Cognitive Behavioral Therapy for Depression
No Results
No Results
processing….
Cognitive-behavioral therapy (CBT) is a term that encompasses numerous specific treatment approaches for various psychiatric disorders. As the name suggests, cognitive-behavioral treatments incorporate both cognitive and behavioral strategies. With regard to depression, CBT refers to the use of both cognitive restructuring and the behavioral strategy of activity scheduling or behavioral activation.
Cognitive-behavioral approaches to the treatment of depression stem from early behavioral treatments that emerged in the 1960s and 1970s. Among the most prominent was Lewinsohn et al’s behavioral treatment for depression. [1] Lewinsohn proposed that depression resulted from deficient response contingent positive reinforcement, which he reported was a function of the following 3 factors: [2]
Individual differences in what is experienced as reinforcing
The availability in the individual’s environment of potentially reinforcing events
The skill level needed to obtain reinforcement
For example, if someone found conversing with others to be reinforcing, had other individuals available with whom to converse, and possessed the social skills needed to engage one of those individuals in conversation, then he or she could experience positive reinforcement. Lewinsohn’s treatment, therefore, aimed to increase depressed individuals’ ability to obtain response-contingent positive reinforcement and therefore improve their mood; he did this by having them identify and engage in events they described as having been, or potentially being, pleasurable and addressing skills deficits that may preclude them from obtaining the desired reinforcement from identified pleasant events. Numerous depression treatments that included activity scheduling emerged during the 1970s and 1980s. [3, 4, 1, 5, 6]
Although early versions of activity scheduling primarily focused on increasing mood-related pleasant events, Beck incorporated a form of activity scheduling into his cognitive therapy for depression, aimed at increasing both pleasant events and providing a sense of accomplishment or mastery (eg, working on a resume, completing a school assignment). [7] Following a component analysis of cognitive therapy that found this activity scheduling component to be as effective as the full treatment package, [8] interest in behavioral treatments for depression increased, leading to modern approaches called behavioral activation (BA) treatments.
Modern BA approaches are based on the same principles as early versions of activity scheduling but incorporate more sophisticated strategies for identifying activity assignments and addressing barriers to their completion. [9, 10] Several meta-analyses have examined studies of activity scheduling and BA approaches over the past several decades and have provided substantial empirical support for these approaches. [11, 12, 13]
During the 1970s, cognitive treatments for depression began to gain in popularity and empirical support, with the most well-known being Beck et al’s cognitive therapy for depression. [7] Cognitive therapy is based on the fundamental assumptions that (1) cognitive activity affects behavior, (2) cognitive activity can be monitored and changed, and (3) cognitive changes can lead to desired behavioral changes. [14] Cognitive therapy emphasizes the need to change cognitions in order to achieve improvements in mood and behavior. As mentioned above, Beck’s cognitive therapy for depression includes activity scheduling treatment strategies adapted from earlier behavioral interventions but also includes cognitive strategies such as cognitive restructuring that were designed to directly challenge and change maladaptive thoughts.
Although behavioral approaches typically do not include any direct attempts to change cognitions (but attempt to indirectly do so through changes in behavior), cognitive therapy does directly attempt to change behavior but does so for the ultimate goal of changing cognitions in order to reduce depressive symptoms. Therefore, at times, such approaches may be called either cognitive therapy or CBT, with both incorporating behavioral and cognitive interventions.
Within the CBT model, individuals with depression are viewed as exhibiting the “cognitive triad” of depression, which includes a negative view of themselves, a negative view of their environment, and a negative view of their future. [15] Related to the cognitive triad, depressed patients are believed to exhibit numerous cognitive distortions that maintain these negative beliefs. [7] Examples of these distortions include all-or-nothing thinking (ie, viewing things in black and white categories), overgeneralization (ie, assuming one negative event constitutes a pattern of never-ending negative events), and fortune telling (ie, making negative predictions about the future that are often inaccurate or negatively biased). [16] Within Beck’s model, negative automatic thoughts and distortions in thinking are hypothesized as stemming from problematic schemas, which are cognitive structures that influence how information is interpreted and recalled. [17, 7] Schemas are often targeted in the later phases of treatment, whereas behavioral strategies and efforts to elicit and test automatic thoughts are implemented earlier in treatment. [15] Elaboration of specific treatment strategies is presented below.
