Treating depression

Question 1

What is the aim of CBT

Answer 1

identifying and challenging irrational thoughts to show the client how irrational their thoughts are, and replacing them with more effective and rational beliefs.

Question 2

How did Ellis extend his ABC model

Answer 2

Changed to ABCDE:
D - Disrupting irrational thoughts
E - effect

Question 3

What is disputing?

Answer 3

directly questioning (asking questions of) the client

Question 4

What are 2 types of disputing?

Answer 4

Empirical disputing involves the therapist challenging irrational thoughts to show that they may not be consistent with reality. The therapist would also present evidence to act as a counterargument.

Logical disputing involves the therapist challenging irrational thoughts to show that they do not logically follow from the information available/facts

Question 5

What is the point of homework in CBT?

Answer 5

testing irrational thoughts against reality and putting new rational beliefs into practice

Question 6

What is behaviour activation? How does ut help treat depression?

Answer 6

CBT often involves a specific focus on encouraging depressed clients to become more active and engage in pleasurable activities.
This is based on the common-sense idea that being active leads to rewards that act as an antidote to depression. Such activity then provides more evidence of the irrational nature of the client’s thoughts.

Question 7

Weakness of CBT (frustration)

Answer 7

Effectiveness and appropriateness
One of the basic principles of CBT is that the focus is on the present and future rather than the past. This is in contrast to some other therapies. Some clients are aware of the link between childhood experiences and current depression and want to talk about these experiences. They can therefore find the ‘present-focus’ very frustrating.

This suggests that if depression is due to psychodynamic factors, CBT will not be an effective treatment for depression. Additionally, it may not be suitable for people who want to explore the effects of the past on their depression, and so CBT should only be used in some cases of treating depression.

Question 8

Weakness of CBT (overlooked)

Answer 8

Effectiveness/appropriateness
There is a risk that because the therapy emphasises what is happening in the mind, the circumstances in which the client is living are overlooked. A client living in poverty or suffering abuse needs to change their circumstances, and any approach that focuses on the individual’s mind rather than their environment can prevent this. CBT techniques used inappropriately can demotivate people to change their situation.

This suggests that if the environment is not changed, CBT will be not be an effective treatment for depression, and so perhaps it shouldn’t be used in such cases, or it needs to be used in combination with an environmental intervention in order to be effective.

Question 10

Supporting evidence for CBT

Answer 10

Effectiveness
There is lots of evidence to suggest that CBT is effective in treating depression. For example, it has been found that after 36 weeks, 81% of depressed patients treated with CBT, 81% of depressed patients treated with medication, and 86% of depressed patients treated with a combination of the two had significantly improved.

This suggests that there is a good case for making CBT the first choice treatment for the NHS as it is more likely to be effective in the long-term by teaching clients new behaviours and ways to challenge their own thinking as this seems to be effective at treating depression (unlike drug therapies where once the drug is no longer taken, it is likely the depression will return), and therefore it should be used to treat depression

Question 11

Weakness of CBT (severity)

Answer 11

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. In such cases, it may be possible to treat patients with medication initially, and commence CBT when they are more alert and motivated.

This suggests that CBT cannot be used as the sole treatment for all cases of depression
Potentially, the gold standard for treating CBT should be a combination of both - drug therapy when the person is severely depressed until they have the motivation to engage with CBT to give them long-term strategies.