The cognitive approach to treating depression

Ellis 1st to use form of CBT 'ratioanl therapy' to emphasise psych problems occur as result of irrational thinking - people frequently develop self-defeating habit b/c of faulty  beliefs about selves + world around them. Aim to turn irrational thoughts into rational.

Renamed 'rational emotive therapy' (RET) b/c focuses on resolving emotional problems, then renamed rational emotional behaviour therapy (REBT) b/c resolves behavioural problems.

Extended ABC model to ABCDEF:
  D) Disputing irrational thoughts + beliefs
  E) Effects of disputing + effective attitude to life
  F) Feelings produced

Key issue - not activating events that cause unproductive consequences. REBT focuses on challenging/disputing irratioanl thoughts, replacing them w/ effective, rational beliefs eg
 - logical disputing
 - empirical disputing
 - pragmatic disputing

Effective disputing changes self-defeating beliefs into more rational beliefs. Client can move from catastrophising to more rational interpretations of events. Helps client feel better + eventually become more self-accepting.

Clients asked to complete assignments b/ween therapy sessions. Might inc asking person out on date when been afraid to do so before - fear of rejection. Vital in testing irrational beliefs against reality + putting new rational beliefs into practice.

CBT often involves specific focus on encouraging depressed clients to become more active + engage in pleasurable activities. Based on commen-sense idea being active -> rewards that act as antidote to depression.

Characteristic of many depressed people is no longer participate in activities that previously enjoyed. In CBT, therapist + client identify potentially pleasurable activities + anticipate + deal w/ any cogntiive obstacles.

Ellis (1994) recognised improtant ingredient in successful therapy convincing client of value as human. If client feels worthless, less willing to consider changing beliefs + behaviour. However, if therapist provides respect + appreciation regardless of what client does + says (unconditional positive regard), this will dacilitate change in attitudes + beliefs.

Ellis (1957) - 90% success rate for REBT, average 27 sessions to complete treatment. Recognised therapy not always effective, suggested could be b/c some didn't put revised beliefs into action. Cuijpers et al (2013) meta-analysis, 75 studies, CBT superior to no treatment.

Support for behavioural activation - Babyak et al (2000) 156 adult volunteers diagnosed w/ major depressive disorder. Randomly assigned to 4 month course aerobic exercise, drug treatment or combination. Clients in all 3 groups exhibited signif improvements at end of 4 months. 6 months after end of study, those in exercise group lower relapse rates than in med group.

Less suitable for people w/ high levels irrational beleifs both rigid + resistant to change (Elkin et al, 1985). CBT appears less suitable in situations where high levels stress in individual reflect realistic stressors in person's life therapy cannot resolve (Simons et al, 1995).

Most popular treatment - use of antidepressants eg SSRIs. Drug therapies adv of requiring less effort on part o client (Ellis 27 sessions for REBT to be successful).

Dodo Bird effect - Rosenzweig (1936) argued all methods treatment for mental disorder almost equally effective - Dodo Bird effect. Research finds small diffs in success rates - Luborsky et al (1975, 2002) meta-analysis, 100 studies, diff therapies - small diffs. R argued lack of diff b/c so many common factors in various diff psychotherapies, inc being able to talk to sympatheric person - enhances self-esteem.