cbt and depression
COGNITIVE BEHAVIORAL THERAPY (CBT)
Liberty University
Psych 565
INTRODUCTION
CBT for Depression: How it works, Effectiveness, and Examples
TOPIC
This research will inspect the effect of Cognitive Behavioral Therapy (CBT) on mental health disorders, primarily depression.
Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior and emotions.
Cognitive behavioral therapy focuses on changing the automatic negative thoughts that can contribute to and worsen emotional difficulties, depression, and anxiety. These spontaneous negative thoughts have a detrimental influence on mood.
Through CBT, these thoughts are identified, challenged, and replaced with more objective, realistic thoughts.
Form of psychotherapy that is effective for a wide range of problems
Leads to significant improvement
Proven to more effective than other forms of treatments
WHAT IS CBT
Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.
Major depressive disorders account for 8.2% of Global Years lived with disability, and a second leading cause of years lived with disability
Contribute to burden of several other mental health disorders indirectly including suicide
13% rise in mental health disorders, and depression is accounted as the most common psychiatric disorder
IMPORTANCE OF THE TOPIC
Research shows that most people who receive psychotherapy experience symptom relief and are better able to function in their lives. About 75 percent of people who enter psychotherapy show some benefit from it.1 Psychotherapy has been shown to improve emotions and behaviors and to be linked with positive changes in the brain and body. The benefits also include fewer sick days, less disability, fewer medical problems, and increased work satisfaction.
With the use of brain imaging techniques researchers have been able to see changes in the brain after a person has undergone psychotherapy. Numerous studies have identified brain changes in people with mental illness (including depression
What are the primary benefits of CBT in the treatment of depression?
RESEARCH QUESTION
There is no absolute contraindication to CBT; however, it is often reported that clients with comorbid severe personality disorders such as antisocial personality disorders and subnormal intelligence are difficult to manage through CBT. Special training and expertise may be needed for the treatment of these clients.
Patient with severe depression with psychosis and/or suicidality might be difficult to manage with CBT alone and need medications and other treatment before considering CBT. Organicity should be ruled out using clinical evaluation and relevant investigations, as and when required.
There are many advantages of CBT in depression
It is used to reduce symptoms of depression as an independent treatment or in combination with medications2. It is used to modify the underlying schemas or beliefs that maintain the depression3. It can be used to address various psychosocial problems, for example, marital discord, job stress which can contribute to the symptoms4. Reduce the chances of recurrence5. Increase the adherence to recommended medical treatment
BACKGROUND INFORMATION – LEARNING PRINCIPLE
DEVELOPMENT
CBT was developed in the 1960s by DR. Aaron Beck who completed experiments to test psychoanalytic concepts.
HOW IT WORKS
CBT is based on the principle that an individual’s thoughts, emotional state, physical ambiances, and actions are interdependent.
Destructive thoughts were categorized and examined to identify cognitive distortions.
Beck’s (1967) system of therapy is similar to Ellis’s, but has been most widely used in cases of depression. Cognitive therapists help clients to recognize the negative thoughts and errors in logic that cause them to be depressed.
The therapist also guides clients to question and challenge their dysfunctional thoughts, try out new interpretations, and ultimately apply alternative ways of thinking in their daily lives.
Aaron Beck believes that a person’s reaction to specific upsetting thoughts may contribute to abnormality. As we confront the many situations that arise in life, both comforting and upsetting thoughts come into our heads. Beck calls these unbidden cognition’s automatic thoughts.
When a person’s stream of automatic thoughts is very negative you would expect a person to become depressed (I’m never going to get this essay finished, my girlfriend fancies my best friend, I’m getting fat, I have no money, my parents hate me - have you ever felt like this?). Quite often these negative thoughts will persist even in the face of contrary evidence.
Beck (1967) identified three mechanisms that he thought were responsible for depression:
The cognitive triad (of negative automatic thinking
Negative self schemas
Errors in Logic (i.e. faulty information processing)
BACKGROUND INFORMATION – LEARNING PRINCIPLE
CBT & DEPRESSION
Individual distinctions in maladaptive thinking practice and the constant destructive appraisal of life events can lead to the growth of negative and dysfunctional cognitions.
Dr. Beck helped the patients in the correction of their negative thoughts through CBT.
Beck’s (1967) system of therapy is similar to Ellis’s, but has been most widely used in cases of depression. Cognitive therapists help clients to recognize the negative thoughts and errors in logic that cause them to be depressed.
