One in three adults (16-34) were obtaining


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 a
mental health issue weekly and depression accounts for 3.3% with depression and
anxiety 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 to
seek out mental health assistance, however the discrepancy maybe due to assumptions
of men viewed as weak and/or less likely to seek professional help (Johnson et
al., 2012; Rickwood, Deane & Wilson, 2007).

The diagnostic and
statistical manual (DSM V) see p161-162 identified major depressive disorder as
a person experiencing 5 or more symptoms during the same 2 week period and at
least 1 of the symptoms is either depressed mood or loss of interest or
pleasure, on the other hand Persistent depressive disorder formerly known as
dysthymia is identified by 2 years of consecutive low mood and 1 year for
children and adolescence with at least 2 symptoms as specified in the DSM V see
p168-169. Depression is a pervasive psychopathological condition, different
approaches to treatment have different philosophical understandings and
definitions of depression however, cognitive behavioural therapy though a
discipline of its own has over the years assimilated many different psychological
and philosophical principals of older approaches such as psychodynamic,
humanistic and REBT.

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Cognitive behavioural
therapy(CBT) is a discipline which has had extensive empirical support for its
processes particularly because of its systematic emphasis in tackling mental
health conditions, the key underlaying theories of depression are negative automatic
thoughts (NAT), Systematic logical errors and negative schemas which contribute
and help persist the depressive condition,  indeed a person experiencing a stressful event
in their life doesn’t necessarily determine that they will develop depression
however, increased maladaptive cognitive patterns of thought can make
individuals defenceless to such conditions and a persistent ideology of
negative thoughts leads to potential spiral of negative information processing (McGinn,

According to Kahneman
(2011) humans have 2 processes of thinking, one which is fast, emotional and
automatic requires very little use of memory, and the other which is more slow,
analytical and systematic which uses long term memory. The fast and automatic
type thinking, or schema is a collection of ideas thoughts and processes to
deal with everyday life situations in other words algorithmic process or short
cuts. Individuals who are depressed will unconsciously adapt these schemas to
fit in with their idea of current situations or mood for example a person who
is depressed will have negative self-schema of themselves his view of himself
will spill over in his view of the world and in turn will have a major effect
on how he foresees their future; Becks called this the cognitive triad. According
to beck’s these schemas are thought to develop in childhood possibly because
children are at their most susceptible in these early years (Mor & Haran, 2009)

The question is how does one
get depressed? where does one draws the line? according to becks and other
researchers it appears that depression starts with a stressor or life event it
then creeps up on individuals through a process of reinforcement i.e. becomes
or its presumed by the individual to be the norm once its accepted as the norm
it becomes automatic therefore, no further analysis is applied, it just is,
because negativity contributes to negative valence of emotions individuals are
in effect in a negative mood/state which leads to
depression (McGinn, 2000; Sudak, 2012).

Three mechanisms of
treatment are usually applied to individuals with a depressive diagnosis. Initial
stage according to Mor & Haran, (2009) and
Sudak, (2012) named behavioural scheduling, is aimed at individuals being
treated to monitor their daily activities and experiences, its not uncommon for
individuals in a depressive state to show disinterest in general activities as
a mechanism to avoid. Thus, the individuals are asked to keep a daily record of
activities to help them identify the link between the behaviours and their mood
which in turn allows them to focus on the events that makes them feel good.
Once these positive reinforcing events are identified then the therapist with
the aid of the recorded logs can set realistic goals in every day life events
with emphasis on behaviour outcome as opposed to emotional ones. With every mile
stone the individual is encouraged to reward themselves (Sudak, 2012). The next
stage the therapist aims to challenge negative thoughts using the Socratic
questions in a humanistic approach, the therapist goal is to restructure the
negative thoughts or schemas by rational thinking and questioning their
internal perspective of events or in effect reconfiguring their thought
patterns or schemas to be more in line with evidence rather than belief. The
last stage and possibly the most important to prevent relapse, individuals are
encouraged to change their beliefs that have an influence in negative thoughts
by testing their perceived ideas with the new and accurate information. Naturally
depression is different for everyone, though they do share commonalities and
different intensities dependant on the situational occurrences and personality
types in a sense depression can be said to be on a spectrum.

CBT has been tested and compared
to antidepressants treatment. In the 90’s cbt was comparable to
antidepressants, a combination of both was not shown to be any better than each
separately. McGinn,  (2000) and Mor & Haran, (2009) stated that neither treatment
achieved more than 60% success however relapse rates for antidepressants was in
the 60% range whilst with CBT in the region of 30% interestingly the national
institute of mental health treatment of depression collaborative research
program (TDCRP) conducted trials and compared placebo, antidepressants, IPT and
CBT and concluded CBT was inferior to IPT and antidepressants and was no more
effective than placebo ( McGinn, 2000),  ironically, TDCRP was the only study that
found CBT inferior than antidepressants, however the alleged discrepancies was
more to do with therapist skill level and adherence to treatment protocols. As
mentioned by Mor & Haran, (2009) experienced CBT practitioners where liken
to antidepressant medication outcomes however CBT does have variations, such as
transdiagnostic approach, is a treatment basis that uses the theoretical
underpinnings of a condition and approach the treatment to individuals with a
kind of blanket approach as opposed to tailoring it to the patients. Hague, Scott & Kellett, (2014) however this
approach was not significant with respect to tailor made treatment.

One important aspect of
CBT treatment is the therapeutic relationship between client and therapist, as mentioned
earlier, skill level of the therapist is paramount Abel et al., (2016)
discusses the phenomenon of sudden gain by definition it refers to clients
whilst following the protocols to CBT treatment, has a cognitive shift and improvement
is far quicker and significant even to the point of less relapse rates among
sudden gain clients. The underlying factor is case conceptualization by the
therapist (a process where the therapist visualises the current situation and
sign posts to the client what the problem maybe, what needs to be done) as
discussed by Abel et al., (2016) therapist that partake in this process shows
far more skill than therapist that don’t and thus the client perceives that the
therapist knows what he/she is doing and gives hope to the client because the he/she
can lean on someone who understands them completely in respect to their
condition and objectively will experience confidence in the therapist and the

More in line with current
facts CBT is in line with antidepressants approx. 58% after 16 weeks however
relapse rates were 30% for cbt while antidepressants were over 75%. TDCRP did a
re analysis and found CBT superior than antidepressants and a combination to be
equally as effective (McGinn, 2000; Mor &
Haran, 2009; Sudak, 2012). Interestingly complete
recovery from major depression by use of CBT treatment was shown to be 61% whilst
antidepressant medication, was shown to have only a 39% chance of recovery (Sudak,
2012). Fundamentally this can be explained on the basis that eventually both
treatments will eventually seize, inferentially, CBT program gives the
individual the opportunity to learn cognitively as well as behaviourally whilst
with medicine there an epigenetic variable which could be lasting or as it has
been shown statistically more chance of a temporary fix (Roshanaei?Moghaddam et
al., 2011) subsequently, though CBT is very affective, its no more efficacious
that other psychotherapies (Leanne, Sharon & Dan, 2010).

Moving in line with the
age of information technology  Foroushani,
Schneider & Assareh, (2011) explored CBT to be administered via computer
without a face to face or a therapist intervention the cCBT package was found
to be a positive on treatment for mild forms of depression however it is still
considered in its infancy, consequently with our Health service over stretched,
could be used and explored in moderate amounts in group sessions with a
therapist to debrief individuals.