The cognitive approach to treating depression - Evaluation

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  • Evaluation
    • It is effective
      • Large body of evidence to support the effectiveness of CBT
      • March et al. (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents with a main diagnosis of depression
      • After 36 weeks 81% of the CBT group, 81% of the antidepressant group and 86% of the CBT plus antidepressant group were significantly improved
      • CBT emerged as just as effective as medication and helpful alongside medication
      • Suggests there is a good case for making CBT the first choice of treatment in public health care systems life the NHS
    • CBT may not work for the most serious cases
      • Depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT
      • May not be able to pay attention to what is happening
      • Possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated
      • A limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression
    • Success may be due to the therapist-patient relationship
      • Rosenzweig (1936) suggested that the differences between different methods of psychotherapy (such as between CBT and SD) might actually be quite small
      • All psychotherapies share of essential ingredient - the therapist-patient relationship
      • May be the quality of this relationship that determines success rather than any particular technique used
      • Many comparative reviews (E.g: Luborsky et al. 2002) find very small differences which support the view that simply having an opportunity to talk to someone who listens could be what matters most
  • Evaluation extra
    • Some patients want to explore their past
      • Focus of CBT is on present and future and not the past
      • Some patients are aware of link between childhood experiences and depression and want to talk about it
      • They can find this 'present focus' frustrating
    • Overemphasis on cognition
      • Risk that CBT may end up minimising the importance of the circumstance in which a patient is living (McCaster 2014)
      • A patient living in poverty or suffering abuse needs to change their circumstances and therapy that emphasises what is happening in their mind can prevent this
      • CBT techniques used inappropriately can demotivate people to change their situation

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