The therapist also guides clients to question and challenge their dysfunctional thoughts, try out new interpretations, and ultimately apply alternative ways of thinking in their daily lives.
Aaron Beck believes that a person’s reaction to specific upsetting thoughts may contribute to abnormality. As we confront the many situations that arise in life, both comforting and upsetting thoughts come into our heads. Beck calls these unbidden cognition’s automatic thoughts.
When a person’s stream of automatic thoughts is very negative you would expect a person to become depressed (I’m never going to get this essay finished, my girlfriend fancies my best friend, I’m getting fat, I have no money, my parents hate me - have you ever felt like this?). Quite often these negative thoughts will persist even in the face of contrary evidence.
Beck (1967) identified three mechanisms that he thought were responsible for depression:
The cognitive triad (of negative automatic thinking
Negative self schemas
Errors in Logic (i.e. faulty information processing)
VIDEOS AND OTHER SOURCES
HOW CBT WORKS?
https://www.youtube.com/watch?v=ZdyOwZ4_RnI
CBT for Depression
https://www.youtube.com/watch?v=Usnlzh8Bneg
CBT Techniques
Depression can be treated through the use of medication, but the best method of treatment for depression is Psychotherapy*.
HYPOTHESIS
* Psychotherapy: A form of talk therapy which is used by psychiatrists, psychologist, or other mental health professionals.
CBT is the best-proven form of talk therapy, also called psychotherapy. It sometimes works as well as antidepressant drugs for some types of depression. Some research suggests that people who get CBT may be half as likely as those on medication alone to have depression again within a year.
Medication works well to treat depression. If you also get CBT, your treatment might work even better and the benefits might last longer. Most people who get CBT for depression or anxiety continue to keep using the skills they learned in therapy a year later.
If you are on medication for depression, never stop taking it without talking to your doctor first, even if you’re working with a CBT therapist. If you quit suddenly, it can cause severe depression and other problems.
LITERATURE REVIEW
Rationale - No new and contemporary meta-analysis has analyzed and studied the effects of cognitive-behavioral therapy (CBT) for depression in adults. This paper conducts such an updated meta-analysis
Methodology –numerous studies were recruited through systematic searches in bibliographical databases. The paper includes studies that analyze the effects of CBT, in comparison with control groups, and other psychotherapies..
Key findings - the study was unable to find any sign that CBT was more or less efficient than other forms of psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone.
Critique – the study shows that over 115 studies proved effectively that combined therapy is effective that alone medication.
“A Meta-Analysis of Cognitive-Behavioral Therapy for Adult Depression, Alone and in Comparison With Other Treatments”
The paper includes studies that analyze the effects of CBT, in comparison with control groups, and other psychotherapies
the study was unable to find any sign that CBT was more or less efficient than other forms of psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone.
115 studies proved effectively that combined therapy is effective that alone medication
Rationale – to study the effectiveness of CBT in the cure of anxiety and depression of COPD patients
Overview – Previous researches indicated an increased prevalence in untreated anxiety and depressions, especially in patients of chronic obstructive pulmonary disease.
Methodology – a random trial for CBT was compared to a enhanced standard care.
Key Findings –An improvement due to CBT in anxiety and depression symptoms were observed and no changes in the control group.
“A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD”
Previous researches indicated an increased prevalence in untreated anxiety and depressions, especially in patients of chronic obstructive pulmonary disease. The contemporary research also analyzed the effects of CBT in co-morbid groups, with clinically higher anxiety and depression in COPD patients.
a random trial for CBT (n=25) was compared to a enhanced standard care (n-26). Both participants were followed up at 2 and 8 months. The measures for the outcomes included Beck Anxiety inventory and Beck Depression Inventory –II.
An improvement due to CBT in anxiety and depression symptoms were observed with the effect size of 1.1-0.9. This was maintained at the 8 month follow up with an effect size of 1.4-0.9. No changes in the control group
Critique – the study design being controlled is helpful in making the study internally valid. Effectiveness CBT in alleviating the symptoms of depression more than what the medical treatment of the COPD patients did.
the study design being controlled is helpful in making the study internally valid. Furthermore, the relevance to my hypothesis, the study highlighted the success of CBT in alleviating the symptoms of depression more than what the medical treatment of the COPD patients did.
