Table of Contents
Overview of Cognitive Behavioural Therapy
Cognitive behavioural therapy (CBT) has gained popularity as one of the most effective approaches in the treatment of depression and other related disorders. Practitioners who rely on the cognitive behavioural therapy need to understand the specific techniques that are likely to register positive outcomes. Scholars describe cognitive behavioural therapy as a structured approach used in the treatment of depression. The fundamental basis of cognitive behavioural therapy is the cognitive model of depression (Beck, 2008). Notably, the cognitive model of depression seeks to describe the mechanisms that trigger the development of depression (Beck & Bredemeier, 2016). Individuals with depression are likely to exhibit a negative perception of themselves, the world, as well as individuals in their life (Beck, 2008). The negative perception eventually leads to negative emotional states that result in maladaptive behaviours (Beck & Bredemeier, 2016). The application of cognitive behavioural therapy seeks to address the negative perceptions and views exhibited by people with depression. Over the years, scholars have developed different cognitive techniques used in the treatment of patients with depression. It is imperative to highlight the characteristics and procedures of cognitive behavioural therapy and determine the most effective intervention for various patients.
Cognitive behavioural therapy denotes a systematic approach used by counsellors and mental health practitioners to help individuals to overcome depression (Jacobson et al., 1996). Therapists relying on cognitive behavioural therapy must demonstrate a critical understanding of the different techniques and procedures that are likely to register positive outcomes. The cognitive behavioural therapy combines both cognitive and behavioural approaches in the treatment of depression as well as anxiety disorders (Hofmann, Sawyer, & Fang, 2010). The main concept behind the cognitive behavioural therapy is that individuals experience challenges in altering their emotions (Coull & Morris, 2011). For this reason, cognitive behavioural therapy helps individuals to change their thoughts and behaviours and alleviate negative emotions. The primary objective of cognitive behavioural therapy is to equip a patient with adequate skills that empower the person to gain an increased awareness of personal thoughts and emotions. Cognitive behavioural therapy also empowers individuals to understand the mechanisms responsible for the existing link between situations, thoughts, behaviours, and emotions. Cognitive behavioural therapy also helps individuals to get rid of dysfunctional thoughts, behaviours, and adopt attitudes that are positive, behaviours, and thoughts.
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Therapists work with patients through a collaborative approach that focuses on meeting the needs of patients (Hofmann, Sawyer, & Fang, 2010). Different studies have demonstrated that cognitive behavioural therapy can register positive outcomes when dealing with patients who exhibit depressive symptoms. The application of cognitive behavioural therapy should depend on a critical analysis of the patient’s condition. Therapists must demonstrate expertise in assessing and understanding the condition of the patient before using the cognitive behavioural therapy. After assessing the patient needs, therapists make important decisions concerning the best technique in the therapy process. The therapist must ensure that patients exhibit a high motivation to achieve the desired change. Moreover, therapists must understand whether the clients have adequate time to commit to the weekly sessions. It is important to analyse the various life stressors that are likely to influence the cognitive and behavioural patterns of the client (Dobson & Dozios, 2010). Additionally, therapists must fully recognise the mechanisms governing the cognitive functioning as well as the psychopathology of the patient. Utilising cognitive behavioural therapy involves behavioural activation through the introduction of daily activities that are likely to have a positive impact on the patient (Hopko et al., 2003).
Specifically, behavioural activation has its basis on the assignment of different activities and tasks that will help patients to develop important skills. Behavioural activation represents one of the treatment conditions governing cognitive behavioural therapy (Hopko et al., 2003). The second element in cognitive behavioural therapy is the emphasis on automatic thoughts. The therapist helps the patient to develop expertise in modifying negative thoughts. From a critical consideration of the automatic thoughts, the therapist can guide the patient to achieve desirable outcomes (Longmore & Worrell, 2007). The cognitive element challenges the existing beliefs and introduces a new set of belief systems that register a positive impact on the cognitive processes (Beck, 2011). The development of the cognitive behavioural therapy since the 1960s has registered positive outcomes in the understanding of the various techniques involved (Dobson & Dozios, 2010). Therapists using this approach must take the time to analyse the thoughts and behaviours of the patient and empower them to achieve certain goals. At the beginning of cognitive behavioural therapy, the therapist helps the patient to develop individual goals that are measurable and achievable. It is easy to determine the progress made by the patient by critically assessing the achievement of different milestones towards the adoption of positive thoughts and remarkable behavioural patterns.
