Cognitive behavioural therapy

Cognitive Behavioural Therapy (CBT) involves both cognitive and behavioural elements. The cognitive element aims to identify irrational and negative thoughts, which lead to depression. The aim is to replace these negative thoughts with more positive ones. The behavioural element of CBT encourages patients to test their beliefs through behavioural experiments and homework

All CBT starts with an initial assessment, in which the patient and therapist identify the patient’s negative/irrational thoughts. Thereafter, the patient and therapist agree on a set of goals, and plan of action to challenge negative thoughts and replace behaviours with more effective (through H/W). Both forms of CBT (Beck’s and Ellis’s) then aim to identify the negative and irrational thoughts, however, their approaches are slightly different. some therapists use back or Ellis but most use a combination 

Identify the automatic thoughts of the world, self, and the future this is the negative triad and once these have been identified thoughts must be challenged with patient and therapist working together the aim to test the reality of their negative beliefs they might set homework such as to record when a happy event occurred this is often referred to as patient as scientist investigating their negative beliefs in future sessions this evidence can be used to counteract if patient in later session they say they have nothing or no one to prove patients thoughts incorrect.

Ellis developed his ABC model to include D (dispute) and E (effect or effective). challenge irrational thoughts, however, with Ellis’s theory, this is achieved through ‘dispute’ (argument).

The therapist will dispute the patient’s irrational beliefs (utopianism), to replace their irrational beliefs with effective beliefs and attitudes. There are different types of dispute which can be used, including logical dispute – where the therapist questions the logic of a person’s thoughts, for example: ‘does the way you think about that situation make any sense?’ Or empirical dispute – where the therapists seek evidence for a person’s thoughts, for example: ‘where is the evidence that your beliefs are true?’ the therapist may set their patient homework. The idea is that the patient identifies their own irrational beliefs and then proves them wrong. 

therapist may encourage a depressed patient to be more active and engage in enjoyable activities this behavioural activation will provide more evidence for the irrational nature of beliefs 

March et al. (2007) found that CBT was as effective as antidepressants, in treating depression. The researchers examined 327 adolescents with a diagnosis of depression and looked at the effectiveness of CBT, antidepressants and a combination of CBT plus antidepressants. After 36 weeks, 81% of the antidepressant group and 81% of the CBT group had significantly improved, demonstrating the effectiveness of CBT in treating depression. However, 86% of the CBT plus antidepressant group suggests there is a good case for making CBT the first choice of treatment in NHS - it is effective 

Rosenzweig 1936 suggested that the differences between different methods of psychotherapy are quite small but all have to share one essential ingredient the relationship between patient-therapist may be the quality of this relationship that determines success rather than particular techniques comparative reviews of different methods that there are small differences suggests relationship is vital 

One issue with CBT is that it requires motivation. Patients with severe depression may not engage with CBT or even attend the sessions and therefore this treatment will be ineffective in treating these patients. Alternate treatments, for example, antidepressants, do not require the same level of motivation and maybe more effective in these cases. Then commence CBT when more alert shows can treat all cases of depression.

cognitive behavioural therapy has been criticised for its overemphasis on the role of cognition. Some psychologists have criticized CBT, as it suggests that a person’s irrational thinking is the primary cause of their depression and CBT does not take into account other factors. CBT, therefore, ignores other factors or circumstances that might contribute to a person’s depression. For example, a patient who is suffering from domestic violence or abuse does not need to change their negative/irrational beliefs, but in fact, needs to change their circumstances. Therefore, CBT would be ineffective in treating these patients until their circumstances have changed.