Psychopathology Learning Table 4: The Cognitive Approach to Treating Depression
AO1
Cognitive behavioural therapy (CBT) is the most commonly used psychological treatment for depression. If you see a clinical psychologist for a mental health problem, the chances are that
you will receive CBT.
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 involves working to change negative and irrational thoughts and finally put more effective behaviours into place. Some CBT therapists do this using techniques purely from Beck’s
cognitive therapy, or some rely exclusively on Ellis’s rational emotive behaviour therapy. Most draw on both.




CBT: Beck’s Cognitive Therapy
The aim is to identify automatic thoughts about the world, the self and the future – this is
the negative triad (see cog. Theory of depression).
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. This is sometimes referred
to as the ‘patient as scientist’, investigating the reality of their negative beliefs in the way a
scientist would.
In future sessions, if patients say that no 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 incorrect.
CBT: Ellis’s Rational Emotive Behaviour Therapy (REBT)
REBT extends the ABC model to an ABCDE model. D stands for dispute and E stands for
effect. The central technique of REBT is to identify and dispute (challenge) irrational
thoughts.
E.g. a patient might talk about how unlucky they have been or how unfair things seem. An
REBT therapist would identify these as examples of utopianism and challenge this thought as
an irrational belief. This would involve a vigorous argument. The intended effect is to change
the irrational belief and so break the link between negative life events and depression.
This vigorous argument is the hallmark of REBT. Ellis identified different methods of
disputing, e.g.:





Effectiveness
P: One strength of CBT is that there is a vast amount of
supportive evidence that suggests it is an effective
method of treating depression.
E: For example, March et al (2007) compared the effects
of CBT with antidepressant drugs and a combination of
the two in adolescents with a main diagnosis of
depression. After 36 weeks, CBT was shown to work as
effectively as drug therapy (81% improvement) and
paired together the rates of improvement were 86%.
E: This is a strength because it shows CBT is just as
effective as drug therapy, and suggests a good case for
making CBT the first choice of treatment in health care
systems such as the NHS. It is a safer (less likelihood of
addiction), more long-lasting alternative to drugs which
may be beneficial for the majority of sufferers.
L: As a result, this suggest that CBT is an effective way to
treat depression.
empirical argument involves disputing whether there is actual evidence to support the
negative belief
Logical argument involves disputing whether the negative thought logically follows on from
the facts.
AO3: Evaluation of the Cognitive Treatments of Depression
Not Appropriate for All Cases
Overemphasis on Cognition
P: One weakness of CBT as a treatment for depression is
that it may not be appropriate for all cases.
E: For example, in some cases, depression can be so
severe that patients cannot motivate themselves to
engage with the hard cognitive work of CBT.
E: This is an issue because these individuals may not be
able to motivate themselves to engage with the hard
cognitive work of CBT. They may have to be treated using
antidepressant medication and could then potentially
commence CBT when they are more alert and motivated.
However this still means that CBT cannot be used as the
main form of treatment in all cases of depression.
L: Consequently, this reduces the credibility of CBT as a
treatment for depression.
P: One weakness of CBT as a treatment for depression is that it
may overemphasise the importance of cognition.
E: For example, McCusker (2014) stated that there is a risk that
because of its emphasis on what is happening in the mind of the
individual patient, CBT may end up minimising the importance of
the circumstances in which the patient is living.
E: This is an issue because a patient living in poverty or suffering
abuse needs to change their circumstances, and any approach to
therapy that emphasises what is happening in the patient’s mind
rather than their environment can prevent this. CBT used
inappropriately can demotivate people to change their situation.
L: As a result, this casts into doubt the appropriateness and
effectiveness of using CBT as a form of treatment for depression.