Cognitive treatments of depression
Specification: The cognitive approach to treating depression: cognitive behaviour therapy (CBT), including challenging irrational thoughts.
Cognitive behavioural therapy (CBT) is the most widely used and well-researched cognitive treatment for depression. For each of the cognitive explanations, Beck and Ellis have a treatment therapy that is slightly different but would still be described as CBT. CBT is effective because it works on both thoughts and behaviour together.
Cognitive treatments for depression are based on the assumption that faulty thinking/thought processes make a person vulnerable to depression. 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 and rational ones. The behavioural element of CBT encourages patients to test their beliefs through behavioural experiments and homework.
There are various components to CBT, including:
Initial assessment
Goal setting
Identifying negative/irrational thoughts and challenging these:
Either using Beck’s Cognitive Therapy
Or
Ellis’s REBT
Homework
There are two different strands of CBT, based on Beck’s theory and Ellis’s ABC model. All CBT starts with an initial assessment, in which the patient and therapist identify the patient’s problems. Thereafter, the patient and therapist agree on a set of goals, and plan of action to achieve these goals. Both forms of CBT (Beck’s and Ellis’s) then aim to identify the negative and irrational thoughts; however, their approaches differ slightly.
Following a session, the therapist may set their patient homework. The idea is that the patient identifies their own irrational beliefs and then proves them wrong. As a result, their beliefs begin to change. For example, someone who is anxious in social situations may be set a homework assignment to meet a friend for a drink.
Evaluation
One strength of cognitive behaviour therapy comes from research evidence which demonstrates its effectiveness in treating depression. Research by 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 treatment with a combination of CBT and 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 with antidepressant group had significantly improved. This suggests that a combination of both treatments may be more effective.
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. Alternative treatments, such as antidepressants, do not require the same level of motivation and may be more effective in these cases. This poses a problem for CBT, as CBT usually cannot be used as the sole treatment for severely depressed patients, who often lack the motivation to attend therapy and to speak about their depression.
Cognitive behavioural therapy has been criticised for its overemphasis on the role of cognitions as the primary cause of depression. Some psychologists have criticised CBT for not taking into account other factors such as social circumstances which 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.
The success of CBT may not be due to either of the specific techniques advocate by Beck or Ellis. Rosenzweig (1936) argued that it is the relationship between the client and the therapist which is of utmost importance in determining the success of a psychological therapy. Simply having someone to talk to may be the crucial component in having a positive outcome rather than the specific techniques adopted by the psychologist. This viewpoint becomes evident when comparison studies such as that conducted by Luborsky et al. (2002) show very little difference between different methods of psychotherapy.
Possible exam questions
Identify and explain one strength of the cognitive approach to treating depression. (3 marks)
Outline what is involved in cognitive behavioural therapy for treating depression. (4 marks)
Describe one or more strategy that might be used within a session with a cognitive behavioural therapist or suggested for a patient to try in the treatment of their depression. (4 marks)
Discuss the cognitive approach to treating depression. (16 marks)
