The Effectiveness of Cognitive Behavioural Therapy

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More than 30% of people have had one episode of depression in their lifetime; therefore depression affects a large amount of the population. “In a clinical setting the term depression refers to a syndrome compromising mood disorder, psychomotor changes, and a variety of somatic and vegetative disturbances.”

However, the definition of depression is subjective and it’s characteristics fluctuates between individuals. “Depression is variously referred to as a sign, symptom, syndrome, reaction, disorder and disease entity” Thus one cannot ultimately define depression in a straightforward way, it’s a complex disorder, which is defined by the personal experience of the individual. Cognitive psychologists propose that people with depression develop their vulnerabilities as a consequence of previous experiences.

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Cognitive psychologist, Albert Ellis was influential in the cognitive revolution and played a key role in the rise of cognitive behavioural approaches. Moreover, he was interested in understanding the cognitions behind depression. In 1979 Ellis formed a simple ABC model to show how emotional and behavioural responses arise. The notation of this approach is as follows: A represents the activating event, B represents the clients’ belief system and C represents the consequences that occur as a outcome. Ellis’ approach is pragmatic, he simply points out that you cannot change the past, you have to accept it, but instead you can change how you think about it. The next stage of the model is labelled D, for disputation. The therapist challenges the individual’s irrational beliefs and discuses with them alternative beliefs they could hold. On the other hand, Ellis also proposed another model of depression, REBT. Rational behaviour in the theory of REBT helps individuals to achieve their basic goals and purposes. Subsequently, irrational behaviour is that which prevents people from achieving their basic goals.

On the other hand, Beck, proposed another cognitive explanation of depression. Beck believed that a person’s cognitions created this vulnerability to depression, thus predisposing the individual to such a disease. Beck believed that all psychogenic disorders are primarily thought disorders, implementing a distinct cognitive approach to his way of explaining depression. Moreover, Beck proposed the ‘Negative traid’, whereby a person develops a dysfunctional view of themselves due of three types of negative thinking that occur involuntarily. When one is depressed, negative thoughts of the world, future and the self often arise as a result. Such negative views guide an individual to interpret their experiences in a negative way and thus making them more vulnerable to depression. Beck also proposed that an individual with depression experiences cognitive distortions. Such distortions signify patterns of exaggerated thoughts, which can support maladaptive behaviour; an example of this is arbitrary inference, which is when one draws a conclusion in the absence of evidence.

Subsequently, when treating depression Cognitive behavioural therapy is the most common treatment and some would argue the most effective. Cognitive behavioural therapy focuses on the way an individual thinks and feels and how this affects behaviour. The therapy aims to change the clients’ thought patterns so that they can respond differently to ambitious and difficult situations. The process of CBT involves a proactive role and relationship between the client and therapist. Thus, the two collaborate and work together to form mutual goals that the client must work through. The client learns and practices skills, which can be used in real-world situations. Moreover, CBT is a gradual process that enables a person to take trivial steps towards a positive change. CBT has proven its effectiveness through extensive research and real-life evidence, treating patient’s symptoms of depression. However, contradictory evidence suggests faults in the therapy and perhaps other approaches are more effective in reducing symptoms of depression.

Moreover, when discussing the effectiveness of cognitive behavioural therapy for treating depression one must reflect on the studies carried out regarding the success of CBT. Gloaguen et al. (1998) conducted an rigorous meta-analysis on CBT for depression. The study used Hedges and Olkin d + method and included 48 controlled trails. In the study there was 2765 patients, of which presented non-psychotic and non-bipolar major depression, or dysthymia of mild to moderate severity. Furthermore, to evaluate the severity of depression, the study used the Beck Depression Inventory (BDI). Beck defined the scale by stating

The study found a highly significant difference in preference of CT versus waiting-list or placebo. The average participant in CT is better of 29% than the average subject in the waiting list or placebo. Therefore demonstrating the effectiveness of CT for treating depression, however one could argue that CT was only compared to waiting list or placebo conditions. Which do not offer a empirical comparison, as opposed to a comparison made with other treatment’s, such as drug therapy. On the other hand, the study found that CT was superior to antidepressants.

Furthermore, in addition a study examined the effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders. The study included a literature search for randomized controlled trials examining CBT-based guided self help interventions for depressive disorders. Moreover, to collect the data for the study they used electronic databases, journals, articles and contacted authors to gain the relevant information. As a result, 13 of the studies met the inclusion criteria. Meta-analysis showed the effectiveness of CBT- based guided self help at post-treatment, however it was found to have restricted effectiveness at follow-up or amongst more clinically representative samples. Additionally, studies that conveyed greater effectiveness of CBT- based guided self help tended to have low methodological quality and overall involved participants who were self-selected rather than recruited. Thus, this creates a bias in sample of participants, potentially skewing the results. Therefore, one can conclude that this form of CBT needs further rigorous evidence before being deemed effective for treating depression. 

This study aimed to evaluate the effectiveness of 4 treatments among adolescents with major depressive disorder. Furthermore, the study consisted of a randomized controlled trial of a volunteer sample of 439 patients between ages of 12-17. The trial was conducted in the US, at 13 clinics between 2000 and 2003. However, this may precede a cultural bias, specifically a beta bias where the results of the study are generalised beyond one culture, thus giving the study a low validity. Besides, the conditions in the study included 12 weeks of fluoxetine alone, CBT alone, CBT with fluoxetine, or placebo. Consequently, the results of the study showed that the combination of fluoxetine with CBT was statistically significant (p=.001) compared with fluoxetine alone (P=.02) and CBT alone (p=.01). Additionally, fluoxetine with CBT showed the greatest reduction in suicidal thinking, hence illustrating the positive effects of the study in regards to the real-world implications. Therefore, in conclusion the combination of fluoxetine with CBT offered the most effective treatment of CBT. Thus, this study demonstrates that although CBT may not be the most beneficial treatment alone, in combination with drugs its effects are immense. Therefore, one can confidently say with intervention of drugs CBT is a very effective treatment for patients with depression.

Thus, to conclude the cognitive approach offers a viable explanation of depression. Further, cognitive psychologists propose a scientific viewpoint in its way of approaching depression. Nevertheless, Beck’s ideas are based on the individuals negative thoughts, which one cannot observe, thus enquiring it’s empirical validity for explaining depression. Unquestionably, cognitive behavioural therapy overall is an effective treatment for patients with depression. However, I question its integrity when used alone, as stated by March et al., which illustrates that CBT is more effective when combined with drugs. On the contrary, Gloaguen et al., found that patients treated with CBT had a lower rate of relapse as opposed to patients treated with antidepressants. Hence, this contradicts to March et al., findings, therefore one cannot confidently say that one treatment is more effective than the other. On the other hand, Cambridge University press studied a different approach of CBT. They found that CBT- based guided self was effective at post-treatment; however, its credibility was questioned when compared to clinical and empirical samples. Consequently, on a whole CBT is more beneficial than no treatment at all, however, a full analysis in its effectiveness in treating depression cannot be accurately made due to the contradicting research.  

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