Cognitive-Behavioral Therapy October 9, 2007

CBT view of depression Depression is related to the way individuals perceive and think about events in their environment Contribute to a negative view of the self, the world, and the future Feelings of self-blame, failure, and hopelessness Impact mood and other behaviors People with depression have cognitive distortions in their views of themselves, the world, and the future

EVENT THOUGHTFEELINGBEHAVIOR

Treatment of Depressive Disorders Psychosocial Interventions  Cognitive therapy Identify, challenge, and modify negative thought processes Misattributions Negative self-monitoring Short-term focus Excessively high performance standards Failure to self-reinforce

Cognitive Distortions All-or-nothing thinking Overgeneralization Mental filter Disqualifying the positive

Cognitive Distortions Jumping to conclusions  Mind reading  The Fortune Teller error

Cognitive Distortions Magnification or minimization Emotional reasoning “Should” statements

Cognitive Distortions Labeling/mislabeling Personalization

Learned Helplessness and Depression Seligman (Seligman, 1974; 1975; 1978) Depression is described in terms of learned helplessness Depression develops in individuals who perceive themselves as having little or no control over rewards and punishments in their environment

Learned Helplessness Depression results from the individual's propensity to view negative events in their life as due to:  their own characteristics (internal attributions) “it’s all my fault, I’m just not good with people, that’s just who I am”  factors that are unlikely to change (attributions of stability) “I keep getting fired because I’m dumb, so why bother trying to get another job”  factors that are likely to have an influence on the individual across situations (global attributions)

Behavioral Views Ferster (1974) and Lewinsohn (1974):  Depression may result from a lack of sufficient positive reinforcement in the environment Lack of reinforcement can be caused by:  change in residence  failure to display appropriate social skills  Etc.

Treatment of Depressive Disorders Psychosocial Interventions, cont.  Behavior therapy focuses on increasing pleasurable activities and events, and providing the youngster with the skills necessary to obtain more reinforcement

SundayMonday 9-10ChurchLaundry 10-11ChurchStudy for test/Laundry 11-12LunchHistory class 12-1Go to moviesLunch 1-2MoviesStudy with friend 2-3Study for testBus to school 3-4Study for testTake test 4-5SwimmingBus home 5-6Dinner 6-7Study for testWatch TV 7-8TV/readingGo out with friends 8-9TV/readingOut with friends

Components of CBT  Integration of cognitive and behavioral therapies, and has shown the most success in treating depression in young people Cognitive restructuring Activity Planning Problem-solving training Relaxation training  Autogenics  Deep Breathing  Progressive Muscle Relaxation (PMR)  Homework assignments

Cognitive Behavior Therapy CBT is designed to change both negative thoughts (cognitions) and behaviors Depressed children/adolescent learn about the nature of depression and how their mood is linked to both their thoughts and actions The focus is on developing better communication, problem-solving, anger-management, relaxation, and social skills CBT (individual or group), is the most well-studied treatment for children and adolescents with depression High relapse rates suggest the need for ongoing treatment