Cognitive-behavioural Therapy (CBT)

Beck (1967)

CBT emphasises the role of maladaptive thoughts and beliefs in the origins and maintenance of depression.

The aim of CBT is to identify and alter these maladaptive cognitions (the cognitive part of therapy) as well as any dysfunctional behaviours that might be contributing to depression (the behavioural part).

CBT generally focuses on current problems and current dyfunctional thinking. It generally is relatively brief (lasting between 16 and 20 sessions).

According to Hammen, 'thought catching' and 'behavioural activation' are the two main ingredients in CBT.

Individuals are taught how to see the link between their thoughts and the way they feel.

The patient might be asked to record any emotion-arousing events, the automatic 'negative' thoughts associated with these events and then their 'realistic' thoughts that might challenge these negative thoughts. For example, they may feel distresed about something they overhear, automatically assuming that the person was talking about them. CBT teaches them to challenge this association by asking themselves questions such as 'Where's the evidence that they were talking about me? Might they have been talking about someone else? What is the worst that can happen if they were?'
By challending these dysfunctional thoughts, and replacing them with more constructive ons, clients are trying out new ways of behaving.

Behavioural activation is based on the commonsense idea that being active leads to rewards that act as an antidote to depression.

In CBT, therapist and client identify potential pleasurable activities and anticipate and deal with any cognitive obstacles (eg. I won't be able to achieve that').

Babyak et al (2000) studied 156 MDD adult volunteers. They were randomly assigned to a four month course of aerobic exercise, drug treatment (an SSRI) or a combination of the two. Patients in all three groups exhibited significant improvement at the end of the four months. Six months after the end of the study, those in the exercise group had significantly lower relapse rates than those in the medication group, partocularly among those who had continued with an exercise regime on their own.

A meta-analysis by Robinson et al found that CBT was superior to no-treatment control groups. However, when these control groups were subdivided into waiting list (ie. no treatment at all) and placebo groups, CBT was not significantly more effective than the placebo condition to reducing depressive symtpoms.

Kuyken and Tsivirkos lend support to this claim by concluding that as much as 15% of the variance in outcome may be attributable to therapist competence.

Research suggest that the clients' engagement with 'homework' predicrs their outcomes and that therapists who are able to improve clients' engagement with homework have associated benefits in terms of outcomes (Bryant et al, 1999).

CBT has successfully been applied to many different client groups, including elderly populations, juveniles and depressed adolescents.

The cognitive aspect of CBT has been administered by computer and shown to be as effective as other forms of psychotherapy treatment (Selmit et al).