Because CBT for depression is a broad category that includes numerous treatment strategies, different aspects of treatment may be emphasized to a greater or lesser extent in practice. In general, however, CBT for depression includes specific behavioral strategies (ie, activity scheduling) as well as cognitive restructuring aimed at changing negative automatic thoughts.
CBT for depression has been examined in numerous clinical trials and has received empirical support across various settings and populations. [18, 19, 20, 21]
Beck’s cognitive therapy for depression has been listed as a well-established treatment by the American Psychological Association’s Task Force on Promotion and Dissemination of Psychological Procedures since its inception in 1993. Several meta-analyses have demonstrated the effectiveness of CBT for depression. [22, 23, 24, 25]
Individual and group-based CBT is recognized in the most recent American Psychiatric Association Guidelines for The Treatment of Major Depressive Disorder as an effective and evidence based treatment for depression. [26] When used, it should be integrated into the overall care that the patient is receiving (ie, communication is needed between the treating therapist and the prescribing psychiatrist or primary care physician).
The use of CBT for a particular patient is often based on patient preference, severity of depression, and ability of the patient to gain access to the treatment. The use of CBT as a stand-alone treatment is recommended for patients with mild-to-moderate major depressive disorder and should also be considered for women who are pregnant, wish to become pregnant, or are actively breast-feeding. It should also be made available for patients that express a preference to use CBT.
A combination of antidepressant medication and psychotherapy such as CBT is recommended for individuals with moderate-to-severe major depressive disorder or for teens with major depressive disorder [27] in order to reduce the risk of relapse. [26, 28] According to the American Psychiatric Association guidelines, CBT combined with pharmacotherapy is also considered first-line treatment in patients with more severe, chronic, or complex presentations of depression. [26]
CBT has been used clinically in almost every imaginable patient population. No evidence-based exclusion criteria for the use of CBT for depression has been established. Many studies of CBT typically exclude individuals with specific characteristics due to beliefs that these characteristics could lead to less improvement in symptoms over the course of treatment. Typical exclusion criteria include an alcohol or other substance disorder, a psychotic disorder, organic brain syndrome, and mental retardation, with many studies also specifying that participants have major depressive disorder in the absence of suicide risk. More research on this issue is needed; many believe that individuals with these characteristics may still benefit from CBT for depression.
The support of family members and friends can assist with treatment by helping remind and encourage patients to complete important aspects of treatment such as attending therapy sessions, taking psychiatric medications (if prescribed), and completing therapy assignments. They may also be active participants in some of the activity scheduling assignments. Further, family members may be asked to attend therapy sessions in order to gain information about depression and CBT and to learn specific ways in which they can support or assist the patient.
Lewinsohn PM, BiglanT, Zeiss, A. Behavioral treatment of depression. P. Davidson (Ed.). Behavioral management of anxiety, depression, and pain. New York: Brunner/Mazel; 1976.
Lewinsohn, PM. A behavioral approach to depression. RJ Friedman and MM Katz (Eds). The Psychology of Depression: Contemporary Theory and Research. New York: Wiley; 1974. 157-185.
Gallagher D, Thompson, LW. Depression in the elderly. Los Angeles. A behavioral treatment manual. University of Southern California Press; 1981.
Lewinsohn PM, Weinstein MS, Alper T. A behavioral approach to the group treatment of depressed persons: a methodological contribution. J Clin Psychol. 1970 Oct. 26(4):525-32. [Medline].
McLean, PD. Decision-making in the behavioral management of depression. P O Davidson (Ed). Behavioral management of anxiety, depression, and pain. New York: Brunner/Mazel; 1976.
Zeiss AM, Lewinsohn PM, Munoz RF. Nonspecific improvement effects in depression using interpersonal skills training, pleasant activity schedules, or cognitive training. J Consult Clin Psychol. 1979 Jun. 47(3):427-39. [Medline].
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. New York: Guilford Press; 1979.
