Cognitive treatments for depression

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  • 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)
    • 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)
    • 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

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