Cognitive treatments for depression
- Created by: Emily~99
- Created on: 23-05-17 16:40
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- Cognitive treatments for depression
- Rational emotive behaviour therapy - Ellis
- Irrational beliefs - Emotionally-laden thoughts that are false or incorrect; in depressed individuals, these beliefs are mostly inflexible and extreme
- The core irrational beliefs of those with depression are often inflexible, extreme and include words like 'must', 'have to' and 'need to'
- There are 3 major musts...
- I MUST do well and be approved of by other people or else I am worthless
- Everyone MUST do 'the right thing' or else they deserve to be punished
- My life MUST be easy with a minimum of discomfort or inconvenience
- Each of these has other beliefs associated with it
- There are serious emotional consequences for depressed individuals who have experiences that fall short of their irrational beliefs; they respond with 'awfulisation' and use words such as 'awful', 'catastrophe' and 'disaster' to describe their situation and 'useless', 'idiot' and 'loser' to describe themselves
- Rational beliefs are flexible and express consequences
- The main focus is to challenge the patient's irrational thoughts and beliefs, which the therapist initially does for them, but they're eventually taught to do this themselves
- Main ways in which a patient's irrational thoughts can be successfully challenged...
- Scientific dispute - 'Where is the evidence that this belief is true?'
- Functional dispute - 'Is my irrational belief making things better or worse for me?'
- Logical dispute - 'Does this belief square with common sense?'
- Once irrational beliefs have been displaced, they can be replaced with positive, flexible ones
- Changing their behaviour is also important (e.g. giving them the motivation to get dressed)
- Beck's cognitive behaviour therapy (CBT)
- 3 main hypotheses
- The access hypothesis - If people receive appropriate training, they can become aware of the content of their own thinking
- The mediation hypothesis - How people interpret life's events influences their emotions /behaviour
- The change hypothesis - People can recover from depression by intentionally modifying their cognitive and behavioural reactions to life's events
- 1976 - Therapy for depression should involve uncovering and challenging negative and unrealistic beliefs
- Involves collaborative empiricism, guided discovery and Socratic dialogue (all of which are designed to challenge irrational thoughts)
- Collaborative empiricism...
- Therapist and patient agreeing on the nature of the problem and therapy goals
- Thoughts are treated as hypotheses, not facts (allows patient to see if they're valid)
- Guided discovery...
- Patient tests their own thinking through observations/experiments (e.g. someone who thinks people are always avoiding them may be asked to keep a diary of when this happens)
- Socratic dialogue...
- Therapist asks the patient questions to make it easier for them to discover new ways of challenging their maladaptive thoughts (e.g. what evidence suggests you're disliked?)
- Form of guided discovery
- Focuses on joint therapist-patient discussions of the patient's ideas (unlike Ellis, who focuses on direct confrontation)
- 3 main hypotheses
- Effectiveness of CBT
- DeRubeis et al. (2005) - Compared CBT with drug therapy (SSRIs) in patients with major depressive disorder and found 58% of each group showed considerable improvement
- Hollon et al. (2005) - Studies those involved in DeRubeis' study 12 months after their treatment ended; 31% of those who had CBT relapsed, compared to 76% of those who had drug therapy (drug therapy is pallative)
- DeRubeis et al. (2005) - Compared CBT with drug therapy (SSRIs) in patients with major depressive disorder and found 58% of each group showed considerable improvement
- Evaluation
- CBT is one of the most common treatments for depression
- Increased focus on behaviour
- Evidence of irrational beliefs producing severe emotional states
- Ignores unconscious processes
- Ignores biological factors/negative childhood experences
- Walsh - CBT can seem to 'cold' and 'rational' to emotioanlly disturbed patients
- Rational emotive behaviour therapy - Ellis
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