Jacobson NS, Dobson KS, Truax PA, Addis ME, Koerner K, Gollan JK. A component analysis of cognitive-behavioral treatment for depression. J Consult Clin Psychol. 1996 Apr. 64(2):295-304. [Medline].
Martell CR, Addis, ME, Jacobson NS. Depression in Context: Strategies for Guided Action. New York: Norton; 2001.
Lejuez CW, Hopko DR, Hopko SD. A brief behavioral activation treatment for depression. Treatment manual. Behav Modif. 2001 Apr. 25(2):255-86. [Medline].
Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev. 2007 Apr. 27(3):318-26. [Medline].
Ekers D, Richards D, Gilbody S. A meta-analysis of randomized trials of behavioural treatment of depression. Psychol Med. 2008 May. 38(5):611-23. [Medline].
Mazzucchelli T, Kane R, Rees, C. Behavioral activation treatments for adults: A meta-analysis and review. Clinical Psychology: Science & Practice, 5. 2009. 291-313.
Dobson KS, Dozois, DJS. Historical and philosophical bases of the cognitive-behavioral therapies. K Dobson. Handbook of Cognitive-Behavioral Therapies. Third Edition. New York: Guilford Press; 2009.
Young JE, Weinberger AD, Beck, AT. Cognitive therapy for depression. D H Barlow (Ed.). Clinical handbook of psychological disorders: A step-by-step treatment manual, third edition. New York: Guilford Press; 2001. 264-308.
Kuyken, W Beck, AT. Cognitive therapy. C. Freeman and M. Power (Eds.). Handbook of evidence-based psychotherapies: A guide for research and practice. Chichester: Wiley; 2007. 15-39.
Beck AT, Freeman A. Associates Cognitive therapy of personality disorders. New York: Guilford Press; 1990.
Clark DA, Beck, AT, Alford, BA. Scientific foundations of cognitive theory and therapy of depression. New York: Wiley; 1999.
DeRubeis RJ, Crits-Christoph P. Empirically supported individual and group psychological treatments for adult mental disorders. J Consult Clin Psychol. 1998 Feb. 66(1):37-52. [Medline].
Dobson KS. A meta-analysis of the efficacy of cognitive therapy for depression. J Consult Clin Psychol. 1989 Jun. 57(3):414-9. [Medline].
Robinson LA, Berman JS, Neimeyer RA. Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research. Psychol Bull. 1990 Jul. 108(1):30-49. [Medline].
Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006 Jan. 26(1):17-31. [Medline].
Gloaguen V, Cottraux J, Cucherat M, Blackburn IM. A meta-analysis of the effects of cognitive therapy in depressed patients. J Affect Disord. 1998 Apr. 49(1):59-72. [Medline].
Murphy GE, Simons AD, Wetzel RD, Lustman PJ. Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression. Arch Gen Psychiatry. 1984 Jan. 41(1):33-41. [Medline].
Biesheuvel-Leliefeld KE, Kok GD, Bockting CL, Cuijpers P, Hollon SD, van Marwijk HW, et al. Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and meta-regression. J Affect Disord. 2015 Mar 15. 174:400-10. [Medline].
American Psychiatric Association. Treatment of patients with major depressive disorder. American Psychiatric Association Practice Guidelines. 3rd ed. 2010.
Alloy LB, Hamilton JL, Hamlat EJ, Abramson LY. Pubertal Development, Emotion Regulatory Styles, and the Emergence of Sex Differences in Internalizing Disorders and Symptoms in Adolescence. Clin Psychol Sci. 2016 Sep. 4 (5):867-881. [Medline].
March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004 Aug 18. 292(7):807-20. [Medline].
Dobson KS, Hamilton KE. Cognitive restructuring: Behavioral tests of negative cognitions. W O’Donohue JE, Fisher, SC Hayes. Cognitive behavior therapy: Applying empirically supported techniques in your practice. Hoboken. NJ: John Wiley & Sons, Inc; 2003. 84-88.
Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010 Oct 13. 5(10):e13196. [Medline]. [Full Text].