Rationale –reanalysis of novel and archival data to compare the time of remission for depression
Overview – the study compared the time of remission during a 12 week treatment period of Chronic depression with antidepressants, psychotherapy, and their combined treatment.
Methodology – Reanalysis of Novel and Archival data.
“Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone.”
the rationale behind the research was the reanalysis of novel and archival data to compare the time of remission for depression during a 12 week treatment following antidepressants.
the study compared the time of remission during a 12 week treatment period of Chronic depression with antidepressants (n=218), and psychotherapy (n=216), and their combined treatment (n=222). Cox regression survival analyses highlighted that the combined treatment’s outcome was more successful than both treatments alone.
Reanalysis of Novel and Archival data, use of Cox regression survival analyses to compare the compared and individual effectiveness of medication and psychotherapy.
Key Findings – Individuals getting the combined treatment were most likely to succeed.
Critique – the authors did not cater to the effectiveness of both therapies individually.
Individuals getting the combined The combined effect of medications and psychotherapy results in much faster remission
the authors did not cater to the effectiveness of both therapies individually, hence, hinting a bias about the combined effect of both. This study is relevant to my hypothesis since it proves that both medication as well as psychotherapy is effective in reducing depression
Rationale - Combining psychotherapy and medication may be an effective strategy.
Overview - Integrating psychotherapy and medicine could be a good idea. However, previous research has rarely demonstrated a demonstrable benefit to the combination.
Methodology - A total of 353 patients were assessed, with 193 being randomly assigned to one of four treatment groups. The patients received 12–16 weeks of treatment.
“Combination Treatment for Acute Depression Is Superior Only when Psychotherapy Is Added to Medication”
Despite the fact that there are various types of effective therapy for patients with severe depressive illness, many individuals do not benefit from treatment. Integrating psychotherapy and medicine could be a good idea. However, previous research has rarely demonstrated a demonstrable benefit to the combination. Where a benefit was discovered, a possible placebo effect of combining two methods of treatment could not be excluded out as the reason of the combination's superior impact..
A total of 353 patients were assessed, with 193 being randomly assigned to one of four treatment groups: nefazodone and furthermore clinical management, interpersonal psychotherapy (IPT), the mixture of the two, or IPT and pill-placebo. All of the individuals had severe depression and a Hamilton Rating Scale score of at least 14 on the 17-item scale (HAMD). The patients received 12–16 weeks of treatment. The HAMD was used as the major outcome measure, with the Montgomery-Asberg Depression Rating Scale (MADRS) serving as the supplementary outcome measure.
Key Findings - Only 138 of the 193 patients who were enrolled in the study completed it. All of the therapies were successful.
Critique/relevance to my hypothesis -The findings of this study suggest the use of medicine in conjunction with psychotherapy is successful rather than medication alone in the treatment of depressed outpatients.
Only 138 of the 193 patients who were enrolled in the study completed it. All of the therapies were successful. On the HAMD, no changes between treatments were identified using a random regression model. Yet, as contrasted to medicine alone, psychotherapy alone, and IPT with pill-placebo, the mixture of medication and psychotherapy was more successful in reducing depressed symptoms on the MADRS..
The findings of this study suggest the use of medicine in conjunction with psychotherapy is successful rather than medication alone in the treatment of depressed outpatients.
Rationale - Antidepressant drugs, psychotherapy, and their added effectiveness in the management of acute depression in adolescents are discussed.
Overview -Conducted a systematic review, researchers believe that a social-psycho-bio model can easily explain adolescent depression and its therapy
Methodology – review of secondary existing scholarship
Key Findings - Psychotherapy should be the primary treatment for depressed children and adolescents.
“Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment”
Conducted a systematic review, researchers believe that a social-psycho-bio model can easily explain adolescent depression and its therapy. We believe that this model offers a solution to the prevalent biopsychosocial paradigm, which highlights the importance of biological components. Furthermore, our study found that psychotherapy should be the first treatment option for depressed children and adolescents, and that there is scant evidence that combining psychotherapy and drug treatment is more successful than psychotherapy separately.
Psychotherapy should be the first line of treatment for depressed children and adolescents, and there is minimal evidence that combining psychotherapy with drugs is more beneficial than psychotherapy solo
Rationale – Effectiveness In treatment of depression and can be an alternative to antidepressants.
