Evaluate the effectiveness of CBT in the treatment of depression

Depression can be described as a mental disorder in causing low mood and energy levels, associating it with withdrawal from aspects of life. Due to its harming symptoms, treatment is vital; thus, effectiveness of CBT will be assessed against other forms of treatment.

Kovacas & Beck (1978) state sufferers will have a ‘black and white’ mentality, in which a situation will be perceived as either very negative or positive and consider an unfortunate event as an absolute disaster. Consequently, (Beck, 1991) proposed his negative triad, which consists of three types of thinking that will occur automatically, leading to an individual developing a dysfunctional view of themselves: ‘negative view of world’, ‘negative view of the future’; ‘negative view on oneself.’ Beck’s cognitive approach to depression can be supported by research (Krantz & Hammen, 1979) that depressed women made more errors in logic when were asked to interpret written material than non-depressed women; further supported by (Bates, Thompson, & Flanagan, 1999) as participants who were given a negative automatic-thought statements become more depressed. This validates his approach to depression, suggesting positive outcomes of CBT; however, as the research doesn’t establish a causal relationship, this can hinder the validity of the approach and the outcomes of CBT.

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Beck (1991) utilised this to establish CBT to challenge irrational thoughts from the negative triad. This is mainly achieved by the therapist setting homework to the patients to record experiences, testing the outcomes to challenge the negative beliefs. Callan et al (2012) claims importance of homework as therapists can improve engagement with homework which have associated benefits in the outcomes, showing effectiveness of CBT strategies. Also, outlines the importance of therapist competence in its effectiveness as the homework must be suitable for the individual; in which (Kuyken & Tsivrikos, 2009) concluded as much as 15% of the variance in outcome may be attributable to therapist competence. However, (Simmons, Milnes, & Anderson, 2008) overemphasis on cognition minimises the circumstances of the patient, e.g. poverty or suffering abuse is prevented to change their thoughts due to their environment.

In comparison, antidepressants like SRRI’s tackle biological factors to depression as its reuptake of serotonin in the synapse, resulting in increased serotonin transmission. In turn, challenges outcomes of CBT, (Healy, 2015) high noradrenaline and low serotonin levels in the brain can cause depression. Kirsch et al (2008) reviewed clinical trials of SRRI anti-depressants and placebos, concluding improvement in severe cases. However, unlike antidepressants, CBT is not always suitable for severe depression (Elkin et al., 1989) where dysfunctional beliefs that are resistant to change patients, thus antidepressants are more suitable in such situations. Nevertheless, (Babyak et al., 2000) study with diagnosed major depressive disorder patients, found that those assigned in the exercise group recorded significantly lower relapse rates than those in the medication group, especially those who had continued afterwards. Similarly, (Shapiro et al., 1994) found that both CBT and PIT were both equally effective in reducing the severity of depression; however, after 12 months, those treated with either PIT or CBT showed tendency for symptoms to recur, thus limits the long-term effectiveness of CBT. Moreover, (March et al., 2007) compared the effects of both CBT, SRRI, and a combination of the two in 327 suicidal adolescents found 86% of the patients who had the combination of the two vastly improved and later analysis showed that CBT had significantly reduced suicidal thoughts; shows that CBT is most effective when combined with drug therapy. 

In conclusion, it can be argued that CBT is significantly effective in the treatment of depression due to its strong valid cognitive foundations proposed by Beck (1991) and the empirical research to support it. Also, strategies used in the CBT is considered effective for patients due to the strategies involved in CBT to work to change irrational thoughts to rational ones. However, as circumstances are ignored it can demotivate people to change and hinders the outcomes of CBT. However, CBT is most effective when combined with drug therapy as drugs will balance neurotransmitters and CBT works on the mental processes. Overall, the positive outcomes of CBT show the reason for being the first choice for treatment in public health services.

References

Babyak, M., Blumenthal, J. A., Herman, S., Khatri, P., Doraiswamy, M., Moore, K., … Krishnan, K. R. (2000). Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine, 62(5), 633–638. https://doi.org/10.1097/00006842-200009000-00006

Bates, G. W., Thompson, J. C., & Flanagan, C. (1999). The Effectiveness of Individual Versus Group Induction of Depressed Mood. The Journal of Psychology, 133(3), 245–252. https://doi.org/10.1080/00223989909599737

Beck, A. T. (1991). Cognitive therapy and the emotional disorders. London: Penguin.

Callan, J. A., Dunbar-Jacob, J., Sereika, S. M., Stone, C., Fasiczka, A., Jarrett, R. B., & Thase, M. E. (2012). Barriers to Cognitive Behavioral Therapy Homework Completion Scale–Depression Version: Development and Psychometric Evaluation. International Journal of Cognitive Therapy, 5(2), 219–235. https://doi.org/10.1521/ijct.2012.5.2.219

Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., … Docherty, J. P. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Archives of General Psychiatry, 46(11), 971–982; discussion 983. https://doi.org/10.1001/archpsyc.1989.01810110013002

Eysenck, M. W., & Keane, M. T. (2015). Cognitive psychology : a student’s handbook. Abingdon, Oxon: Psychology Press.

Healy, D. (2015). Serotonin and depression. BMJ, 350(apr21 7), h1771–h1771. https://doi.org/10.1136/bmj.h1771

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Kovacas, M., & Beck, A. (1978). Maladaptive cognitive structures in depression. American Journal of Psychiatry, 135(5), 525–533. https://doi.org/10.1176/ajp.135.5.525

Krantz, S., & Hammen, C. L. (1979). Assessment of cognitive bias in depression. Journal of Abnormal Psychology, 88(6), 611–619. https://doi.org/10.1037//0021-843x.88.6.611

Kuyken, W., & Tsivrikos, D. (2009). Therapist Competence, Comorbidity and Cognitive-Behavioral Therapy for Depression. Psychotherapy and Psychosomatics, 78(1), 42–48. https://doi.org/10.1159/000172619

March, J., Silva, S., Vitiello, B., Petrycki, S., Wells, K., Fairbank, J., … Curry, J. (2007). The Treatment for Adolescents With Depression Study (TADS). Archives of General Psychiatry, 64(10), 1132. https://doi.org/10.1001/archpsyc.64.10.1132

Shapiro, D. A., Barkham, M., Rees, A., Hardy, G. E., Reynolds, S., & Startup, M. (1994). Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. Journal of Consulting and Clinical Psychology, 62(3), 522–534. https://doi.org/10.1037/0022-006x.62.3.522

Simmons, A. M., Milnes, S. M., & Anderson, D. A. (2008). Factors Influencing the Utilization of Empirically Supported Treatments for Eating Disorders. Eating Disorders, 16(4), 342–354. https://doi.org/10.1080/10640260802116017

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