According to Martin, Garske, and Davis (2000), the relationship between the therapist and the patient is of critical importance because it determines the effectiveness of the techniques used. For this reason, the therapist should focus on understanding the patient needs and developing a favourable relationship that will foster the effectiveness of the cognitive behavioural therapy. Each therapist can adopt different techniques when conducting counselling using the cognitive behavioural therapy approach. It is important for the therapist to recognise the interconnection between biological, psychological, and social experiences. Understanding the principles of cognitive behavioural therapy is of critical importance for each therapist. Specifically, cognitive behavioural therapy relies on a structured approach that is limited to a certain period. In agreement with Martin, Garske, and Davis (2000), therapists provide counselling for different sessions and utilise homework assignments to reinforce the development of alternative coping skills. The approach centres on the present and helps patients to recognise that they have a measure of control over their thoughts and emotions. The emphasis on cognitive behavioural therapy is to help patients to understand their thought processes and how they influence their emotions.
Understanding the Causes and Models of Depression
There is evidence that depression has become significantly prevalent. A critical understanding of the onset of depression helps in the development of effective treatment approaches. A negative life event can trigger the onset of depression. Particularly, the loss of a loved one, the end of a romantic relationship, as well as other cases of personal failure may trigger depression (Beck, 2008). The main characteristics of depression include hopelessness and worthlessness (Barton et al., 2017). Some individuals experience short-term depressive reactions, which may eventually become long-term depressive episodes (Peckham, McHugh, & Otto, 2010). Individuals with depression have a negative thought process because they believe that they cannot achieve their desired outcomes. Particularly, the feeling of hopelessness is accompanied by negative thought and beliefs that an individual is bound to experience or encounter negative outcomes. Worthlessness compels the individuals to consider themselves as inadequate, weak, or excessively flawed.
Depression makes it difficult for individuals to act upon their undesirable situations due to hopelessness and helplessness. For this reason, individuals with depression register low levels of self-esteem and lack a proper sense of self-worth. In many instances, individuals with depression do not realise when it becomes a long-term depressive episode. Different scholars have developed various models of understanding depression and the manner in which it affects an individual’s perspective. The Beck’s (2008) cognitive model of depression has become the most popular approach to understanding the development of depression. According to Beck (2008), individuals who experience life-altering events become vulnerable to depression because of the existing dysfunctional beliefs. The life-altering events only serve to activate the dysfunctional beliefs and make the individual increasingly vulnerable to developing depression.
The dysfunctional beliefs compel the individual to focus on interpreting their experiences in distorted ways. There is evidence that the negative interpretations contribute to the development of negative views towards the self, the world, as well as the future (Beck & Bredemeier, 2016). The Beck model considers the negative beliefs as part of the negative cognitive triad that represents the initial symptoms of depression. The lack of therapy leads to the advancement of depression as exhibited by sleeplessness, sadness, as well as motivational disturbances. The most important aspect of Beck’s cognitive model of depression is the fact that depression occurs because of the negative self-schemer. In consonance with views by Beck and Bredemeier (2016), the distorted interpretation of a person’s experience often leads to negative belief systems that characterise depression. Scholars have relied on Beck’s model with the core objective of understanding the cognitive processes that govern depression. Different scholars agree that negative thinking is a significant contributor to the development of depression.
Various studies have examined the measures of negative thinking and ascertained that increased negative thinking serves as a critical mechanism in the onset of depression. As highlighted by Beshai et al. (2016), the negative thinking also serves as a platform for maintaining the long-term depressive episodes. Negative thinking is a result of biased cognitive processes that are likely to distort the reality of events and experiences. It is important to understand the cognitive processes governing depression and the extent to which the impairment of cognitive functioning harms the life of an individual. Negative belief systems that the Beck’s model highlights eventually trigger somatic disturbances, motivational disturbances, and affective disturbances (Beck & Bredemeier, 2016). Individuals with depression exhibit automatic negative thoughts that occur without any conscious awareness. As reported by Beck (2008), the automatic negative thoughts eventually become highly intrusive during the long-term depressive episodes. Depressed individuals have reported dominant automatic negative thoughts that make it impossible for the individuals to lead normal lives.
