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C OGNITIVE B EHAVIOURAL T HERAPY. Psychoeducation. from RCT, educational materials play a significant role in improvement in depression Robinson, Katon, Von Korff et al., 1997. Cognitive Behaviour Therapy. Dispute about unique effect Murphy, Carney et al., 1995 May reduce relapse

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  • from RCT, educational materials play a significant role in improvement in depression

Robinson, Katon, Von Korff et al., 1997

cognitive behaviour therapy
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

cbt assumptions
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

other assumptions
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
automatic thoughts beck
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”
core beliefs
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
cognitive distortions
Cognitive Distortions
  • Overgeneralisation
  • Dichotomous thinking
  • Magnification
  • Personalisation
  • Disqualifying positives
  • Jumping to conclusions
  • Catastrophising
  • Emotional Reasoning
  • Shoulds & Oughts
  • Labels
cognitive triad
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

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

  • 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

major cbt strategies
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
major cbt strategies13
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
initial interview
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
initial interview15
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
initial interview16
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
subsequent sessions
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?
subsequent sessions18
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
subsequent sessions19
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 can’t do anything, a no lose situation will learn something regardless
    • Predicted difficulties
  • Feedback from client
    • Understanding ( summarise main points
    • Reactions to session