This research essay is to explore whether or not
Cognitive Behavioural Therapy is an effective treatment for depression. Cognitive Behavioural Therapy is a form of talking therapy that can help
patients manage their own problems by changing the way they think and
behave (Beck, 1976). Royal College of Psychiatrists
(2013) describes Cognitive Behavioural Therapy as being based on the theory
that your thoughts, feelings, behaviors and actions are connected and that
negative thoughts and feelings can have you going round in a circle unable
to break the cycle. Resources according to Beck (2011) may include setting an
agenda for the therapy session, thought challenging, activity scheduling, behavioural
experiments, goal setting, solving problems, role plays, education around the condition
and relaxation techniques such as mindfulness.
Cognitive Behavioural Therapy has some positive effects for
patients who have depressive symptoms. Depression as defined by World Health
Organisation (1994 pp 131) is a “mild, moderate or severe depressive episode
where the patient suffers from lowering of mood, reduction of energy and
decrease in activity”. To measure the
effectiveness of the reduction in depressive symptoms several tools can be used.
These include The Beck Depression Inventory (Beck, 1996) and The Hospital
Anxiety and Depression Scale (Zigmond and Snaith 1983), although the assessment
is recommended to be used as a screening tool for depressive symptoms. A common difficulty is the
diagnosis of depression in people with learning disabilities, therefore
Cuthill, Espie and Cooper (2003) created the Glasgow Depression Scale for people
with a learning disability (GDS-LD).
When exploring Cognitive Behavioural Therapy
and the effects it has on depression there is a lot of evidence supporting the
therapy. NHS Choices (2016) made public their findings with regards to the benefits
for Cognitive Behavioural Therapy as well as looking at the negatives for this
therapy. They discussed it being
effective due to the therapy being a short intervention which helps patients
find new ways of using practical skills once the course is complete. This
allowed the writer to explore research into what other forms of Cognitive
Therapy were available and the different resources used to facilitate this.
Some alternative ways of
offering the therapy were found, including Internet Cognitive Behavioural
Therapy. Anderson and Cuijipers (2008) suggest
that even small interventions can have a big impact on depressive symptoms.
They also indicate many problems with this therapy, which include loss of data,
diagnostic issues, small effects and acknowledging the need for human support
in a condition such as depression, where motivation to change is a major
issue’. However, once these issues are rectified, online Cognitive Behavioural
Therapy should be considered as part of primary care where most patients are
seen and treated, such as general practitioner surgeries.
Although Richards et al (2016)
agrees that Cognitive Behavioural Therapy is effective, he discussed it being
an expensive form of therapy. He completed a trial to explore if Behavioural
Activation has the same benefits as Cognitive Behavioural Therapy or if indeed
it was less effective. Behavioural Activation according to Richards, et al
(2017) means looking at situations instead of ruminating on them to explore
goals and values within their life. He
trialed the completion of Behavioural Activation by trained Mental Health
Workers instead of Cognitive Behavioural Therapy which is completed by highly
skilled therapists. During the trial Mental Health Workers were trained in looking
at behavioural activation interventions. His findings concluded that both
therapies appeared to have a reduction in depressive symptoms. Although NICE
(2009) recommends Cognitive Behavioural Therapy as the therapy of choice for
depression, Richards, et al (2017) argues that Behavioural Activation needs to
be considered as an alternative due to the cost implications that Cognitive Behavioural
Therapy may have on services.
While the two articles both agree that Cognitive
Behavioural Therapy is effective in the reduction of depressive symptoms, Lancet (2016) wants to allow
people to look at a more cost effective way of providing this service to people
in primary services.
In conclusion, NICE (2012)
recommends “individual Cognitive
Behavioural or mindfulness-based cognitive therapy (MBCT) as psychological
interventions for relapse prevention in people who are at significant risk of
relapse is recommended”. It is also the Psychological Therapy of choice for
depression in the general public (Ponsford et al 2016). Within the role of the
Associate Practitioner (Wheeler 2017), Cognitive Behavioural Therapy is used as
a treatment within person centered pathways of care which cite NICE (2012). There
is an argument that looking at a more cost effective talking therapy such as Behavioural
Activation could be used with in primary care services. This would allow patients
to access early interventions to help support with depressive symptoms.