Pittaway S, Cupitt C, Palmer D, et al. Comparative, clinical feasibility study of three tools for delivery of cognitive behavioural therapy for mild to moderate depression and anxiety provided on a self-help basis. Ment Health Fam Med. 2009 Sep. 6(3):145-54. [Medline]. [Full Text].
Carlbring, P., Hagglund, M., Luthstrom, A., et al. Internet-based behavioral activation and acceptance-based treatment for depression: A randomized controlled trial. Journal of Affective Disorders. 2013. 148:331-337.
Vernmark, K., Lenndin, J., Bjarehed, J., et al. Internet administered guided self-help versus individualized e-mail therapy. Behaviour Research and Therapy. 2010. 48:368-376.
Andersson, G., Bergstrom, J., Hollandare, F., et al. Internet-based self-help for depression: A randomised controlled trial. British Journal of Psychiatry. 2005. 187:456-461.
Andersson, G., Hesser, H., Hummerdal, D., et al. A 3.5-year follow-up of Internet-delivered cognitive behavoiur therapy for major depression. Journal of Mental Health. 2013. 22:155-164.
Andersson, G., Carlbring, P., Ljotsson, B., et al. Guided Internet-based CBT for common mental disorders. Journal of Contemporary Psychotherapy. 2013. 43:223-233.
Keller MB, McCullough JP, Klein DN, Arnow B, Dunner DL, Gelenberg AJ. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000 May 18. 342(20):1462-70. [Medline].
de Maat S, Dekker J, Schoevers R, et al. Short psychodynamic supportive psychotherapy, antidepressants, and their combination in the treatment of major depression: a mega-analysis based on three randomized clinical trials. Depress Anxiety. 2008. 25(7):565-74. [Medline].
Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined pharmacotherapy and psychological treatment for depression: a systematic review. Arch Gen Psychiatry. 2004 Jul. 61(7):714-9. [Medline].
Thase ME, Greenhouse JB, Frank E, et al. Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations. Arch Gen Psychiatry. 1997 Nov. 54(11):1009-15. [Medline].
Hollon SD, Jarrett RB, Nierenberg AA, Thase ME, Trivedi M, Rush AJ. Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment?. J Clin Psychiatry. 2005 Apr. 66(4):455-68. [Medline].
Haynes RB, Yao X, Degani A, et al. Interventions to enhance medication adherence. Cochrane Database Syst Rev. 2005. (4):CD000011. [Medline].
Kanter JW, Bowe, WM, Baruch, DE, Busch, et al. Behavioral Activation. D W pringer, C Beevers, A Rubin (Eds). Treatment of Depression in Youth and Adults. Hoboken, NJ: John Wiley & Sons; 2011. 113-182.
National Institute for Clinical Excellence. Computerised cognitive behaviour therapy for depression and anxiety: Review of Technology Appraisal 51. Available at http://www.nice.org.uk/nicemedia/pdf/TA097guidance.pdf..
Task Force on Promotion and Dissemination of Psychological Procedures. A report to the Division 12 Board. Washington DC: American Psychological Association. 1993.
Jerry L Halverson, MD Medical Director of Rogers Memorial Hospital at Oconomowoc; Voluntary Clinical Assistant Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health; Clinical Assistant Professor of Psychiatry, Department of Psychiatry and Behavioral Sciences, Medical College of Wisconsin
Jerry L Halverson, MD is a member of the following medical societies: American College of Psychiatrists, American Medical Association, American Psychiatric Association
Disclosure: Nothing to disclose.
Rachel C Leonard, PhD Behavioral Activation Specialist and Clinical Supervisor, OCD Center and Cognitive-Behavioral Therapy Services, Rogers Memorial Hospital
Disclosure: Nothing to disclose.
Bradley C Riemann, PhD Director, Center for Anxiety Disorders, Director, Obsessive-Compulsive Disorder Center and Cognitive-Behavioral Therapy Services, Rogers Memorial Hospital
Disclosure: Nothing to disclose.
David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry
Disclosure: Nothing to disclose.
Cognitive Behavioral Therapy for Depression
Research & References of Cognitive Behavioral Therapy for Depression|A&C Accounting And Tax Services
Source
0 Comments