Saturday, 18 February 2012

CBT for Depression - a brief overview of treatment with free resources

According to the NICE Guidelines, CBT is one of the most evidence-based treatments of choice for (unipolar) depression.  In this short article I will describe how a CBT therapist might treat depression in  a course of therapy, giving links to free off-site depression resources.

In an assessment, the therapist will screen for depression, possibly using the PHQ-9 amongst other measures to assess the level of depression and assess risk. The clinician will explain the rationale and basics of CBT for depression, often giving a handout on CBT for depression for the client to read as homework. The might also recommend self-help books to read about depression.

In the first session the therapist will start by setting an agenda, which will include reviewing the homework and starting a simple formulation of the client's depression. This may well include helping the client see if they are in a vicious cycle of depression, where low mood leads  low energy and fatigue,  leading to decreased activity and neglect of duties, feelings of guilt and hopelessness and increased depression ... The first intervention may well be activity monitoring and activity scheduling.  This will allow the therapist and client to see how active or inactive they have become and also to identify possible activities that will give them either some pleasure or sense of achievement that will lift their mood and start moving them into a virtuous cycle.
Later sessions will include cognitive restructuring, challenging negative automatic thoughts using a thought record.
Other inteventions may include problem-solving and behavioural experiments. 
For example, a behavioural experiment may test out some dysfunctional assumptions that are maintaining the clients depression - e.g. "if I go out, I won't enjoy myself" or "if I call a friend, they won't wont to speak to me.".  In some cases, it may be necessary to try to help unhelpful schemas and negative core beliefs.

In the final sessions, a blueprint will be created to manage relapse

Recommended Links - free resouces for CBT of Depression

Very Good self-help guide from MoodJuice

Excellent handout on Vicious Cycle of Depression

NICE guidelines on depression (2009 64 page PDF)
NICE quick reference guide on depression

WORD version of Activity Scheduling - grid and tips

Thought Record for Depression

Simple explanation of CBT for depression

PHQ-9 - Free Patient Health Questionnaire frequently used in NHS as quick and easy way to measure depression

First Chapter of "Depression for Dummies"

The evidence base for cognitive–behavioural therapy in depression: delivery in busy clinical settings - full 2003 article

2007 review of evidence for CBT for depression

Useful CBT/REBT manual for clinicians for depression
Short article expalining CBT for depression

Short handout for clients on CBT for depression

Good article on problem-solving therapy which has been shown to be effective for depression