Cognitive Treatments of Depression (Cognitive Behavioural Therapy (CBT)
The notion that underpins the cognitive approach is that mental disorders result from errors in thinking. The aim of cognitive therapy (more often referred to as cognitive-behavioural therapy) is to challenge any irrational or dysfunctional thoughts and to replace them with more rational ones. Two main therapies are based on the Cognitive approach:
- Ellis (1957) Rational-emotive therapy (now re-named REBT)
These therapies share many similarities and so we will only deal with one example here.
Ellis’ Rational-Emotive Behavioural Therapy (REBT)
- Rational-Emotive Behavioural Therapy (REBT) was developed by Ellis (1957) and is based on the idea that many problems are the result of irrational thinking.
- It incorporates the ABC model developed by Ellis which helps to demonstrate the idea that beliefs are the main influence behind our emotional well-being.
How it works:
- Ellis proposed that many problems are caused by irrational and self-defeating beliefs that put unreasonable demands on the individual.
- Ellis particularly focuses on how self-defeating attitudes cause problems when something unpleasant happens (such as in the example given over the page – failing a driving test – or an AS exam!)
- The therapy is designed to replace the beliefs in B with a new belief system called D (a dispute belief system) that allows the person to interpret what happens to them in ways that are more realistic and positive.
- The first part of the therapy is confrontational; the aim is for the therapist to persuade the client that their beliefs are irrational and are the cause of their emotional turmoil.
- The client’s beliefs (their irrational thoughts) are constantly challenged (this is the cognitive part of the therapy).
- Clients are given homework assignments which make them face up to their irrational beliefs in everyday life – with the effect that they will then change their behaviour (this is the behavioural part of the therapy).
- The eventual goal is a full acceptance of the new, rational beliefs.
Ellis emphasises that it is not the activating event that causes unproductive consequences – it is the beliefs that lead to the self-defeating consequences. REBT therefore focuses on challenging or disputing these beliefs and replacing them with effective, rational beliefs. For example:
- Logical disputing: questioning ‘does thinking in this way make sense?’
- Empirical disputing: Asking ‘are these beliefs consistent with reality?’ ‘Where is the proof that this belief is accurate?’
- Pragmatic disputing: Emphasising the lack of usefulness of self-defeating beliefs, ‘how is this belief likely to help me?’
This process helps a patient to move from catastrophising to a more rational interpretation of events.
Evaluation, AO3 of Cognitive Treatments of Depression (Cognitive Behavioural Therapy (CBT):
(1) POINT: A strength of CBT is that research has suggested that it can successfully treat abnormalities such as OCD. EXAMPLE: From a meta-analysis, Engels et al (1993) concluded CBT is an effective treatment for a range of different disorders such as depression and social phobia. EVALUATION: This is positive because it suggests that CBT can be useful to more people than many other treatments, without the harmful side effects of drug therapies. Furthermore, CBT can be seen to not just assist individuals with dealing with the symptoms of their depression, many patients can transfer the skills they have developed through CBT to help them with other issues such as stress management.
(1) POINT: However, CBT may not be a suitable treatment for all depression sufferer. EXAMPLE: For example, individual differences can affect whether or not CBT is effective from person to person. Some individuals feel very positive about treatments such as CBT and are prepared to engage with the programme whereas others refuse to engage with programme requirements such as the completion of homework tasks/find it difficult to actively apply the principals to their everyday life. EVALUATION: This is a weakness as it suggests that CBT would not be the best treatment for all depression sufferers, this means that it is vitally important that the needs of the individual client/patient should always be considered before a course of treatment is decided.
(2) POINT: CBT fails to acknowledge that some mental disorders may be due to biological factors. EXAMPLE: For example, according to the Biological approach, OCD may be linked to low levels of serotonin in the brain suggesting that the cognitive therapies ignore the role that biology can play in a mental disorder. EVALUATION: This is problematic because it means that CBT will not work for some clients as the role of biology in mental disorders is not being considered.