Unit 1 Psychopathology Treating Depression The Cognitive Approach

Unit 1 - Psychopathology Treating Depression – The Cognitive Approach

Treating Depression � What have we studied as a key cause of depression? �Therefore, how might depression be treated? �Is it likely to be successful?

Cognitive-Behavioural Therapy (CBT) � This approach links depression to irrational and dysfunctional thoughts. � Negative events occur that can trigger negative schemata that may have been acquired in childhood e. g. “I will never succeed at anything”. � This leads to the negative automatic thoughts that you are indeed a failure at everything. � The aim of CBT is to challenge these irrational and dysfunctional thought processes. � Two examples of the Cognitive approach are Beck’s therapy for depression and Ellis's RET which both follow the same assumptions and share many similarities. � Summary Clip

Beck’s Cognitive Therapy � � � Beck (1976) believed that negative schemata lead to pessimistic thoughts about the self, the world and the future. These sort of cognitive biases maintain negative thoughts. The aim of Beck’s approach is to challenge these irrational cognitions and replace them with more realistic appraisals. The therapist helps the client identify specific negative thoughts e. g. “I always fail exams in that subject” or “I will never have a successful relationship”. They will often advocate keeping a diary record. The therapist challenges these records by pointing out positive incidents and drawing their focus onto these. This is a form of reality testing. Beck also uses behavioural techniques to encourage more positive behaviour e. g. setting someone who is depressed a list of small goals to achieve such as getting up by a certain time. This is to give them a sense of personal effectiveness. Training in problem solving skills is another aspect along with relaxation techniques to reduce anxiety in stressful situations.

Rational-emotive behaviour therapy (REBT) • Remember: Ellis’s ABC Model… ACTIVATING EVENT Getting a bad mark for an essay. SELF-DEFEATING BELIEFS I’m hopeless and will never get the grade I need. CONSEQUENCES No longer trying and just accepting my lot. • RET (renamed REBT) helps clients substitute more effective problem solving methods. • This treatment has been used in a variety of situations and can be helpful for conditions such as anxiety disorders, depression and addictions. • The therapist and client work together to identify situations and negative reactions they produce. • The therapist then helps the client rationalise the situation, giving the client a more realistic perspective. • Ellis developed a more confrontational approach to therapy than Beck, challenging the client’s self-defeating beliefs in intense debates.

CBT in Action �From the video clips, write down specific examples for the following aspects of CBT: �Identifying automatic negative thoughts about the self/world/future �Identifying the activating event and the negative irrational belief that has resulted from it �Effort to challenge maladaptive thoughts �Engagement in empirical and logical dispute (attempts to get the client to consider if their interpretations are based on sound evidence or if they are logical) �Clip 1

Treating depression with CBT � Greta suffers from depression. She often experiences feelings of hopelessness and worries constantly that she is a burden to others; she feels guilty for having depression. This has affected her work, as she believes she cannot cope; some days she finds it difficult to even get up let alone travel to work. She reports losing interest in food and finds sleeping difficult. Previously, Greta was in a relationship which she describes as very controlling. Following the breakdown of this relationship, Greta found herself staying home more, avoiding friends and losing enthusiasm for life in general. Although she now realises her partner was very manipulative, she blames herself for how she was treated. Following a discussion with her GP, Greta has been referred to a psychologist for cognitive behavioural therapy. � � In pairs, read the scenario above Design 5 questions which a therapist might ask Greta

Examples of Questions Is this thought realistic? What is the evidence for and against this idea? Might this belief be a habit, rather than something based on facts? How long have I been thinking this? What possible misinterpretations might I be making? Am I thinking in all-or-none/black-and-white terms? Is there any room for “grey” with this thought? Am I using words or phrases that are extreme or exaggerated (i. e. , always, forever, never, need, should, must, can’t, ever time, etc. )? Is extreme and/or exaggerated language implied in this thought? In what way might I be focusing only on one aspect of the event (possibly negative)? Who has given me this message before? o Other people in my life? o A younger version of myself? o Is that person a reliable source of information when it comes to this thought? What are the odds that this thought is true? Am I overestimating the likelihood that this thought is true? Am I overestimating the odds that something bad will happen? Are my judgments based on feelings rather than facts? In what way might I be focused on irrelevant factors? What are the costs and benefits of this thought? o How might I arrive at similar benefits with different thoughts?