Overview – the efficiency of individual CBT in the treatment of acute depression
Methodology - Secondary data analysis
Key findings – CBT may produce change in cognition, helps in reducing depression symptoms
Critique – relevant to the hypothesis
“Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators and Mediators”
Cognitive behavior therapy (CBT) is efficacious in the acute treatment of depression and may provide a viable alternative to antidepressant medications (ADM) for even more severely depressed unipolar patients when implemented in a competent fashion. CBT also may be of use as an adjunct to medication treatment for bipolar patients, although the studies are few and not wholly consistent. CBT does appear to have an enduring effect that protects against subsequent relapse and recurrence following the end of active treatment, something that cannot be said for medications. Single studies that require replication suggest that patients who are married or unemployed or who have more antecedent life events may do better in CBT than in ADM, as might patients who are free from comorbid Axis II disorders, whereas patients with comorbid Axis II disorders appear to do better in ADM than in CBT. There also are indications that CBT may work through processes specified by theory to produce change in cognition that in turn mediate subsequent change in depression and freedom from relapse following treatment termination, although evidence in that regard is not yet conclusive.
Critique – The article does little to prove the relationship between the combined effect of medication and psychotherapy.
The article does little to prove the relationship between the combined effect of medication and psychotherapy however, it supports this research’s hypothesis by giving psychotherapy importance.
Rationale – to evaluate existing reviews of e-CBT for patient groups.
Overview – e-CBT packages are available and are helpful in the treatment of depression and anxiety.
Methodology – reanalysis of existing secondary data
Key Findings – 12 systematics reviews were yielded with appraised results.
Critique – dives into a new dimension for CBT and allows an easier access.
“Meta-review of the effectiveness of computerized CBT in treating depression”
Several computerised cognitive behaviour therapy (cCBT) packages are now available to treat mild to moderate depression with or without anxiety. These have been usually been reviewed alongside cCBT for a wide range of psychological problems. Here, we single out the results of these reviews for the most common mental disorder, mild to moderate depression. The aim of this paper is to evaluate the quality of existing reviews and to enable reliable comparisons of alternative computer packages for the same patient group.
A thorough search and analysis of reviews of efficacy of cCBT published between 1999 and February 2011
The search yielded twelve systematic reviews from ten studies covering depression. Their methodology is appraised and selected findings are presented here
The meta-review supports the efficacy of cCBT for treatment of depression; however there is limited information on different approaches, whose relative cost-effectiveness remains to be demonstrated. Suggestions are made for future studies in the field.
Rationale – to assess whether CBT has added benefits to medication
Overview – Analysis of adolescent depression through the help of combine CBT and medication treatment and its effectiveness
Methodology – meta analysis of controlled trials
Key Findings – short term benefits of combined treatments were found.
“Combined treatment with cognitive–behavioural therapy in adolescent depression: meta-analysis”
To address the question of whether CBT confers additional benefit to antidepressant treatment in adolescents with unipolar depression for depressive symptoms, suicidality, impairment and global improvement.
Meta-analysis of randomised controlled trials (RCTs) of newer-generation antidepressants and CBT in adolescent depression.
There was no evidence of a statistically significant benefit of combined treatment over antidepressants for depressive symptoms, suicidality and global improvement after acute treatment or at follow-up. There was a statistically significant advantage of combined treatment for impairment in the short-term (at 12 weeks) only. There was some evidence of heterogeneity between studies.
DISCUSSION
SUMMARY
Studies highlighted the importance of psychotherapy in reducing the symptoms of depression.
Individuals who have medications in combination with CBT have shown low levels of relapse than otherwise.
Scientific study shows that collective therapy is more in effect than psychotherapy and medications alone in the reduction of depression.
Psychotherapy -- or "talk therapy" -- is an effective treatment for clinical depression. On its own, it may not be enough to treat severe depression. But it can play an important role when used with other treatments, including medications.
It's used to help the person find ways to deal with everyday stressors. It can also encourage you to use your medications properly.
Many studies support the idea that therapy can be a powerful treatment for depression. Some have also found that combining depression medicine with therapy can be very effective. A large-scale trial involving more than 400 people with treatment-resistant depression found that talk therapy alongside medication improved symptoms.
RECOMMENDATIONS
This research indicates the importance of Psychotherapy.
The research further implies that psychotherapy is an effective tool in regression of depression.
This research indicates the importance of Psychotherapy, more specifically Cognitive Behavioral Therapy in reducing the effects of depression in individuals.
