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Yasmin has just been made redundant Yasmin has just been made redundant. She takes this very hard and finds herself suffering symptoms of depression. When questioned, Yasmin says that the situation is unfair and that she is ashamed. How would you put the sequence of events into Ellis’s ABC model? What kinds of thinking is Yasmin displaying? Does Yasmin have any symptoms that Ellis’s model would struggle to explain? Stretch and Challenge - How might you go about challenging these thoughts if you were a cognitive behavioural therapist?

Evaluation of cognitive explanation It only offers a partial explanation so has limitations Some depression does occur as a result of an activating event (reactive depression). However not all depression arises as a result of an obvious cause It has practical application in CBT Like Beck’s explanation, Ellis’ explanation has led to successful therapy. Irrational negative beliefs are challenged and this can help to reduce depressive symptoms suggesting that the irrational beliefs had some role in the depression. It has good supporting evidence Much research has supported the proposal that depression is associated with faulty information processing, negative self-schemas and the triad of impairments

Cognitive Treatments 4.1.4 Psychopathology The cognitive approach to treating depression: cognitive behavioural therapy including challenging irrational thoughts

Cognitive Behaviour Therapy (CBT) CBT is the most commonly used psychological treatment for depression, as well as other mental health problems (e.g. anxiety, panic, phobias, stress, bulimia, OCD, Post-Traumatic Stress Disorder, bipolar disorder, etc.) This is a method for treating mental disorders based on both behavioural and cognitive techniques The therapist aims to make the client aware of the relationship between thought, emotion and actions CBT can help people to change how they think (‘cognitive') and what they do (‘behaviour'). These changes can help them to feel better.

Each session will last between 30 and 60 minutes. What does CBT involve? The Sessions Meet with a therapist for between 5 and 20, weekly, or fortnightly sessions. Each session will last between 30 and 60 minutes. Some CBT therapists work with the techniques influenced by Beck and some work with the techniques influenced by Ellis. Most draw on both Handout with process Then worksheet

Beck’s CBT Beck developed a therapy to challenge the negative triad (beliefs) of the client.   First, the client will be assessed to discover the severity of their condition. The therapist will establish a baseline (or starting point), prior to treatment, to help monitor improvement.

Thoughts influence emotions and behaviour. To feel better you must think positively. The client is asked to provide information about how they perceive themselves, the future and the world. The therapist would use a process of reality testing e.g. if the client says, ‘I’m useless, and I always fail’, they will be asked whether in reality, they have been successful at something. The therapist might ask the client to do something to demonstrate their ability to succeed.

The client’s beliefs are directly challenged Clients are made aware of their negative views. In this way, irrational ideas can be replaced with more optimistic and rational beliefs. Through this process, irrational ideas can be replaced with more optimistic and balanced beliefs.  

Ellis’ REBT Ellis’ Rational Emotive Behaviour Therapy REBT extends the ABC model to an ABCDE model D = Dispute (challenge the thoughts) E = Effect (see a more beneficial effect on thought and behaviour) Therefore the central technique of REBT is to identify and dispute the patient’s irrational thoughts

Common irrational thoughts Ellis identified what he saw as the most common faulty beliefs experienced by people with mental health problems. I am worthless unless I am competent at everything I try I must be approved of and loved by everyone I meet My unhappiness is always caused by external events; I cannot control my emotional response It is upsetting when things are not the way I would like them to be Certain people are thoroughly bad and should be severely blamed or punished for it Because something once affected my life, it will do so indefinitely There is always a perfect solution to human problems and it is awful if it is not found I should depend on others who are stronger than I am It easier to avoid difficulties and responsibilities than to face them If something unpleasant happens I should keep dwelling on it

Worksheet Should I opt for CBT?

How effective is CBT? CBT is effective CBT is effective in reducing symptoms of depression and in preventing relapse and there is a large body of evidence to support this (March et al, 2007) It is the most effective psychological treatment for moderate depression. It is as effective as antidepressants for many types of depression (Fava et al, 1994).

How effective is CBT? CBT may not work for the most severe cases In some cases depression may be so severe that patients cannot motivate themselves to engage in the therapy In these cases, it is possible to treat the patient with antidepressants and then CBT can commence at a later date This is therefore a limitation as it means that CBT cannot be used as the sole treatment in all cases

CBT and Drug Treatment Keller et al (2000) Recovery rates (from depression) 55% drugs alone 52% CBT alone 85% when used together.

Strengths Weaknesses Clients can become dependant on their therapist, or non-cooperative CBT is not effective for people with rigid attitudes or resistance to change, or for people who have high stress levels in response to genuinely difficult life circumstances (depressive realism) CBT is not a quick fix. A therapist is like a personal trainer that advises and encourages - but cannot 'do' it for the client. Client is actively involved in their recovery CBT is not physically invasive Client learns to help themselves, and can use the skills in new situations. CBT works (e.g. Mrach, Fava) Particularly when combined with drug treatment (Keller)

CHANGE VIEW: 10 key facts about CBT Change: your thoughts and actions View: events from another angle Homework: practice makes perfect I can do it: self-help approach Action : don't just talk, do! Experience: test out your beliefs Need: pinpoint the problem Write it down: to remember progress Goals: move towards them Evidence: shows CBT can work

"We are what we think. All that we are arises with our thought "We are what we think. All that we are arises with our thought. With our thoughts, we make our world." The Buddha