Quick recap Here are some key aspects of CBT below: � � � Identifying automatic negative thoughts about the self/world/future (thought catching) Identifying the activating event and the negative irrational belief that has resulted from it Effort to challenge maladaptive thoughts Engagement in empirical and logical dispute (attempts to get the client to consider if their interpretations are based on sound evidence or if they are logical) Encouragement to engage in activities (behavioural activation) Evidence that the client is beginning to change their interpretations to become more positive in their thinking

Evaluating CBT as a treatment for depression �Do you think CBT is an effective and appropriate treatment for depression? �How else might we treat depression? �What does that tell us about CBT?

Effective or Appropriate? � Department of Health (2001) reviewed research papers of treatments for depression and found CBT to have positive outcomes. However they did not endorse the use of CBT alone as other treatments were also useful. This suggests that although CBT is successful it is not the only treatment for depression. It may depend on the individual’s case as to which treatment is used. � In cases of severe depression, patients may not be able to motivate themselves enough to engage in CBT therefore it may be better to treat these patients with anti-depressants and commence CBT when they are able to fully engage with the treatment. Therefore CBT may be best when used as a combined approach to treating severe depression. � CBT could be seen as more appropriate than other treatments as it is designed to have long term benefits. It is used continually to stop symptoms reoccurring by trying to alter the negative thoughts and beliefs at the root of the depression. However, there are economic implications here as this type of treatment is time consuming and potentially costly to the NHS. Perhaps it should only be used for people with severe depression.

Effective or Appropriate? � David et al (2008) found, using 170 patients suffering from major depressive disorder, patients who were treated with 14 weeks of REBT had better treatment outcomes than those treated with the drug fluoxetine 6 months after treatment. This suggests that CBT is a better treatment for depression than the drug therapies and suggests it provides a suitable long term treatment for depression. � Craighead and Dunlop (2014) carried out a meta-analysis to find out whether CBT is best when used on its own or in combination with drug therapy. For longlasting depression, combined treatment was generally best. This suggests that biological factors also play a role in the depression and that it is not suitable to just use CBT to treat depression long term. � CBT could be seen as more useful than other treatments as it is designed to have long term benefits. It is used continually to stop symptoms reoccurring by trying to alter the negative thoughts and beliefs at the root of the depression. However, there are economic implications here as this type of treatment is time consuming and potentially costly to the NHS. Perhaps it should only be used for people with severe depression.

Effectiveness: � Department of Health (2001) reviewed research papers of treatments for depression and found CBT to be the most effective. However they did not endorse the use of CBT alone as other treatments were also effective. This suggests that although CBT is successful it is not the only effective treatment for depression. It may depend on the individual’s case as to which treatment is used. � David et al (2008) found, using 170 patients suffering from major depressive disorder, patients who were treated with 14 weeks of REBT had better treatment outcomes than those treated with the drug fluoxetine 6 months after treatment. This suggests that CBT is a more effective treatment for depression than the drug therapies and suggests it provides a suitable long term treatment for depression. � Craighead and Dunlop (2014) carried out a meta-analysis to find out whether CBT is more effective when used on its own or in combination with drug therapy. For long-lasting depression, combined treatment was generally more effective. This suggests that biological factors also play a role in the depression and that it is not suitable to just use CBT to treat depression long term.

Appropriateness: � Since many of the symptoms of depression are cognitive, it seems appropriate for therapy’s central focus to be changing negative and irrational views into ones that are more positive and realistic. � In cases of severe depression, patients may not be able to motivate themselves enough to engage in CBT therefore it may be more appropriate to treat these patients with anti-depressants and commence CBT when they are able to fully engage with the treatment. Therefore CBT may be more effective when used as a combined approach to treating severe depression. � CBT could be seen as more appropriate than other treatments as it is designed to have long term benefits. It is used continually to stop symptoms reoccurring by trying to alter the negative thoughts and beliefs at the root of the depression. However, there are economic implications here as this type of treatment is time consuming and potentially costly to the NHS. Perhaps it should only be used for people with severe depression.

Further evaluation: � The success of the treatment could be down to the patient-therapist relationship rather than the particular techniques that are used. � Many comparative reviews (e. g. Luborsky et al, 2002) find very small differences, supporting the idea that simply having someone to talk to and who will listen is what is most important. Therefore support groups could be used instead as it may not be necessary for a trained mental health professional to be involved in the treatment, support groups would be more accessible, fewer resources would be needed and so would cost less money. � CBT could be criticised for overemphasising cognitions and underestimating the importance of the patients personal circumstances (e. g. if they are in poverty or suffering abuse). It may be that the patients circumstances need to change and focussing on the mind rather than the environment could prevent this.

Quick test… �The central part of REBT is to identify and dispute irrational thoughts and beliefs. True or False? (1) �Describe the findings from one study that supports cognitive treatments of depression (2) �Why might treating someone with depression with drug therapy and CBT be more appropriate? (1)