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Rational Emotive vs. Cognitive vs. Pharmacotherapy in M.D.D.
The purpose of this study was to examine the mechanisms of change in the treatment of
major depressive disorder (MDD) by comparing two cognitive-behavioral therapies, Rational
Emotive Behavior Therapy (REBT) and Cognitive Therapy (CT), with pharmacotherapy (SSRI)
(David et al., 2008, p. 524). The researchers aimed to determine whether changes in specific
cognitive processes, such as automatic thoughts, dysfunctional attitudes, and irrational beliefs,
could account for the improvement in depressive symptoms. This investigation is significant
because understanding how these therapies work can help refine treatment approaches and
potentially reduce relapse rates in patients with depression (David et al., 2008, p. 526).
The study’s research questions focused on whether REBT and CT lead to improvements
in depression by altering different types of cognitions. Specifically, the authors hypothesized that
REBT would reduce irrational beliefs, especially demandingness and self-downing, while CT
would primarily target automatic thoughts and intermediate/core beliefs (David et al., 2008, p.
526). The psychological approach used in the study was cognitive-behavioral, which is based on
the idea that our thoughts, feelings, and behaviors are interconnected (King, 2022, p. 13; Beck,
1976; Ellis, 1962).
In explaining the theory behind the study, it is important to note that the cognitivebehavioral framework holds that distorted or irrational thoughts contribute to emotional distress.
REBT, developed by Albert Ellis, argues that irrational beliefs, such as demandingness and selfdowning, play a central role in depression (Ellis, 1962, 1994, as cited in David et al., 2008, p.
524). In contrast, CT, as developed by Aaron Beck, suggests that negative automatic thoughts
and deep-seated schemas are the primary drivers of depressive symptoms (Beck, 1976, as cited
in David et al., 2008, p. 524). The study was designed to test these theories by measuring
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changes in these cognitive processes over the course of treatment, and the results provided
support for the idea that modifying these cognitions is associated with reduced depression (David
et al., 2008, p. 535). I believe the theories used were appropriate for this study because they
directly address the cognitive vulnerabilities that are often present in depression, offering clear
targets for therapeutic intervention. If I were to conduct a similar study, I might also consider
integrating principles from Acceptance and Commitment Therapy (ACT) to explore how
psychological flexibility may further contribute to improved outcomes (Hayes et al., 1999, as
summarized in David et al., 2008, p. 533).
The theory discussed in the article clearly falls under the cognitive-behavioral approach.
Both REBT and CT are rooted in the belief that the way individuals interpret events plays a
crucial role in how they feel and behave. In REBT, the focus is on challenging and changing
irrational beliefs, while CT emphasizes identifying and modifying negative automatic thoughts
and core beliefs. This focus on cognition as the mediator between events and emotional
responses is a hallmark of cognitive-behavioral therapy, and it explains why these approaches are
effective in reducing depressive symptoms (David et al., 2008, p. 535). The study’s findings,
which link changes in cognitive processes with reductions in depression, further support the
central tenets of this approach (David et al., 2008, p. 536).
Personally, I most identify with the cognitive-behavioral approach because it offers
practical and structured strategies to help individuals recognize and change their negative
thought patterns. This approach is backed by a strong body of research and provides clear, stepby-step methods for improving mental health. On the other hand, I least identify with approaches
that focus solely on biological factors, as they tend to overlook the role of thought processes and
personal experiences in the development and maintenance of depression. By combining
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techniques from both REBT and CT, clinicians can address a broader range of cognitive
vulnerabilities, making the treatment more flexible and responsive to each patient’s needs (David
et al., 2008, p. 536).
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References
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities
Press.
David, D., Szentagotai, A., Lupu, V., & Cosman, D. (2008). Rational-emotive behavior therapy
versus cognitive therapy versus pharmacotherapy in the treatment of major depressive
disorder: A randomized clinical trial. Psychotherapy: Theory, Research, Practice,
Training, 45(4), 523–538. https://doi.org/10.1037/a0014332
Ellis, A. (1962). Reason and emotion in psychotherapy. Lyle Stuart.
Ellis, A. (1994). Reason and emotion in psychotherapy: Revised and updated. Citadel Press.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An
experiential approach to behavior change. Guilford Press.
King, L. A. (2022). The science of psychology: An appreciative view (5th ed.). McGraw-Hill
Education.