CBT - Depression

CBT was first developed in the 1960s, there have since been two key therapies based on CBT, these are, rational-emotive behaviour therapy (REBT, by Albert Ellis) and Aaron Beck’s cognitive therapy for depression.

The aim of CBT is to identify the patient’s negative and irrational thoughts so they can be replaced with more positive rational ways of thinking. The therapy includes behavioural and cognitive elements with homework between sessions.

• Identify and change beliefs/thoughts that contribute to depression
• The ABC model (REBT)can be used to help the patient to better see how their faulty cognitions are leading to undesirable thoughts and behaviour e.g depression (Activating event, Beliefs, Consequences)

• The patients’ beliefs are reality tested through experimentation
• Reality testing is when faulty cognitions are tested to see if they are causing the abnormal behaviour e.g. negative thoughts about your ability to do a task is likely to lead to depressive feelings/avoidance of the task
• Therapist sets behavioural goals in order for new rational ways of thinking to be used. E.g. risking failure and completing and task or becoming more socially active to overcome depression

• Client helped to recognise and question beliefs
• Therapist encourages the client to ask themselves things like ‘who says I have to be perfect?’
• Therapist teaches the client to substitute unrealistic beliefs for more realistic/positive beliefs
• They’re also encouraged to view failure as ‘unfortunate’ rather than a ’disaster’ that makes them worthless

• Stage 1: clients are encouraged to draw up a schedule of activities and to become more active and confident
• Stage 2: clients are encouraged to recognise their automatic, negative thoughts (e.g. if I don’t get A* grades I’ll never go to university or get a good job) and to record them and bring them to the weekly CBT sessions. The therapist then helps them to test the reality of their thoughts (for example, by identifying people who have gone to university without getting A* grades)
• Stage 3: the therapist helps clients to recognise the underlying illogical thinking processes that produce negative thinking
• The therapist helps clients to change their maladaptive attitudes, often by asking them to test them out in real-life situations. They are also encourage to keep actively engaged in pleasurable activities.

Effectiveness:

• JARRETT ET AL found that CBT and MAOI antidepressant drugs to be equally effective with 108 patients with severe depression in a 10 week trial.
• Hollon et al studied 107 patients over a 12 week trial and found the same with tricyclic antidepressant drugs. 
• They also reported that CBT effect is maintained beyond therapy termination, whereas relapse is known to be common with antidepressant drug treatment. A problem with such studies though is that the timescale is too short to assess the longer-term effectiveness.

Clear Goals:

• Therapies are well-structured, with clear goals and measurable outcomes.

Use and Effectiveness:

• Particularly effective for depression, anxiety and sexual disorders. Research suggests that CBT is at least as effective as antidepressant drugs, without the harmful side effects and long-term, follow-up studies suggest a lower relapse rate compared to drug therapy. Produces quick results. Rapidity is beneficial in term of both outcome and cost.

Difficulty evaluating therapies:

• Senra and Polaino used several different depression scales for measuring the improvement rates associated with CBT and found that each scale gave a different measure of improvement for each of their 52 participants.
• ELKIN: This was a 6 year study comparing depressed patients randomly allocated to cognitive therapy, antidepressant drugs, or placebo. The active treatments were equally effective and both were more effective than the placebo. However, Elkin concluded that CBT is more appropriate for someone interested in understanding the aetiology (cause)of their depression.

Appropriateness:

• Not suitable for patients with rigid attitudes who are resistant to change. CBT causes patients to be more active than is the case with drugs – they are provided with techniques to help themselves in the long term – indeed, success depends on client co-operation.

Appeal:

• CBT attempts to empower clients by educating them into self-help strategies. It also appeals to those who might find psychoanalysis too threatening.