Cognitive Approach to Treating Depression

Cognitive Behaviour Therapy:CBT begins with an assessment in which the patient and cognitive behaviour therapist work together to clarify the patients problems. They jointly identify goals for the therapy and put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from a challenge. CBT then involves working to change negative and irrational thoughts and finally put more effective behaviours into place.CBT - Becks Cognitive Therapy:The idea of cognitive therapy is to identify automatic thoughts about the world, the future and the self - this is the negative triad. Once identified these thoughts must be challenged. As well as challenging these thoughts directly, cognitive therapy aims to help patients test the reality of these negative beliefs. They might therefore set a homework such as to record when they enjoyed an event or when people were nice to them. This is sometimes called 'patient as scientist' investigating the reality of their beliefs in the same way a scientist would. In future sessions if patients say that no one is nice to them or there is no point in going to events, the therapist can then produce this evidence and use it to prove the patient's statements are incorrect

CBT - Ellis's Rational Emotive Behaviour Therapy (REBT):REBT extends the ABC model to an ABCDE model - D stands for Dispute and E for Effect. The central technique of REBT is to identify and dispute irrational thoughts. For example a patient might talk about how unlucky they have been or how unfair things seem. A REBT therapist would identify these as examples of utopianism and challenge this as an irrational belief. This would involve a vigorous argument. The intended effect is to change irrational belief and so break the link between negative life events and depression. Ellis identified different methods of disputing; Emperical argument - involves disputing whether there is actual evidence to support the negative belief Logical argument - involves disputing whether the negative thought logically follows from the facts Behavioural Activation:Alongside the cognitive aspects of CBT, a therapist may also work to 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

Evaluation: Lot of evidence to support the effectiveness of CBT for depression. March et al. compared the effects of CBT with antidepressants and a combination of the two in 327 adolescents with a main diagnosis of depression. After 36 weeks 81% of the CBT group, 81% of the antidepressants group and 86% of the combination group were significantly improved. This suggests there is a good case for making CBT the first choice of treatment to public health care systems. In some cases depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT. They may not even be able to pay attention to what is happening in a session. Where this is the case it is possible to treat patients with antidepressant medication and commerce CBT when they are more alert and motivated. Although it is possible to work around this by using medication, this is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression Rosenweig suggested that the difference between CBT and systematic desensitisation might actually be quite small. All psychotherapies share one essential ingredient - the therapist-patient relationship. It may be the quality of this relationship that determines success rather than any particular technique CBT focuses on the present and future however some patients want to talk about past experiences which CBT doesn't cover There is a risk that becuase of its emphasis of what goes on in the mind, CBT maay minimise the importance of the circumstances in which a patient is living. e.g. a patient living in poverty or suffering abuse needs to change their environment as well as what is happening in their mind. CBT techniques used inappropiately can demotivate people to change their situation