Psychopathology Learning Table 4: The Cognitive Approach to Treating Depression
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Cognitive behavioural therapy (CBT) is the most commonly used psychological treatment for depression. If you see a clinical psychologist for a mental health problem, the chances are that you will receive CBT.
CBT begins with an assessment in which the patient and the cognitive behaviour therapist work together to clarify the patient’s problems. They jointly identify goals for the therapy and put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge.
CBT then involves working to change negative and irrational thoughts and finally put more effective behaviours into place. Some CBT therapists do this using techniques purely from Beck’s cognitive therapy, or some rely exclusively on Ellis’s rational emotive behaviour therapy. Most draw on both.
CBT: Beck’s Cognitive Therapy / CBT: Ellis’s Rational Emotive Behaviour Therapy (REBT)
  • The aim is to identify automatic thoughts about the world, the self and the future – this is the negative triad (see cog. Theory of depression).
  • 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 patients 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 ‘patient as scientist’, investigating the reality of their negative beliefs in the way a scientist would.
  • In future sessions, if patients 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 patient’s statements are incorrect.
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  • REBT extends the ABC model to an ABCDE model. D stands for dispute and E stands for effect. The central technique of REBT is to identify and dispute (challenge) irrational thoughts.
  • E.g. a patient might talk about how unlucky they have been or how unfair things seem. An REBT therapist would identify these as examples of utopianism and challenge this thought as an irrational belief. This would involve a vigorous argument. The intended effect is to change the irrational belief and so break the link between negative life events and depression.
  • This vigorous argument is the hallmark of REBT. Ellis identified different methods of disputing, e.g.:
empirical argument involves disputing whether there is actual evidence to support the negative belief
Logical argument involves disputing whether the negative thought logically follows on from the facts.
AO3: Evaluation of the Cognitive Treatments of Depression
Effectiveness
P: One strength of CBT is that there is a vast amount of supportive evidence that suggests it is an effective method of treating depression.
E: For example, March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in adolescents with a main diagnosis of depression. After 36 weeks, CBT was shown to work as effectively as drug therapy (81% improvement) and paired together the rates of improvement were 86%.
E: This is a strength because it shows CBT is just as effective as drug therapy, and suggests a good case for making CBT the first choice of treatment in health care systems such as the NHS. It is a safer (less likelihood of addiction), more long-lasting alternative to drugs which may be beneficial for the majority of sufferers.
L: As a result, this suggest that CBT is an effective way to treat depression. / Not Appropriate for All Cases
P: One weakness of CBT as a treatment for depression is that it may not be appropriate for all cases.
E: For example, in some cases, depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT.
E: This is an issue because these individuals may not be able to motivate themselves to engage with the hard cognitive work of CBT. They may have to be treated using antidepressant medication and could then potentially commence CBT when they are more alert and motivated. However this still means that CBT cannot be used as the main form of treatment in all cases of depression.
L: Consequently, this reduces the credibility of CBT as a treatment for depression. / Overemphasis on Cognition
P: One weakness of CBT as a treatment for depression is that it may overemphasise the importance of cognition.
E: For example, McCusker (2014) stated that there is a risk that because of its emphasis on what is happening in the mind of the individual patient, CBT may end up minimising the importance of the circumstances in which the patient is living.
E: This is an issue because a patient living in poverty or suffering abuse needs to change their circumstances, and any approach to therapy that emphasises what is happening in the patient’s mind rather than their environment can prevent this. CBT used inappropriately can demotivate people to change their situation.
L: As a result, this casts into doubt the appropriateness and effectiveness of using CBT as a form of treatment for depression.