The Cognitive approach to treating depression
AQA specification -
- The cognitive approach to explaining and treating depression: Beck’s negative triad and Ellis’s ABC model; cognitive behaviour therapy (CBT), including challenging irrational thoughts.
Cognitive Behaviour Therapy
Cognitive behaviour therapy is the most commonly used treatment for depression and other mental health issues.
The cognitive behaviour therapist will try to identify the clients irrational thoughts and challenge them to help the client see that they are being irrational and to try to turn irrational thoughts into rational ones with more positive feelings.
Beck's Cognitive therapy
This approach takes in Beck's theory of negative triad - negative thoughts about the world, the self and future. Once these thoughts are identified they must be challenged.
Thought catching - the therapist will train the client how to catch, identify and record automatic negative thoughts. Once identified, these thoughts can be recognised and challenged.
As well as challenging these thoughts, clients are sometime given homework tasks to complete to investigate the reality of their irrational beliefs. This can provide proof that the person's irrational beliefs were indeed irrational and this can help the person recover.
Such homework tasks could include;
1. A person with agoraphobia (fear of going outside). This person may be asked to go outside and stand on their grass for 5 minutes. When the person see's that nothing bad happened in that time it challenged their irrational belief that something bad would happen and it helped them begin to recover.
2. A person who believes no one will ever like or love them. This person may be asked with going and asking someone out on a date. This person may be surprised to find that the response was positive and this then challenges their irrational beliefs.
Ellis's rational emptive behaviour therapy (REBT)
Rational emotive behaviour therapy extends the ABC model to an ABCDE model - D for dispute and E for effect. The main idea behind REBT is to challenge and dispute irrational thoughts.
In disputing irrational thoughts the therapist can ask does this way of thinking make sense, the therapist can challenge if thoughts are consistent with reality (where is the evidence that this belief is consistent with reality) and how is this belief going to help you?
The effect of disputing can lead to more rational interpretations of events instead of all or nothing/black and white thinking, e.g. just because I failed one exam doesn't mean that I am a failure and that I will fail everything else in life.
Evaluation
Limitation - high relapse rates. A study by Shezhad Ali et al (2017) for that a follow up study on clients who had received CBT, 42% had relapsed into depression. This calls into question the long term benefits of CBT.
Strength - there is a lot of evidence showing the benefits of CBT on depression. March et al (2007) conducted a study to conclude that CBT was just as effective in treating depression as medication such as anti-depressants, and even more so when used in combination with anti depressants.
Limitation - CBT can take a long time, often sessions up to 20 weeks and beyond. This can make it time consuming for therapists and costly for NHS as this is funded. It can be costly for clients too who chose to pay for therapy privately.
Additional thought! The below article published on 20 July 2022 calls into question the effectiveness of anti-depressants for treating depression.
To finish - lets see a CBT session in practice.
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