrational belief that has
resulted from it
Effort to challenge maladaptive thoughts
Engagement in empirical and logical dispute (attempts to get the client to
consider if their interpretations are based on sound evidence or if they are
logical)
Encouragement to engage in activities (behavioural activation)
Evidence that the client is beginning to change their interpretations to
become more positive in their thinking
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Do you think CBT is an effective and
appropriate treatment for depression?
How else might we treat depression?
What does that tell us about CBT?
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Department of Health (2001) reviewed research papers of treatments for
depression and found CBT to have positive outcomes. However they did not
endorse the use of CBT alone as other treatments were also useful. This suggests
that although CBT is successful it is not the only treatment for depression. It may
depend on the individual’s case as to which treatment is used.
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In cases of severe depression, patients may not be able to motivate themselves
enough to engage in CBT therefore it may be better to treat these patients with
anti-depressants and commence CBT when they are able to fully engage with the
treatment. Therefore CBT may be best when used as a combined approach to
treating severe depression.
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CBT could be seen as more appropriate than other treatments as it is designed to
have long term benefits. It is used continually to stop symptoms reoccurring by
trying to alter the negative thoughts and beliefs at the root of the depression.
However, there are economic implications here as this type of treatment is time
consuming and potentially costly to the NHS. Perhaps it should only be used for
people with severe depression.
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David et al (2008) found, using 170 patients suffering from major depressive
disorder, patients who were treated with 14 weeks of REBT had better treatment
outcomes than those treated with the drug fluoxetine 6 months after treatment.
This suggests that CBT is a better treatment for depression than the drug
therapies and suggests it provides a suitable long term treatment for depression.
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Craighead and Dunlop (2014) carried out a meta-analysis to find out whether
CBT is best when used on its own or in combination with drug therapy. For longlasting depression, combined treatment was generally best. This suggests that
biological factors also play a role in the depression and that it is not suitable to
just use CBT to treat depression long term.

CBT could be seen as more useful than other treatments as it is designed to have
long term benefits. It is used continually to stop symptoms reoccurring by trying
to alter the negative thoughts and beliefs at the root of the depression. However,
there are economic implications here as this type of treatment is time
consuming and potentially costly to the NHS. Perhaps it should only be used for
people with severe depression.

Department of Health (2001) reviewed research papers of treatments for
depression and found CBT to be the most effective. However they did not
endorse the use of CBT alone as other treatments were also effective. This
suggests that although CBT is successful it is not the only effective treatment for
depression. It may depend on the individual’s case as to which treatment is used.

David et al (2008) found, using 170 patients suffering from major depressive
disorder, patients who were treated with 14 weeks of REBT had better treatment
outcomes than those treated with the drug fluoxetine 6 months after treatment.
This suggests that CBT is a more effective treatment for depression than the drug
therapies and suggests it provides a suitable long term treatment for depression.

Craighead and Dunlop (2014) carried out a meta-analysis to find out whether
CBT is more effective when used on its own or in combination with drug therapy.
For long-lasting depression, combined treatment was generally more effective.
This suggests that biological factors also play a role in the depression and that it
is not suitable to just use CBT to treat depression long term.
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Since many of the symptoms of depression are cognitive, it seems
appropriate for the therapy’s central focus to be changing negative and
irrational views into ones that are more positive and realistic.

In cases of severe depression, patients may not be able to motivate
themselves enough to engage in CBT therefore it may be more
appropriate to treat these patients with anti-depressants and commence
CBT when they are able to fully engage with the treatment. Therefore
CBT may be more effective when used as a combined approach to
treating severe depression.

CBT could be seen as more appropriate than other treatments as it is
designed to have long term benefits. It is used continually to stop
symptoms reoccurring by trying to alter the negative thoughts and
beliefs at the root of the depression. However, there are economic
implications here as this type of treatment is time consuming and
potentially costly to the NHS. Perhaps it should only be used for people
with severe depression.
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The success of the treatment could be down to the patient-therapist
relationship rather than the particular techniques that are used.
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Many comparative reviews (e.g. Luborsky et al, 2002) find very small
differences, supporting the idea that simply having someone to talk to
and who will listen is what is most important. Therefore support groups
could be used instead as it may not be necessary for a trained mental
health professional to be involved in the treatment, support groups
would be more accessible, fewer resources would be needed and so
would cost less money.
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CBT could be criticised for overemphasising cognitions and
underestimating the importance of the patients personal circumstances
(e.g. if they are in poverty or suffering abuse). It may be that the patients
circumstances need to change and focussing on the mind rather than the
environment could prevent this.
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The central part of REBT is to identify and
dispute irrational thoughts and beliefs. True or
False? (1)
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Describe the findings from one study that
supports cognitive treatments of depression (2)
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Why might treating someone with depression
with drug therapy and CBT be more
appropriate? (1)