COGNITIVE BEHAVIOUR THEORY
– CBT is the most commonly used psychological treatment for depression and a range of other mental health problems.
– CBT begins with an assessment in which the patient and the cognitive behaviour therapist work together to clarify the patient’s problems.
– They jointly identify goals for the therapy and put together a plan to achieve them.
– One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge.
– CBT then involved working to change negative and irrational thoughts and finally put more effective behaviours into place.
– Some CBT therapists do this by using techniques purely from Beck’s cognitive therapy or Ellis’s rational emotive behaviour therapy. Most draw on both.
BECK’S COGNITIVE THERAPY
– The idea behind cognitive therapy is to identify automatic thoughts about the world, the self and the future. – Once identified these thoughts must be challenged.
– This is the central component of the therapy.
– As well as challenging these thoughts directly, cognitive therapy aims to help patients test the reality of their negative beliefs.
– They might therefore be set homework such as to record when they enjoyed an event or when people were nice to them.
– In future sessions if patients say that on one is nice to them or there is no point in going to events, the therapist can then produce this evidence and use it to prove the patient’s statements are correct.
ELLIS’S RATIONAL EMOTIVE BEHAVIOUR THERAPY (REBT)
– REBT extends the ABC model to the ABCDE model.
– D stands for dispute and E for effect.
– The central technique of REBT is to identify and dispute irrational thoughts.
– Ellis identified different methods of disputing. For example, empirical argument involves disputing whether there is actual evidence to support the negative belief.
– Logical argument involves disputing whether the negative thought logically follows the facts.
BEHAVIOURAL ACTIVISM
– Patients are also encouraged to be more active and engage in enjoyable activities
UNCONDITIONAL POSITIVE REGARD
– Ellis came to realise that an important part of successful therapy was convincing the client of their worth as a human being
– If the therapist provides respect and appreciation regardless of what the client says or does will facilitate a change in beliefs and attitudes.
EVALUATION OF CBT
STRENGTHS
Effectiveness
– There is a large body of evidence to support the effectiveness of CBT for depression.
– For example, a study by March et al in 2007 compared the effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents with a main diagnosis of depression.
– After 36% weeks 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved.
– This suggests that there is a good case for making CBT the first choice of treatment in public health care systems like the national health system.
Economic Advantages
– Providing services to effectively treat depression means that people don’t have to take so many days off of work for depression
– This means that people are working more often and creating stability
– They will also be working quicker and more effectively than before
– This means that there will be positives on the economy
LIMITATIONS
Might Not Work for the Most Severe Cases
– Some cases of 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.
– Although it is possible to work around this by using medication, this is a limitation of CBT because it means it cannot be used as the sole treatment for all cases of depression.
Doesn’t Explore the Past
– One of the basic principles of CBT is that the focus in therapy is on the present and the future, not the patient’s past.
– This is in contrast to some other forms of psychological therapy.
– Some patients are aware of the link between their childhood experiences and current depression and want to talk about their experiences.
– They can find this ‘present-focus’ very frustrating.
– This means that the root of the cause of depression is not explored and is just covered up with looking at the future.