The Effectiveness of Cognitive Behavioral Therapy in The Treatment of Major Depressive Disorder

Introduction

Major Depressive Disorder (MDD) is a psychological condition that negatively impacts people’s emotional state and their behaviour (Its Psychology, 2019). Signs and symptoms include a low, depressed mood almost daily, low self-esteem, fatigue, lack of energy and enthusiasm to do anything, counting their favourite activities. The cognitive approach, developed by Aaron Beck and Albert Ellis, explains depression through the idea that our internal processes affect our behaviour, therefore, an individual with depression’s behaviour is controlled by their irrational thinking. Beck and Ellis use other theories to demonstrate this such as, the Cognitive Theory (1967), the ABC Model (1957) and the Cognitive Triad (1976) which led to the creation of different treatments. One of the many treatments that is regularly used, is Cognitive Behavioural Therapy (CBT). The therapy involves a therapist listening to their client’s thoughts, working to challenge and change their irrational thoughts with alternative beliefs, to eliminate them. Research has been done to uncover whether this treatment is an effective method for treating MDD and to discover its limitations and this will be discussed in this essay.

Body

A person can acquire depression; after experiencing a traumatic event like a loss of a loved one, some suggest through genetics (chemical imbalance in the brain) or through their personality traits. The cognitive explanation of depression concentrates on internal processes and focuses on irrational thinking leading to a negative effect on behaviour. Albert Ellis was a psychologist who created the ABC Model to provide insight to how depressed people behave and suggested that their irrational thoughts are triggered by external events and our own beliefs then infer how we feel about the given situation (Katsikis, Kostogiannis & Dryden 2016). A in the ABC Model represents the activating negative event, for example, a breakup. B in a depressed person’s mind, is their irrational belief system. In this example, the belief is that because they have gone through a breakup, they are no longer good enough for another relationship. C represents an unhealthy negative emotion and the consequences of their irrational belief; feeling of worthlessness. If this process continues within an individual, it can lead to depression (Murguia & Díaz 2015). Psychiatrist Aaron Beck’s Cognitive Theory states that depression is caused by one’s beliefs, instead of their negative self-perception being due to depression. These dysfunctional beliefs are formed from early life experiences and become negative automatic thoughts and responses therefore the problem is the way the person perceives situations, more than the situation itself (Lemoult & Gotlib, 2019). Negative thoughts originate from schemas. Schemas are stored, organised mental representations of long-term memories and information and experiences all connected to one another, creating a web to help interpret new incoming information that in turn impacts cognitive processing. People with MDD’s negative schemas are activated every time they encounter a new situation resembling an original experience, causing their minds to reinitiate the same thinking route leading to the irrational beliefs (Orue, Calvete & Padilla 2014). Furthermore, Beck stated that cognitive distortions are involved in acquiring depression; distortions are biases that highlight the vulnerable factors minds have to depression (Dhanalakshmi, D. 2014). These include dichotomous reasoning (the individual thinks if they do not achieve a certain task then there is no point trying), selective abstraction (only remembering the negative parts of an event) and overgeneralisation (sweeping conclusions are made based on one negative event) (Rnic, Dozois & Martin, 2016). Aaron Beck developed his theory further by creating the Cognitive Triad, a mechanism showing the three forms of negative thinking, representative of those with MDD. One point of the triad is the negative views about the world, the second is the negative views about oneself, finally, negative views about the future. Beck believes the thoughts are formed early in one’s life and could trigger underlying assumptions by experiencing trauma. This results in again, future information being processed in a negative light.

From the cognitive approach to depression, Cognitive Behaviour Therapy (CBT) was formed as treatment for the disorder. CBT aims to challenge the client’s negative assumptions about themselves and events they have experienced and transform them into positive, realistic thoughts and attempts to address the underlying cognitions causing the depressive behaviour. Part of a patient’s thinking process is rumination. Rumination is repetitive, deep thinking over the same thought, event or problem (Elizabeth J. Lewis and Jutta Joorman, 2018). CBT aims to eliminate this as it repeats the irrational thinking an unhealthy amount. In addition to this, the therapist looks at the way the patient thinks and feels about a past event and how it affected them (Kendra Cherry, 2019). CBT provides tools for the patient to use outside of therapy like a diary, activity scheduling and activity scheduling to prevent relapse occurring. A study used blood biomarkers to help measure whether CBT was effective with a sample of 44 participants suffering from MDD and 30 healthy participants and found there was a positive mood change after a session of CBT (Keri, Szabolcs, Szabo, Csilla, & Kelemen, Oguz, 2014). Although this indicates CBT’s efficiency, only 44 participants were used, therefore it may not represent the whole target population of those with MDD. Moreover, another study demonstrates how other studies have been done, showing CBT reduces rumination and how it reduced post event processing too (Price & Anderson 2011). Although the study produced positive results, it was focused on social anxiety, the effect of CBT on depression may differ and have less impact. On top of this, a study was done, which altered CBT to be rumination-focused, producing positive results that CBT can help reduce the rates of rumination and depressive symptoms, suggesting focused CBT is more effective than general CBT (Watkins et al., 2007, Watkins et al., 2011). More so, some studies have shown that CBT is effective but becomes even more effective when extended, for example, with mindfulness. A study found that depressive symptoms and relapse rates decreased with the use of mindfulness incorporated with CBT, meaning CBT may have restrictions with how much it can do for a depressed person Dimidjian, Kleiber & Segal, 2010). A meta-analysis was done by Gloaguen et al (1998) uncovering the idea that CBT had much more impact than antidepressants and placebo control groups supporting the treatment to actually be working properly (Gloaguen et al., 1998). Butler et al (2006) also conducted a large meta-analysis and found big effect impact on MDD, with CBT illuminating its efficacy. Not only were meta-analyses done on the original CBT, but a meta-analysis was conducted on the internet-based CBT: they found it was more effective on anxiety symptoms, not as much on depression symptoms and this may be due to it having less therapist and patient interaction. This insinuates that perhaps CBT should be executed in its original format to produce the best results.

Conclusion

To conclude, depression is a psychological disorder, disrupting daily life and causing negative feelings and behaviour to occur in individuals and is explained by Beck and Ellis through; the Cognitive Theory, the Cognitive Triad (three negative views all in connection with one another), the ABC Model, negative schemas and cognitive distortions. All go hand in hand to help evoke a bigger picture of how depression is developed. Both men believed that depressed individuals with depression had dysfunctional internal beliefs which lead to illogical thinking patterns and control their behaviour. A good way to combat MDD and these patterns is through CBT. CBT is very effective in treating MDD and catering to an individual’s specific needs in areas they suffer most with in terms of rumination or their thinking pattern. CBT is most efficient and impactful when used alongside other treatments like mindfulness or when it focuses on one aspect of the therapy: rumination. However, there are limitations to the treatment, as it has been formatted to be an internet-based therapy too, wherein lacks the therapist and patient relationship. Moreover, many CBT studies have shown effectiveness, mainly for other disorders before depression implying it is not the best method to treat MDD.