Psychologists have characterised negative self-schemers as playing an important role in the maintenance of depression. The schemers represent hypothetical cognitive structures that determine how the brain processes different types of information (Beck, 2008). In the depressive mode, individuals exhibit a distorted version of personal processing of information. Depressed individuals pay more attention to the undesirable aspects of their lives and focus on the self-defeating characteristics when interpreting events. Such schemers explain why patients with depression are less likely to overcome their self-defeating attitudes (Beck & Bredemeier, 2016). Depression causes distorted information processing tendencies. In agreement with Beshai et al. (2016), the distortion motivates depressed patients to see undesirable characteristics in their lives. The distortion may focus on analysing details that do not fit within a specific context. Additionally, depressed individuals are prone to overgeneralisation of their experiences as well as arbitrary inferences. Due to the negative schemers, depressed individuals exhibit dichotomous thinking even when it does not apply.
Cognitive Behavioural Therapy Processes Used in Depression Therapy
Different scholars have analysed the various processes that govern cognitive behavioural therapy. There is evidence that cognitive behavioural therapy represents a complex treatment procedure with various protocols. One of the significant approaches in cognitive behavioural therapy that reduces depressive symptoms is behavioural activation. Various studies have demonstrated that cognitive behavioural therapy registers positive outcomes in the treatment of depression. Behavioural activation represents one of the critical components of cognitive behavioural therapy. Behavioural activation emerged as a form of treatment that focuses on the reinforcement explanation of depression (Cuijpers, Van Straten, & Warmerdam, 2007). The reinforcement model posits that depression is because of the absence of positive reinforcement. Without adequate positive reinforcement, individuals are less likely to exhibit desirable behaviours. The reinforcement model links a person’s mood with the type of activities that the individual chooses to participate (Dichter, Felder, & Smoski, 2010). When individuals with depression engage in pleasant activities, their mood is likely to improve significantly.
Behavioural activation represents an important component in cognitive behavioural therapy that helps therapists to improve the moods of their patients (Hopko et al., 2003). The therapist encourages patients to monitor how their mood changes as they engage in various daily activities. The regular monitoring of one’s mood helps the patients to recognise that there is a correlation between activities and moods. Through the monitoring process, individuals become aware of the unpleasant events of activities that trigger negative moods and eliminate them (Hopko, Robertson, & Carvalho, 2009). On the other hand, patients with depression focus on increasing the frequency of activities that trigger the development of desirable moods. Behavioural activation seeks to emphasise the need for self-control skills that empower an individual to pay attention to goal-directed behaviour (Mazzucchelli et al., 2009; Rhodes et al., 2014). It is possible to avoid negative consequences by focusing on activities that have positive outcomes. Behavioural activation encourages patients to master the specific activities that increase pleasure. The therapist also encourages individuals to undertake activities that are likely to register higher levels of pleasure.
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Various studies have investigated the effectiveness of behavioural activation in reducing depressive symptoms (Mazzucchelli et al., 2009; Rhodes et al., 2014). Particularly, the governing concept of behavioural activation helps patients to develop realistic and attainable goals in managing their behaviour (Hopko, Robertson, & Carvalho, 2009). Moreover, the mastery of the connection between activities and the person’s mood also serves as an effective way of reinforcing positive behaviours. Depressed patients register positive outcomes in the reduction of depressive symptoms as long as they recognise patterns that govern their behaviour (Hopko et al., 2003). Through self-monitoring and scheduling of different activities, patients often experience an increased ability to control their moods by determining the most pleasurable activities. Behavioural activation serves as a component of cognitive behavioural therapy that therapists often implement when they need to improve a patient’s mood (Mazzucchelli et al., 2009; Rhodes et al., 2014).
An additional process of cognitive behavioural therapy includes techniques that seek to modify the negative automatic thoughts that characterise depression. Notably, the Beck’s model of depression explains how depressed individuals develop automatic negative thoughts that eventually become intrusive and adversely affect the person’s life (Beck, 2008). In cognitive behavioural therapy, the therapist seeks to ensure that there are treatment techniques that focus on addressing the automatic thoughts (Dobson & Dozios, 2010). These procedures include the identification of the negative automatic thoughts that the person experiences and their emergence. Therapists rely on daily thought records that the patients maintain. With these records, the patients indicate the various thoughts that affect their normal functioning and help the therapist to understand the advancement of depression (Hofmann et al., 2012).
