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THE COGNITIVE APPROACH TO TREATING DEPRESSION - Coggle Diagram
THE COGNITIVE APPROACH TO TREATING DEPRESSION
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COGNITIVE BEHAVIOUR THERAPY
Beck: patient + therapist work together
They work together to clarify the patient's problems
Identify where there might be negative or irrational thoughts that will benefit from challenge
CHALLENGING NEGATIVE THOUGHTS RELATING TO NEGATIVE TRIAD
The aim is to identify negative thoughts about the self, the world and the future - the negative triad
These thoughts must be challenged by the patient taking an active role in their treatment
THE PATIENT AS THE 'SCIENTIST'
Patients are encouraged to test the reality of their irrational beliefs
They might be set homework, e.g., to record when they enjoyed an event or when people were nice to them. This is referred to as the 'patient as the scientist'
In future sessions if patients say that no-one is nice to them or there is no point going on, the therapist can produce this evidence to prove the patient's beliefs incorrect
ELLIS'S RATIONAL EMOTIVE BEHAVIOUR THERAPY (REBT)
D= dispute (challenge irrational beliefs)
REBT extends the ABC model to an ABCDE model
E = effect
CHALLENGING IRRATIONAL BELIEFS
A patient might talk about how unlucky they have been or how unfair life is. An REBT therapist would identify this as utopianism + challenge it as an irrational belief
Empirical argument - disputing whether there is evidence to support the irrational belief
Logical argument - disputing whether the negative thought actually follows from the facts
BEHAVIOURAL ACTIVATION
As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms
The goal of treatment, therefore, is to work with depressed individuals to gradually decrease their avoidance + isolation, and increase their engagement in activities that have been shown to improve mood, e.g., exercising/ going out to dinner ect
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IT MAY NOT WORK FOR THE MOST SEVERE CASES OF DEPRESSION
Where this is the case it is possible to treat patients with antidepressant medication and commence CBT when they are more alert + motivated
This is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression
In some cases depression can be so severe that patients cannot motivate themselves to take on the hard cognitive work required for CBT
IT IS EFFECTIVE
There is a large body of evidence to support the effectiveness of CBT for depression, e.g., March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents
After 36 weeks, 81% of the CBT group, 81% of the antidepressant group and 86% of the CBT + antidepressants group were significantly improved. CBT emerged as just as effective as medication and helpful alongside medication
This suggests there is a good case for making CBT the first choice of treatment in public health care systems in the NHS
SOME PATIENTS REALLY WANT TO EXPLORE THEIR PAST
In some other forms of psychotherapy patients make links between childhood experiences and current depression
The 'present-focus' of CBT may ignore an important aspect of the depressed patient's experience
One of the basic principles of CBT is that the focus of the therapy is on the patient's present + future, rather than their past