Cognitive approach to treating depression

Patient and therapist:

• Work together to clarify patients problems
• Identify where there ight e negative or irrational thoughts that will benefit from challenge

Challenging thoughts relating to the negative triad

• The aim is to identify negatuve thoughts about the self, world and future
• These thoughts are callenged by the patient taking an active role in their treatment

Patient as scientist

• Patients are encouraged to test the reality of their irrational beliefs
• They may have to do activities such as record when people were nice to them
• In future sessions if patiens say no-one likes them, for example, the therapist can produce evidence to prove that the patient is incorrect

REBT extends the ABC model into an ABCDE model

• D for dispute- challenge irrational beliefs
• E for effect

Challenging irrational beliefs

• An REBT therapist would challengean irrational belief through 2 different types of argument
  • Empirical argument- disputing whetehr there is evidence to support the belief
  • Logical argument- disputing whether the negative thought actually follows from the facts

Behavioural activtion

• As individuals become depressed, they tend toincreasingly avoid difficult situations and become isolated, which maintains or worsens symptoms
• The goal of the treatment is to work with patients to gradually decrease their avoidance and isolation and increase their engagement in mood-improving activities e.g. exercise

CBT is effective

• There is evidence to support CBT as an effective treatment for depression
• March et al (2007) compared the effects of CBT against antidepressant drugs and a combination of the 2. CBT emerged just as effective as medication and helpful alongside medication
• There is a good case to be made for making CBT the first choice of of treatment in public healthcare systems sucg as the NHS

CBT may not work with severse cases of depression 

• Some patients may have depression that is so severe they can't engage with cognitive therapy
• This means patients have to be treated with antidepressants and engage with CBT when they are more alert and motivated
• This means CBT can't be used as the sole treatent for depression

Sucess may be due to therapist-patient relationships

• Differences between methods of therapy may be quite small, and it may be the quality of the therapist-patient relationship that detrmines success rather than the actual therapy
• This suggests that different therapies share a common basis, so CBT may have equal effectiveness for treament as any other therapy

Patients want to explore their past

• The focus on CBT is the present and future rather than the past, but other therapies make linkes between childhood experiences and current depression
• CBT may ignore important aspects of the depressed patient's experience

There may be an over-emphasis on cognition

• CBT may minimise the impotance of circumstances the patient is living in, but CBT focuses on what is in the patient's mind rather than how to change their circumstances
• CBT techniques used inappropriately can demotivate people to change their situation