The research further implies that psychotherapy is an effective tool in regression of depression, however, the effects of psychotherapy combined with medication yields the most effective results.
This research is relevant to individuals of all institutions including family, government agencies, educational institutions, physical and mental health institutions since depression is the most common form of mental health disorder that affects all
This research can help these institutions in devising relevant therapy programs that can help in alleviating the prevalence of mental health disorders.
RECOMMENDATIONS
This research is relevant to individuals of all institutions
This research can help these institutions in devising relevant therapy programs that can help in alleviating the prevalence of mental health disorders.
This research indicates the importance of Psychotherapy, more specifically Cognitive Behavioral Therapy in reducing the effects of depression in individuals.
The research further implies that psychotherapy is an effective tool in regression of depression, however, the effects of psychotherapy combined with medication yields the most effective results.
This research is relevant to individuals of all institutions including family, government agencies, educational institutions, physical and mental health institutions since depression is the most common form of mental health disorder that affects all
This research can help these institutions in devising relevant therapy programs that can help in alleviating the prevalence of mental health disorders.
FUTURE RESEARCH
There is a need for future research to study more about the effectiveness and inefficiency of psychotherapy and CBT
Most of the scholarship indicated the positive effects of the combined treatment, therefore future research should look more into the individual effectiveness of CBT.
Future research should also look for the sole success of psychotherapy for the treatment of depression without the need for medication.
There is a need for future research to study more about the effectiveness and inefficiency of psychotherapy and CBT
Most of the scholarship indicated the positive effects of the combined treatment, therefore future research should look more into the individual effectiveness of CBT.
Future research should also look for the sole success of psychotherapy for the treatment of depression without the need for medication
Although clearly efficacious, there is still room for improvement, because a substantial number of patients still remain symptomatic even after a full course of CBT. Also, except for children and elderly populations, few (if any) meta-analytic studies of CBT have reported on specific subgroups, such as ethnic minorities and low income samples. Thus, although CBT can still be improved and expanded, it clearly paves the way for the future given its remarkable success.
CONCLUSION
Major depressive disorders account for 8.2% of Global Years lived with disability, and a second leading cause of years lived with disability
Fund the burden of developing several other mental health disorders indirectly including suicide
13% rise in mental health disorders, and depression is accounted as the most common psychiatric disorder
Depression can be treated through the use of medication, but the best method of treatment for depression is Psychotherapy.
The thesis statement is partly substantiated since, psychotherapy is an effective tool in regression of depression
However, the research more importantly highlighted that psychotherapy in combination with medication helps to more effective
In sum, keeping in view the literature, it can be concluded that psychotherapy and medication combined treatment proves to be a much more effective treatment for depression
REFERENCES
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments. The Canadian Journal of Psychiatry, 58(7), 376–385. https://doi.org/10.1177/070674371305800702
Hynninen, M. J., Bjerke, N., Pallesen, S., Bakke, P. S., & Nordhus, I. H. (2010). A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD. Respiratory Medicine, 104(7), 986–994. https://doi.org/10.1016/j.rmed.2010.02.020
Blom, M. B. J., Jonker, K., Dusseldorp, E., Spinhoven, P., Hoencamp, E., Haffmans, J., & Dyck, R. van. (2007). Combination Treatment for Acute Depression Is Superior Only when Psychotherapy Is Added to Medication. Psychotherapy and Psychosomatics, 76(5), 289–297. https://doi.org/10.1159/000104705
Manber, R., Kraemer, H., Arnow, B., Trivedi, M., Rush, A., Thase, M., Rothbaum, B., Klein, D., Kocsis, J., Gelenberg, A., & Keller, M. (2008). Faster Remission of Chronic Depression With Combined Psychotherapy and Medication Than With Each Therapy Alone. Journal of Consulting and Clinical Psychology, 76, 459–467. https://doi.org/10.1037/0022-006X.76.3.459
REFERENCES
Sommers-Flanagan, J., & Campbell, D. G. (2009). Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment. Journal of Contemporary Psychotherapy, 39(2), 111–120. https://doi.org/10.1007/s10879-008-9106-0
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments. The Canadian Journal of Psychiatry, 58(7), 376–385. https://doi.org/10.1177/070674371305800702
Driessen, E., & Hollon, S. D. (2010). Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators and Mediators. The Psychiatric Clinics of North America, 33(3), 537. https://doi.org/10.1016/j.psc.2010.04.005
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