In the treatment process, the therapist examines the available evidence that governs the occurrence of the automatic thoughts. According to Dobson and Dozios (2010), the patient must be able to determine the available evidence that supports the occurrence of the automatic negative thoughts. Most significantly, therapists encourage patients to carry out an analysis of the biases that result in negative thoughts (Longmore & Worrell, 2007). The various interventions to address the automatic negative thoughts help patients to identify the processes and activities that lead to bias or distorted view of events (Dobson & Dozios, 2010). With such mastery, it becomes possible for the patients to avoid or reduce the automatic negative thoughts. A critical understanding of how the thoughts emerge only prepares the person for a higher commitment to avoid the negative interpretations that trigger the negative thoughts (Hofmann et al., 2012). Therapists combine behavioural activation and the modification of negative automatic thoughts to increase positive outcomes in depressed patients.
Cognitive therapy represents an additional component of cognitive behavioural therapy. The component of cognitive therapy seeks to modify the dysfunctional belief systems and distorted assumptions. The therapist utilises various approaches to help the patients identify the core beliefs that govern depression. According to the Beck’s cognitive model, it is important to identify the belief systems and assumptions that govern and maintain depression (Beck, 2011). Cognitive behavioural therapy sessions focus on helping the patients to develop alternative belief systems (DeRubeis et al., 2010). The combination of the three components explains why cognitive behavioural therapy registers positive outcomes in reducing depressive symptoms (Lorenzo-Luaces, German, & DeRubeis, 2015). The combination of different techniques in behavioural activation, modification of automatic thoughts, and cognitive therapy help the depressed individual to develop positive schemers, attitudes, and beliefs that are likely to enhance the processing of information (Garratt et al., 2007; Lorenzo-Luaces, German, & DeRubeis, 2015).
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Implications of Cognitive Behavioural Therapy and Clinical Practice in Improving Access to Psychological Therapies
Over the years, scholars have sought to determine the effectiveness of cognitive behavioural therapy in reducing depressive symptoms. Many scholars believe that cognitive behavioural therapy registers high levels of effectiveness due to the combination of cognitive and behavioural techniques during the treatment process. However, some scholars have questioned the effectiveness of behavioural activation as an independent model in the treatment of depression compared to the effectiveness of cognitive behavioural therapy (Boston et al., 2006; Coffman et al., 2007). Socioeconomic and professional developments have raised concerns regarding the use of behavioural activation as an independent form of treatment due to its simplistic model and effectiveness. The complexity of cognitive behavioural therapy has prevented many therapists from applying the therapy because they are yet to master its various components (Cuijpers et al., 2013). Over the years, scholars have questioned the effectiveness of cognitive behavioural therapy during the early stages of depression. There is a need to demonstrate further evidence on how the processes of cognitive behavioural therapy specifically address the depressive symptoms and register effectiveness (Cuijpers et al., 2016). Despite the effectiveness of cognitive behavioural therapy, therapists are yet to implement the treatment model in patients who do not use antidepressants effectively.
The combination of behavioural and cognitive components has been the focus of many studies. Some scholars have questioned the significance of the cognitive approaches in reducing depressive symptoms (Coffman et al., 2007). It is important to consider the implications for improving access to psychological therapies. Many patients with depression have resulted in committing suicide due to the lack of access to psychological therapies. There is a need to improve access to various psychological therapies that can help in reducing the adverse effects of depression. Specifically, behavioural activation is likely to be the most accessible psychological therapy because therapists prefer it due to its straightforward nature. Accessing the cognitive behavioural therapy may still be a challenge for many patients because of its complexity and economic implications. However, there is a need to demonstrate its superior effectiveness in reducing the symptoms of depression so that more therapists can embrace the approach in their daily practice. It is important to develop personalised therapies depending on the radically distinctive circumstances of individuals with depression (Cuijpers & Christensen, 2017; Cuijpers et al., 2016). Currently, many therapists tend to use one approach that is likely to register positive outcomes for different patients. However, there is a need for extensive studies that will help therapists to identify psychological therapies that are relevant to each patient’s condition (Cuijpers, 2016; Kessler et al., 2016).
It is evident that cognitive behavioural therapy proves to be an effective approach in reducing depressive symptoms. However, many therapists have continued to use behavioural activation, which registers remarkable levels of effectiveness. For this reason, it is important to understand the specific mechanisms of cognitive behavioural therapy that help in reducing depressive symptoms. The combination of behavioural and cognitive approaches to reducing depressive symptoms serves as the defining characteristics of cognitive behavioural therapy. There is evidence that cognitive behavioural therapy is complex and expensive. For this reason, behavioural activation is more accessible to patients with depression because of its straightforward nature. There is a need for further research to demonstrate the superiority of cognitive behavioural therapy in reducing depressive symptoms.
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