Treating Depression - Cognitive Behavioural Therapy (CBT)

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 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 are slightly different.

Beck’s Cognitive Therapy

If a therapist is using Beck’s cognitive therapy, they will help the patient to identify negative thoughts in relation to themselves, their world and their future, using Beck’s negative triad.

The patient and therapist will then work together to challenge these irrational thoughts, by discussing evidence for and against them.

The patient will be encourage to test the validity of their negative thoughts and may be set homework, to challenge and test their negative thoughts.

Ellis’s Rational Emotive Behaviour Therapy (REBT)

Ellis developed his ABC model to include D (dispute) and E (effect or effective). Like Beck, the main idea is to challenge irrational thoughts, however, with Ellis’s theory this is achieved through ‘dispute’ (argument).

The therapist will dispute the patient’s irrational beliefs, to replace their irrational beliefs with effective beliefs and attitudes. There are different types of dispute which can be used, including: logical dispute – where the therapist questions the logic of a person’s thoughts, for example: ‘does the way you think about that situation make any sense?’ Or empirical dispute – where the therapists seeks evidence for a person’s thoughts, for example: ‘where is the evidence that your beliefs are true?’

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 a combination of CBT plus 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 plus antidepressant group had significantly improved, suggesting 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. Alternate treatments, for example antidepressants, do not require the same level of motivation and maybe more effective in these cases. This poses a problem for CBT, as CBT cannot be used as the sole treatment for severely depressed patients.

Furthermore, cognitive behavioural therapy has been criticised for its overemphasis on the role of cognitions. Some psychologists have criticised CBT, as it suggests that a person’s irrational thinking is the primary cause of their depression and CBT does not take into account other factors. CBT therefore ignores other factors or circumstances that 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.