1) ‘What are the important aspects of cognitive behaviour therapy (CBT) in the

treatment of depression?’

Clinical depression is a mood disorder generally characterised by consistent low mood,

feelings of hopelessness, irritability, sleep disruption, memory issues, problems
concentrating, and apathy, among a wide array of other differing symptoms. Depressive
patients often find themselves unable to continue their day-to-day activities due to the
aforementioned apathy and hopelessness, although many patients maintain some
significant degree of functioning despite the cognitive deficits the condition leaves them
with. According to the American Psychological Association, depression is reported to have a
lifetime prevalence of between 17%, with women anywhere between 1.5 and three times as
likely to be diagnosed. This is a point that has recently been drawn into debate, as
juxtaposed with the higher rate of male suicide, it is believed the condition may be just as, if
not more, prevalent in males, though they are much less likely to seek treatment. One of
the most prominent psychological models of depression is Beck’s 1976 cognitive model. This
consists of three main aspects – the negative triad, cognitive distortions, and core irrational
beliefs. The cognitive triad refers to a cyclical, self-fulfilling trio of negative thoughts –
negative thoughts about the self, the world, and the future. Cognitive distortions refer to
faulty processing of information, jumping to conclusions and negative perception – if you
will, finding the sum of two and two to be far more than four. Core irrational beliefs refer to
reinforced, instilled ideas that certain qualities are conditional, such as ‘I am only a good
person if I’m happy or successful.’

There are many potential methods in treating depression, as both therapeutic and
psychopharmacological interventions have been proven to be effective, and combinations of
the two proven to be more so. In terms of the former, cognitive behaviour therapy (CBT) is
seen as the foremost therapeutic intervention for the treatment of depression. CBT is a
hybrid therapy, blending techniques and strategies from the two schools of therapies that
act as its spiritual progenitors – behavioural therapies and cognitive therapies. This gives
CBT effectively the ‘best of both worlds’, as it allows leniency for the idea that there are
some behaviours than are outside of the control of rational thought, but also pushes the
idea that if rational thought can be controlled, so can the behaviours that those thoughts
can lead to.

CBT is often described as ‘problem focused, action oriented’, as it centres around specific
problems that the patient suffers from. The therapist will often set extremely specific goals
with a tangible end-goal. In the case of a depressive patient, the therapist may decide a
tangible goal is returning to work or study after a particularly severe depressive episode.
This allows the therapist to select specific strategies to direct the patient towards those
goals, thus decreasing the negative effects of depression on the patient’s life. The patient is
also expected to actively participate in their own therapy – they are often given ‘homework’
by their therapist, where they are required to actively do things in the intervening time
between sessions. This could be keeping a mood diary- this enables the therapist to notice
moments where the cognitive triad is reflected in writing. That would then be used as a
centre point for picking apart those negative thoughts about the self, world, and future.
CBT is also rigorously structured, as opposed to alternative, more freeform therapies. The
patient may give an example of a particularly problematic behaviour they have exhibited in
the last week. The therapist will then use this as a fulcrum of the rest of the session, using
said behaviour as a comparison or an example, which allows the patient a more informed
view of situations in which they can use their newly learned strategies. For example, the
patient may say something like ‘everybody hates me’, which the therapist will recognise as a
clear example of overgeneralisation, a form of cognitive distortion. The therapist could then
decide to use a cognitive restructuring technique to help the patient realise their faulty
thinking. The majority of a therapy session may resemble a tutoring session. This is because
the very nature of CBT allows the therapist to teach the patient how to deal with their
problematic thoughts and behaviours. This structural rigor may be beneficial in combatting
the apathy frequently found in sufferers of depression, as the progression of therapy is not
overly reliant on self-motivation on the part of the patient – they can be ‘guided along’ by
the therapist.
Another notable feature of cognitive behaviour therapy is its transparency. This differs to
other therapies, such as psychodynamic therapies, in that CBT assumes that the patient can
and should know everything about their ongoing treatment. When one considers that
depression can, at times, seem an incredibly irrational condition, it does indeed make sense
that a patient can benefit from understanding the logical, rational reasoning behind certain
strategies. Imparting a certain self-reflective quality on depressive patients is beneficial, as it
helps patients take a step back and recognise irrationality in their ways of thinking or
behaving. Taking the previous example of the patient believing ‘everybody hates me’, the
transparency of CBT enables the patient to effectively catch themselves out thinking in this
inaccurate, sensationalist way, and thus employ a strategy they have learned to nip the
behaviour in the bud, preventing a further spiral into depressive thoughts and tendencies
predicted in the idea of cognitive distortions.
Finally, CBT is a notably flexible therapy, applicable in a wide range of scenarios, intensities
and timescales. It can be conducted on an individual or in groups, less frequent drop-in
sessions and more intense, consistent outpatient style rehabilitations. Of course, depression
can be a complex disorder, and learning strategies to combat irrational core beliefs can take
a large amount of time due to the way that they are engrained in a patient’s psyche. As a
result, this flexibility is beneficial in the way that it allows for longer, more intense courses
of therapy to more fully work out the issues one would face when experiencing irrational
core beliefs.