1. C OGNITIVE B EHAVIOURAL T HERAPY

2. Psychoeducation from RCT, educational materials play a significant role in improvement in depression Robinson, Katon, Von Korff et al., 1997

3. Cognitive Behaviour Therapy Dispute about unique effect Murphy, Carney et al., 1995 May reduce relapse Fava, Grandi, Zielezny et al., 1996 Therapist competency is vital Scott, Tacchi, Jones & Scott, 1997 Meta-analysis suggests effect size post- treatment Reinecke, Ryan & DuBois, 1998

4. CBT Assumptions Cognitive activity affects behaviour Cognitive contents & processes can be monitored & changed Behavioural (& emotional) change may be affected through cognitive change Dobson and Dozois, 2001

5. Other assumptions Processing of information is active & adaptive Individuals derive meaning from their experiences using information processing Belief systems are idiosyncratic New information is assimilated into existing belief systems

6. Automatic Thoughts (Beck) Specific, discrete essential words Shorthand distilled format Not a result of deliberation, reasoning, or reflection - Just happen Not sequential as in goal directed thinking or problem solving Autonomous – person does not need to make any effort to generate & may have difficulty switching off

7. Core Beliefs Learned through childhood experiences 2 broad categories – helplessness and unlovability Core dysfunctional beliefs latent during low stress periods Reactivated by negative experiences that resemble conditions under which original beliefs were formed

8. Cognitive Distortions Overgeneralisation Dichotomous thinking Magnification Personalisation Disqualifying positives Jumping to conclusions Catastrophising Emotional Reasoning Shoulds & Oughts Labels

9. Cognitive Triad Negative view of self, the world, and the future central to maintenance of depression Beck (1983) subsequently proposed that individuals are particularly likely to experience depression if there is a congruence between negative life events & depressogenic schemata

10. Research High levels of depressive symptomatology in children with pessimistic attributional styles and presence of internal, stable, global negative style: suggest causal role of attributional style in development of depression increase risks of depression in adolescence predict future increases in depressive symptoms among adolescents irrespective of negative life events Spence et al., 2002

11. Research 40% of adolescents who responded to CBT relapsed within 6 months Significant number of adolescents discontinue treatment prematurely, do not comply or remain depressed at end of intervention (approx 33%) Younger children seem to better Need to investigate involvement of family Spence & Reinecke, 2004

12. Major CBT strategies Behavioural activation: Getting the person to do something –Monitoring activities, pleasure, mastery –Scheduling activities –Graded task assignment Cognitive activities –Distraction techniques –Time set aside for thinking

13. Major CBT strategies C-B strategies –Identifying negative thoughts –Questioning negative thoughts –Behavioural experiments Preventative strategies –Identifying assumptions –Challenging assumptions –Use of set-backs –Preparing for future

14. Initial Interview Assessment of current difficulties Symptoms Life problems, e.g., interpersonal, medical, practical Associated negative thoughts Onset/development/context of depression Hopelessness/suicidal thoughts/lack of energy Agreed problem list

15. Initial Interview Goal definition – may change later but helps correct unrealistic expectations, provides a standard to monitor progress, focuses attention on future. Presentation/acceptance of treatment rationale Practical details – what is involved, homework, between session tasks, frequency

16. Initial Interview Introduction to basic relationship between negative thoughts & depression Possibility of change Beginning intervention Specific: »Select first target »Agree appropriate homework, monitoring/reading General: »Give Client experience of CBT style (focus on specific issues, active collaboration, homework) Overall aims: »Establish rapport »Elicit hope »Give pt preliminary understanding of model »Get working agreement to test it in practice

17. Subsequent sessions Set agenda Weekly items Review events from last session Feedback from client on last session Homework review (emphasises self-help, independent functioning) Outcome? Difficulties? What has been learned?

18. Subsequent sessions Major topic for session Specific strategies (e.g., relaxation, learning evaluate automatic thoughts Specific problems (e.g., difficulties that have arisen during week) Long term problems List in order of priority

19. Subsequent sessions Homework assignments Task Should follow logically from session content Needs to be clearly defined Rationale explicit e.g., to test the idea that I cant do anything, a no lose situation will learn something regardless Predicted difficulties Feedback from client Understanding ( summarise main points Reactions to session