Cognitive Treatments of Depression
MALADAPTIVE THINKING
Cognitive-behavioural therapies suggest that psychological problems arise because individuals have
developed a malfunctioning way of thinking. The problem only exists in the way that a person thinks
about their problem and not the problem itself. In order to treat such disorders a client needs to be
challenged about their maladaptive and irrational thoughts.
Ellis (1962) called this ‘faulty thinking’ and developed rational emotive behaviour therapy (REBT) as a
way to help people cure themselves.
AIMS OF CBT
The aim of CBT is to help the client to identify their negative, irrational thoughts and to replace these
with more positive, rational ways of thinking (it’s a teaching therapy). A therapy session includes both
cognitive and behavioural elements, with homework between sessions (filling in a diary, for example).
A diary will make a person feel embarrassed and shocked at what they have written in the past.
A key part of CBT is that the therapist will treat irrational thinking as a hypothesis.
The course of treatment usually lasts from 5 to 20 sessions, with each session normally lasting 30 to
60 minutes.
COGNITIVE ELEMENT
The therapist encourages the client to become aware of beliefs which
contribute to anxiety or depression. This involves direct questioning, such as ‘ Tell me what you think
about...’ The therapist does not comment upon the client’s beliefs, but instead they are treated as
hypotheses and examined for validity. The ABC model can be used to help the client understand
better where their faulty cognitions are leading them.
BEHAVIOURAL ELEMENT
The therapist and client decide together how the client’s beliefs can be reality-tested through
experimentation, either through role-play or as homework assignments (brushing teeth 2x a day,
showering everyday, writing a diary). The aim is that by testing out possibilities, clients will themselves
come to recognize the consequences of their faulty cognitions. The therapist and client then work
together to set new goals for the client in order that more realistic and rational beliefs are incorporated
into ways of thinking. These are usually in graded stages of difficulty so that clients can build upon
their own success.
RATIONAL EMOTIVE BEHAVIOURAL THERAPY (REBT)
REBT is a form of CBT, and uses its main concepts and ideas of challenging irrational behaviour.
Ellis was the main developer of the therapy and adapted it several times before his death in 2007.
● Reframing phase - patient is asked to challenge negative thoughts by reinterpreting the ABC
in a more positive and realistic way.
● Education phase - patient goes to therapy once or twice every two weeks for about fifteen
sessions and learns not to think in extremes of behaviour and distinguish fact from fiction.
● Behavioural action phase - patient participates in rewarding behaviour to reinforce the
changes made in their thinking in previous phases.
EVALUATION OF COGNITIVE TREATMENTS
Costly - CBT takes a lot of sessions and they are expensive - someone with depression may
discontinue use - ineffective.
Wider positive implications - taught transferable skills - useful.
Might only be effective if used alongside drugs - better treatment and more effective.
MALADAPTIVE THINKING
Cognitive-behavioural therapies suggest that psychological problems arise because individuals have
developed a malfunctioning way of thinking. The problem only exists in the way that a person thinks
about their problem and not the problem itself. In order to treat such disorders a client needs to be
challenged about their maladaptive and irrational thoughts.
Ellis (1962) called this ‘faulty thinking’ and developed rational emotive behaviour therapy (REBT) as a
way to help people cure themselves.
AIMS OF CBT
The aim of CBT is to help the client to identify their negative, irrational thoughts and to replace these
with more positive, rational ways of thinking (it’s a teaching therapy). A therapy session includes both
cognitive and behavioural elements, with homework between sessions (filling in a diary, for example).
A diary will make a person feel embarrassed and shocked at what they have written in the past.
A key part of CBT is that the therapist will treat irrational thinking as a hypothesis.
The course of treatment usually lasts from 5 to 20 sessions, with each session normally lasting 30 to
60 minutes.
COGNITIVE ELEMENT
The therapist encourages the client to become aware of beliefs which
contribute to anxiety or depression. This involves direct questioning, such as ‘ Tell me what you think
about...’ The therapist does not comment upon the client’s beliefs, but instead they are treated as
hypotheses and examined for validity. The ABC model can be used to help the client understand
better where their faulty cognitions are leading them.
BEHAVIOURAL ELEMENT
The therapist and client decide together how the client’s beliefs can be reality-tested through
experimentation, either through role-play or as homework assignments (brushing teeth 2x a day,
showering everyday, writing a diary). The aim is that by testing out possibilities, clients will themselves
come to recognize the consequences of their faulty cognitions. The therapist and client then work
together to set new goals for the client in order that more realistic and rational beliefs are incorporated
into ways of thinking. These are usually in graded stages of difficulty so that clients can build upon
their own success.
RATIONAL EMOTIVE BEHAVIOURAL THERAPY (REBT)
REBT is a form of CBT, and uses its main concepts and ideas of challenging irrational behaviour.
Ellis was the main developer of the therapy and adapted it several times before his death in 2007.
● Reframing phase - patient is asked to challenge negative thoughts by reinterpreting the ABC
in a more positive and realistic way.
● Education phase - patient goes to therapy once or twice every two weeks for about fifteen
sessions and learns not to think in extremes of behaviour and distinguish fact from fiction.
● Behavioural action phase - patient participates in rewarding behaviour to reinforce the
changes made in their thinking in previous phases.
EVALUATION OF COGNITIVE TREATMENTS
Costly - CBT takes a lot of sessions and they are expensive - someone with depression may
discontinue use - ineffective.
Wider positive implications - taught transferable skills - useful.
Might only be effective if used alongside drugs - better treatment and more effective.
