Treating depression

The aim is to identify negative thoughts about the self, the world and the future - the negative triad.

These thoughts must be challenged by the patient taking an active role in their treatment.

Beck suggested that patient and therapist must work together.

The two must work together to clarify the patient's problems.

They should then identify where there might be negative or irrational thoughts that will benefit from challenge.

Patients are encouraged to test the reality if their irrational beliefs.

They might be set homework e.g. to record when they enjoyed an event or when people were nice to them. This is reffered to as the 'patient as scioentist'.

In future session if the patient says no one is nice to them or there is no point going on, the therapsit can produce this evidence to prove the patient's beleifs incorrect.

Ellis' theory causes a developement on CBT, REBT.

REBT stands for rational emotive behaviour therapy.

REBT extends the ABC model to an ABCDE mode:

     D stands for dispute (challenge) irrational beliefs.

     E is for effec

A patient might talk about how unlucky they have been or how unfair life is. An REBT therapist would identify this as utopianism and challenge it as an irrational belief.

      Empirical argument - disputing whether there is                 evidence to support the irrational belief

      Logical argument - disputing whether the negative             thought actually follows from the facts.

As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsen symptoms.

The goal of treatment, therefore, is to work with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood, e.g. exercising, going out to dinner, etc.

A strength of CBT is that it is effective. There is a large body of evidence to support the effectiveness of CBT for depression.

March et al. (07) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents.

After 36 weeks 81% of the CBT group, 81% of the antidepressant group and 86% of the CBT and antidepressants group were significantly improved. CBT emerged as just as effective as medication and helful alongside medication.

This suggests there is a good case for making CBT the first choice of treatment in public health care systems like the NHS. 

In some cases depression can be so servere that patients cannot motivate themselves to take on the hard cognitive work required for CBT.

Where this is the case it is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated.

This is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression.

Rosenzwieg (36) suggested that the differences between various methods of psychotherapy might actually be quite small.

All psychotherapies have one essential ingredient- the realtionship between therapist and patient. It may be the quality of this relationship that determines success rather than any particular technique.

Many comparative reviwes find very small differences between therapies, suggesting they share a common basis.

One of the basic principles of CBT is that the focus of the therpay is on the patient's present and future, rather than their past.

In some other forms of psychotherapy patients make links between childhood experiences and current depression.

The 'present-focus' of CBT may ignore an important aspect of the depressed patient's experience.

CBT may end up minimising the importance of the circumstances in which the patient is living.

A patient living on poverty or suffering abuse needs to change their circumstances, and any approach that empahsises what is in the patient's mind rather than their environment can prevent this.

CBT techniques use inappropriately can demotivate people to change their situation.