One in three adults (16-34)were obtaining advice or treatment in the UK according to NHS digital,according to MIND one in four are seeking treatment, one in six experience amental health issue weekly and depression accounts for 3.3% with depression andanxiety 7.8% or depression related condition accounting for 11.
1% of the population,based on 2014 figures reported in 2016. Women are almost twice as likely toseek out mental health assistance, however the discrepancy maybe due to assumptionsof men viewed as weak and/or less likely to seek professional help (Johnson etal., 2012; Rickwood, Deane & Wilson, 2007).The diagnostic andstatistical manual (DSM V) see p161-162 identified major depressive disorder asa person experiencing 5 or more symptoms during the same 2 week period and atleast 1 of the symptoms is either depressed mood or loss of interest orpleasure, on the other hand Persistent depressive disorder formerly known asdysthymia is identified by 2 years of consecutive low mood and 1 year forchildren and adolescence with at least 2 symptoms as specified in the DSM V seep168-169.
Depression is a pervasive psychopathological condition, differentapproaches to treatment have different philosophical understandings anddefinitions of depression however, cognitive behavioural therapy though adiscipline of its own has over the years assimilated many different psychologicaland philosophical principals of older approaches such as psychodynamic,humanistic and REBT.Cognitive behaviouraltherapy(CBT) is a discipline which has had extensive empirical support for itsprocesses particularly because of its systematic emphasis in tackling mentalhealth conditions, the key underlaying theories of depression are negative automaticthoughts (NAT), Systematic logical errors and negative schemas which contributeand help persist the depressive condition, indeed a person experiencing a stressful eventin their life doesn’t necessarily determine that they will develop depressionhowever, increased maladaptive cognitive patterns of thought can makeindividuals defenceless to such conditions and a persistent ideology ofnegative thoughts leads to potential spiral of negative information processing (McGinn,2000). According to Kahneman(2011) humans have 2 processes of thinking, one which is fast, emotional andautomatic requires very little use of memory, and the other which is more slow,analytical and systematic which uses long term memory. The fast and automatictype thinking, or schema is a collection of ideas thoughts and processes todeal with everyday life situations in other words algorithmic process or shortcuts.
Individuals who are depressed will unconsciously adapt these schemas tofit in with their idea of current situations or mood for example a person whois depressed will have negative self-schema of themselves his view of himselfwill spill over in his view of the world and in turn will have a major effecton how he foresees their future; Becks called this the cognitive triad. Accordingto beck’s these schemas are thought to develop in childhood possibly becausechildren are at their most susceptible in these early years (Mor & Haran, 2009)The question is how does oneget depressed? where does one draws the line? according to becks and otherresearchers it appears that depression starts with a stressor or life event itthen creeps up on individuals through a process of reinforcement i.e. becomesor its presumed by the individual to be the norm once its accepted as the normit becomes automatic therefore, no further analysis is applied, it just is,because negativity contributes to negative valence of emotions individuals arein effect in a negative mood/state which leads todepression (McGinn, 2000; Sudak, 2012).Three mechanisms oftreatment are usually applied to individuals with a depressive diagnosis. Initialstage according to Mor & Haran, (2009) andSudak, (2012) named behavioural scheduling, is aimed at individuals beingtreated to monitor their daily activities and experiences, its not uncommon forindividuals in a depressive state to show disinterest in general activities asa mechanism to avoid. Thus, the individuals are asked to keep a daily record ofactivities to help them identify the link between the behaviours and their moodwhich in turn allows them to focus on the events that makes them feel good.
Once these positive reinforcing events are identified then the therapist withthe aid of the recorded logs can set realistic goals in every day life eventswith emphasis on behaviour outcome as opposed to emotional ones. With every milestone the individual is encouraged to reward themselves (Sudak, 2012). The nextstage the therapist aims to challenge negative thoughts using the Socraticquestions in a humanistic approach, the therapist goal is to restructure thenegative thoughts or schemas by rational thinking and questioning theirinternal perspective of events or in effect reconfiguring their thoughtpatterns or schemas to be more in line with evidence rather than belief.
Thelast stage and possibly the most important to prevent relapse, individuals areencouraged to change their beliefs that have an influence in negative thoughtsby testing their perceived ideas with the new and accurate information. Naturallydepression is different for everyone, though they do share commonalities anddifferent intensities dependant on the situational occurrences and personalitytypes in a sense depression can be said to be on a spectrum.CBT has been tested and comparedto antidepressants treatment. In the 90’s cbt was comparable toantidepressants, a combination of both was not shown to be any better than eachseparately. McGinn, (2000) and Mor & Haran, (2009) stated that neither treatmentachieved more than 60% success however relapse rates for antidepressants was inthe 60% range whilst with CBT in the region of 30% interestingly the nationalinstitute of mental health treatment of depression collaborative researchprogram (TDCRP) conducted trials and compared placebo, antidepressants, IPT andCBT and concluded CBT was inferior to IPT and antidepressants and was no moreeffective than placebo ( McGinn, 2000), ironically, TDCRP was the only study thatfound CBT inferior than antidepressants, however the alleged discrepancies wasmore to do with therapist skill level and adherence to treatment protocols. Asmentioned by Mor & Haran, (2009) experienced CBT practitioners where likento antidepressant medication outcomes however CBT does have variations, such astransdiagnostic approach, is a treatment basis that uses the theoreticalunderpinnings of a condition and approach the treatment to individuals with akind of blanket approach as opposed to tailoring it to the patients. Hague, Scott & Kellett, (2014) however thisapproach was not significant with respect to tailor made treatment.One important aspect ofCBT treatment is the therapeutic relationship between client and therapist, as mentionedearlier, skill level of the therapist is paramount Abel et al.
, (2016)discusses the phenomenon of sudden gain by definition it refers to clientswhilst following the protocols to CBT treatment, has a cognitive shift and improvementis far quicker and significant even to the point of less relapse rates amongsudden gain clients. The underlying factor is case conceptualization by thetherapist (a process where the therapist visualises the current situation andsign posts to the client what the problem maybe, what needs to be done) asdiscussed by Abel et al., (2016) therapist that partake in this process showsfar more skill than therapist that don’t and thus the client perceives that thetherapist knows what he/she is doing and gives hope to the client because the he/shecan lean on someone who understands them completely in respect to theircondition and objectively will experience confidence in the therapist and theprocess.More in line with currentfacts CBT is in line with antidepressants approx.
58% after 16 weeks howeverrelapse rates were 30% for cbt while antidepressants were over 75%. TDCRP did are analysis and found CBT superior than antidepressants and a combination to beequally as effective (McGinn, 2000; Mor &Haran, 2009; Sudak, 2012). Interestingly completerecovery from major depression by use of CBT treatment was shown to be 61% whilstantidepressant medication, was shown to have only a 39% chance of recovery (Sudak,2012). Fundamentally this can be explained on the basis that eventually bothtreatments will eventually seize, inferentially, CBT program gives theindividual the opportunity to learn cognitively as well as behaviourally whilstwith medicine there an epigenetic variable which could be lasting or as it hasbeen shown statistically more chance of a temporary fix (Roshanaei?Moghaddam etal., 2011) subsequently, though CBT is very affective, its no more efficaciousthat other psychotherapies (Leanne, Sharon & Dan, 2010).Moving in line with theage of information technology Foroushani,Schneider & Assareh, (2011) explored CBT to be administered via computerwithout a face to face or a therapist intervention the cCBT package was foundto be a positive on treatment for mild forms of depression however it is stillconsidered in its infancy, consequently with our Health service over stretched,could be used and explored in moderate amounts in group sessions with atherapist to debrief individuals.
