The Cognitive Approach to Depression

ASSUMPTIONS:

• BEHAVIOURS are controlled by THOUGHTS and BELIEFS
• FAULTY COGNITIONS can lead to DEPRESSION.

ELLIS'S ABC MODEL:

Activating event - where the disorders BEGIN; leads to the BELIEF

Belief about why this has happened - RATIONAL or IRRATIONAL; leads to the CONSEQUENCE

Consequences of belief - RATIONAL beliefs = ADAPTIVE consquence; 

                                  - IRRATIONAL beliefs = MALADAPTIVE consequence

BECK'S NEGATIVE TRIAD: 

• Consists of AUTOMATIC THOUGHTS linked to DEPRESSION.
• NEGATIVE views about:

         - THEMSELVES; cannot SUCCEED.

         - the WORLD; must be SUCCESSFUL to be a GOOD PERSON.

         - the FUTURE; NOTHING will CHANGE.

STRENGHTS:

• Cognitive model is USEFUL appoach; considers the role of THOUGHTS and BELIEFS.
• HOLLON & KENDALL (1980) - ATQ; measures NEGATIVE THINKING associated with depression.
• HARRELL & RYON (1983) -  used ATQ to compare NEGATIVE THINKING in 114 DEPRESSED and NON-DEPRESSED participants; DEPRESSED scored SIGNIFICANTLY HIGHER than non-depressed; CORRELATION,  NEGATIVE THINKING - DEPRESSION.
• Cognitive THERAPIES; SUCCESSFULLY TREATED depression.

WEAKNESSES:

• FAULTY COGNITION may just be a CONSEQUENCE; CAUSE may be CHEMICAL IMBALANCE in BRAIN which causes NEGATIVE THINKING.
• PERSON may feel that thay are to BLAME for their DEPRESSION.

AIMS:

• To IDENTIFY&CHANGE the patient's FAULTY COGNITIONS
• Patient learns how to NOTICE NEGATIVE THOUGHTS and WHEN they occur; learns to TEST how ACCURATE they are.

STEPS OF CBT:

• Therapist and client IDENTIFY FAULTY COGNITIONS.
  
• THERAPIST tries to HELP client to see that these cognitions are NOT TRUE.
• Set GOALS to think in more POSITIVE/ADAPTIVE ways.

Treatment usually focuses on the PRESENT SITUATION.

The PATIENT is sometimes encouraged to keep a DAIRY to record their THOUGHT PATTERNS, FEELINGS and ACTIONS.

STRENGTHS:

• EMPOWERS patients; IN CHARGE of their own TREATMENT; SELF-HELP STRATEGIES - means FEWER ETHICAL ISSUES.
• DERUBEIS ET AL (2005) - CBT/DRUG THERAPY in a PLACEBO - CONTROLLED TRIAL; both MORE EFFECTIVE than PLACEBO after 8 WEEKS. 2 therapies SIMILARLY EFFECTIVE; CBT LESS EFFECTIVE if the therapist LACKS EXPERIENCE.
• HOLLON ET AL (2005) - compared DeRubeis's participants that were WITHDRAWN from BOTH treatments with those who CONTINUED DRUG THERAPY. Withdrawn from CBT; LESS LIKEY to RELAPSE after 1 year than those withdrawn from DRUG THERAPY and NO MORE LIKELY to RELAPSE than those who CONTINUED DRUG THERAPY.
• BRANDSMA ET AL (1978) - CBT effective for people who put a lot of PRESSURE on themsleves and feel GUILTY about being ADEQUATE.

WEAKNESSES:

• May take a LONG TIME and be COSTLY.
  
• DERUBEIS ET AL (2005) - CBT only effective with an EXPERIENCED therapist; DRUG THERAPY better with an INEXPERIENCED therapist.
  
• PATIENT may feel that they are to BLAME for their DEPRESSION.