Download The cognitive treatments for mood disorders aim to challenge and

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The cognitive treatments for mood disorders aim to challenge and remove negative thoughts.
Cognitive therapy also aims to help people to try and solve practical problems in their lives in a positive
way.
Cognitive therapy is meant to be brief, for example over 3 months.
It involves techniques that help to change the way a person thinks and behaves to help change their
negative behaviours to more positive ones.
There are two main types of cognitive therapy in place to treat depression, known as Rational Emotive
Therapy RET & Beck’s Cognitive Therapy
Rational Emotive Therapy (Albert Ellis)
This type of therapy aims to replace a person’s irrational thoughts with rational ones. Negative thoughts or self
defeating ways of thinking are regarded as irrational. The therapist task is to make the sufferer aware for their
self defeating and irrational thoughts – for example ‘I must be perfect at everything I do’. The therapist then
challenges the person’s irrational belief through confrontation and argument. Finally the irrational belief is
replaced by a more rational belief – for example ‘I try to do things the best of my ability but accept that I cannot
do this all the time’. Self esteem will increase as a result of success.
RET is about replacing the irrational thoughts with more positive ones.
First therapist makes person recognise their negative thoughts
They must decide whether these are logical or irrational – for example do you really have to be liked by
everyone – do you like everyone?
Think more positively – Not everyone is going to love me but hey – most people I know like me, I get
on with them and anyways its not like I love everyone I meet anyways – so whatever!
The crucial step is for clients to have full acceptance of their new rational beliefs
For example – how could you deal with the following scenario
Your friend cannot make it to your birthday lunch at school. What negative thoughts and positive
thoughts could occur?
EVALUATIONS
Newmark et al (1973) found that 65% of anxious patients and only 2% of normals agreed with the
statement “It is essential that everyone be loved by virtually everyone in their community”….
Therapists who practice RET are said to be generally more argumentative than therapists who practice
for example client centred therapy showing less concern for their sensitivities. Thus this therapy is only
right for a certain type of client. For example it is best suited to those who are guilty about their own
attitudes and so really want to change.
Beck’s Cognitive therapy (Aaron Beck)
Beck’s cognitive triad is aimed at changing the cognitive triad of thoughts that is shown by people with
depression. There are four main types:
Phase 1
Phase 2
Phase 3
Phase 4
Increasing confidence and elevating mood
Challenging automatic negative thoughts
Identifying negative thoughts
Changing key attitudes and beliefs
Beck’s therapy involves the ‘patient as scientist’ with the patient and therapist together setting hypotheses to
test the patient’s negative thoughts. The patient then gathers evidence to refute the negative thoughts. This
form of therapy usually lasts around 20 sessions over a 10 week period. Between sessions the individual keeps a
diary to monitor their thoughts and identify situations where they think negatively. The person is also asked to
change behaviour in specific ways between sessions and report back on this at the next session.
Clients must uncover then challenge their unrealistic and negative beliefs – in other words challenge the
cognitive triad
They see themselves as worthless and inadequate, they look at things in a defeatist way and see their
world full of obstacles they can’t handle!
Collaborative empiricism – Client and therapist agree on nature of problem and set achievable goals
The clients negative thoughts are tested out by the therapist by challenging them
The behaviour of the client is noted between sessions – i.e. did they go to work every day this week?
The aim is to make the client accept their negative thoughts are irrational – diary of people who are
avoiding them must be logged in a diary – its probably not as often as they think!
If the client has successfully managed to change their thoughts to more rational and realistic ideals then
ultimately they will also change their behaviours in their daily life.
This usually involves the client adhering to homework assignments such as initiating the conversation,
making a deadline, going out to a bar with friends etc…
Study
Hollon et al (2006) compared the effectiveness of cognitive therapy and drug therapy. People with moderate
to severe depression were given either drug therapy or cognitive therapy. Those given cognitive therapy
received treatment for 16 weeks and then treatment was terminated. Both groups were followed up over a
period of one year. Relapse rates for people who had cognitive therapy were around 40%. Those on drugs
relapsed at around 45%. People given a placebo instead of a drug relapsed at 80%. Cognitive therapy is as
effective as drugs for people with moderate to severe depression.
Evaluations
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Cognitive therapy has been shown to be a highly effective treatment for depression and recovery rates
are typically 60-70% after a 10-12 week programme.
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Cognitive therapy can be used in both one-one settings and small group settings and so is very cost
effective and so it is time limited and economical.
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A combination of both drug therapy and cognitive therapy has been shown to be highly effective and is
very commonly used – see study to support
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Cognitive therapy is also successful in preventing mild depression from developing into severe
depression.
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Cognitive therapy is not useful for people in the manic phase of bipolar – as it involves insight into their
problem.
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Cognitive therapy differs from other therapies in that it is concerned with patients’ current concerns and
beliefs and not with the past and the unconscious which gives it more structure and testable hypotheses.
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This treatment does not deal with the underlying cause of the disorder. Also, if negative thoughts are a
symptom not a cause of depression, then the depression may continue even with cognitive therapy.
Cognitive therapy for depression.
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Depressed peoples’ negative, illogical and automatic thoughts must be identified and then changed.
Beck states that depressed people make some systematic errors of thinking that cause them to see
reality in a distorted way.
Beck says that therapists can use the following strategies to help patients change their thinking by
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Challenging the assumptions of the patient
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Arguing why the patient should adopt more positive assumptions about themselves, their world and
their future.
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Giving reattribution training i.e. pointing out the factors (other than the patient’s worthlessness) that
have contributed to their problems.
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Activity raising i.e. rewarding the patient for becoming involved in more activities.
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and graded task assignment i.e. rewarding the patient for behaving in a progressively more positive
way in the real world.
Beck’s approach to therapy
Therapist: Why do you think you won’t be able to get into the university of your choice?
Client: Because my grades were not really so hot.
Therapist: What was your grade average?
Client: Well, pretty good up until the last semester in high school.
Therapist: What was your grade average in general?
Client: As and Bs.
Therapist: Well, how many of each?
Client: Well, I guess all of my grades were As but I got terrible grades my last semester.
Therapist: What were your grades then?
Client: I got two As and two Bs.
Therapist: Since your grade average would seem to be almost all As, why do you think you won’t be able to
get into the university?
Client: Because of competition being so tough.
Therapist: Have you found out what the average grades are for admissions to the college?
Client: Well, somebody told me that a B+ would suffice.
Therapist: Isn’t your average better than that?
Client: I guess so.
Evaluation of cognitive therapies