1. Beck Cognitive Behavioural Therapy Developed by Beck Aim – Teach ‘clients’ to rethink and challenge their negative perceptions/cognitions

2. Beck Cognitive Behavioural Therapy Beck’s Cognitive Therapy Stage 1 Therapist & client agree on nature of problem & goals for therapy Client engages in behaviour between sessions in an attempt to challenge these negative thoughts Stage 2 Therapist challenges the client’s negative thoughts Aim is for client to realise thoughts are irrational. Homework = diary kept

3. Cognitive Behavioural Therapy Most common features of CBT are: 1.Client monitors their negative, automatic thoughts (cognitions) 2. Client recognises the connection between cognitions, affect (mood) and behaviour 3. Client examines evidence for and against their distorted thoughts 4. Client learns to substitute biased cognitions for more realistic ones 5.Client learns to identify & alter their beliefs that predispose them to distort their experiences

4. Cognitive Behavioural Therapy Further developed to include challenging behaviour too Usually a series of 20 sessions over 16 weeks Homework set Thought-catching

5. Cognitive Behavioural Therapy 4 basic assumptions of CBT Kendall Hammen Response to life is based on interpretations of self & world rather than what the actual case is Thoughts, behaviour & feelings are interrelated & influence each other – none are more important than the others Must clarify & change the way they think about themselves & world around them Need to change cognitions AND behaviour

6. Cognitive Behavioural Therapy Effectiveness Compared depressed patients receiving a range of therapies 60 pts randomly allocated Beck’s CT IPT Tricyclics Placebo - no treatment Improvement IPT = 55% Drugs = 57% CT = 51% Placebo = 29% Drug = fastest to reduce symptoms Placebo = better for mildly dep than severely IPT = best for social functioning CT = best for dysfunctional attitudes Elkin et al (1989) All treatments – 16 wks Assessed before, during, at end & follow ups Assessed: Symptoms of dep Overall symptoms & life functionin 18 mths later = only 20-30% dep free IPT = most satisfied with treatment IPT & CT = able to recognise sources of dep & better social rels LT = psychological better Relapse higher for drugs than CT (47% - 31%)

7. Cognitive Behavioural Therapy de Similar to Elkin 58% showed elimination of symptoms if CT or drug treatment deRubeis et al (2005) Follow on 12 mths later by Hollon (2005) found difference in relapse rates: 31% for CT 47% for drug treatment 76% if no real treatment given So CT has longer lasting effect & targets underlying problem not just masking symptoms. Drug treatment is purely a palliative treatment Effectiveness

8. Cognitive Behavioural Therapy Effectiveness Rush (1977) – CBT at least as effective as drugs Blackburn & Moorhead (2000) CBT superior to drugs in particular 1 year + Kupfer & Frank (2001) Most effective treatment is A combi of CBT & anti-depressants

9. Cognitive Behavioural Therapy Appropriateness Appropriate to use with depression as many symptoms are faulty cognitions Gives the patient some control over disorder & the power to change Allows opportunity to use strategies in range of situations No real side effects or withdrawal symptoms Deals with root cause not just symptoms Successful & long lasting for many

10. Cognitive Behavioural Therapy Appropriateness Difficult to know how well a client will respond to CBT – Simons not suitable for people with rigid attitudes Not a quick fix – can take months to see improvement unlike drugs Does not focus on why negative beliefs held – may actually be based on realistic concerns As relpase may be that negative beliefs etc are suppressed rather than eliminated Expensive & time consuming People do still relapse

11. Cognitive Behavioural Therapy Take notes from textbook on p 185 to expand evaluation & studies