This document discusses cognitive behavioral therapy (CBT) as a treatment for depression. It begins with definitions of depression and an overview of Beck's cognitive model of depression. It then describes the CBT approach, which aims to modify negative and distorted thoughts and behaviors. Therapists help clients develop a case formulation and use techniques like thought challenging to dispute negative automatic thoughts. The document concludes that numerous studies have shown CBT to be an effective treatment for depression and is comparable or superior to antidepressant medication alone.

1. Table of Contents
Introduction.......................................................................................................................................1
Definition of Depression .....................................................................................................................2
Course of Depression..........................................................................................................................2
Cognitive behavioral approach to treating Depression..........................................................................3
Effectiveness of Cognitive Behavior Therapy for Depression..................................................................4
Conclusion .........................................................................................................................................5
References.........................................................................................................................................6

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Introduction
Behavior modification is based on the principles of operant conditioning, which were developed
by American behaviorist B. F. Skinner (1904-1990). Skinner formulated the concept of operant
conditioning, through which behavior could be shaped by reinforcement or lack of it. Skinner
considered his concept applicable to a wide range of both human and animal behaviors and
introduced operant conditioning to the general public in his 1938 book, The Behavior of
Organisms.
One behavior modification technique that is widely used is positive reinforcement, which
encourages certain behaviors through a system of rewards. In behavior modification, it is
common for the therapist to draw up a contract with the client establishing the terms of the
reward system.
Another behavior modification technique is negative reinforcement. Negative reinforcement is a
method of training that uses a negative supporter. A negative supporter is an event or behavior
whose reinforcing properties are associated with its removal. For example, terminating an
existing electric shock after a rat presses a bar is a negative supporter.
In addition to rewarding desirable behavior, behavior modification can also discourage unwanted
behavior, through punishment. Punishment is the application of an aversive or unpleasant
stimulus in reaction to a particular behavior. For children, this could be the removal of television
privileges when they disobey their parents or teacher. The removal of reinforcement altogether is
called extinction. Extinction eliminates the incentive for unwanted behavior by withholding the
expected response. A widespread parenting technique based on extinction is the time-out, in
which a child is separated from the group when he or she misbehaves. This technique removes
the expected reward of parental attention.
In this discuss I will talk about the nature of depression and how it is responsive to treatment
using Cognitive Behavioral Therapy.
Depression is a very common mental disorder and can have many precipitants. Some people are
born with neurological disorders that leave them predisposed to depression. However for many
others, depression occurs as a consequence to changing life circumstances. There are numerous

3. 2 | P a g e L Y S O N P H I R I
medications that are prescribed to depressed people. However many people find these have
unpleasant side effects and there is also a cultural distain in many sections of the general public
for antidepressant
Given the above, another approach is needed. According to Beck et al. (1979) CBT can treat
depression by attempting to modify how the client structures his view of the world. This makes
CBT a very useful alternate for those people who won’t or can’t take the medication.
Definition of Depression
A depressive disorder is an illness that involves the body, mood, and thoughts. It interferes with
daily life, normal functioning, and causes pain for both the person with the disorder and those
who care about him or her.
The DSM-IV-TR (APA, 200a) suggests that between 10-25% of women and 5-12% of men will
experience depression over their lifetime. DSM-IV also tries to define depression in terms of
symptoms displayed over a short period of time, i.e. two weeks. The key symptoms are
depressed mood and diminished interest in many daily activities.
While the DSM-IV definition lists these observable phenomena as though unconnected, Beck
(1976) suggested that the characteristics of depression could be viewed as an underlying shift in
the person’s cognitive organization of his world. Beck (1976) explains this all-encompassing
sense of loss in terms of the cognitive triangle. The cognitive triangle is composed of:
1. A negative view of the world in general. 2. A person’s negative view of themselves. 3. A
negative view of the future.
Course of Depression
Like Seligman, Beck (1976) also talks of those who are predisposed to depression to a greater or
lesser degree. He suggests that early traumatic life events will leave a psychological mark on
these people, and this mark will cause the person to over react when analogous situations happen
later in life. Other people set very rigid standard for themselves and become depressed when they
find that they can no longer maintain them

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Cognitive behavioral approach to treating Depression.
Given the general audience around the cognitive modification typical of depression by all the
major CBT players, it is obvious that modifying the client’s thinking habits along with
encouraging the adoption of more functional behavior would be the foundation of the CBT
solution.
During the sessions, the therapist helps the client frame the problems they present with in terms
of the above. Carr (2006) suggests the development of a case formulation that links predisposing,
precipitating and maintaining factors of the person’s depression, and offset these against any
protective factors in his life. This will allow the bigger picture to be seen and will also allow the
client to see the therapeutic interventions in terms of their own personal life.
Carr further suggests that the goal of therapy is to encourage the client to look for correlations
between activating events and mood changes. During sessions the client is taught to use “thought
catching” to get at the underlying belief and the accompanying negative automatic thought.
These beliefs and the negative automatic thoughts can then be examined evenly.
A useful way to help the client distance themselves from their negative automatic thoughts is to
get to them to keep a Record of Unhelpful Thoughts. This small chart allows the clients to write
down their troubling thoughts and the emotions they gave rise to, along with a brief description
of the triggering situation they found themselves in at the time. They can then consciously look
for alternatives to the negative automatic thoughts. This can be done by questioning the
evidence that at first glance seems to support the negative automatic thought. When plausible
alternatives are discovered, the client is then encouraged to reflect on the emotion induced by the
more positive alternate thought.
Aaron T. Beck and colleagues initially developed cognitive therapy as a treatment for
depression. Cognitive behavioral treatment (CBT) of depression involves the application of
specific, empirically supported strategies focused on depress genic information processing and
behavior. In order to alleviate depressive affect, treatment is directed at the following three
domains: cognition, behavior, physiology. In the cognitive domain, patients learn to apply
cognitive restructuring techniques so that negatively distorted thoughts underlying depression

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can be corrected, leading to more logical and adaptive thinking. Within the behavioral domain,
techniques such as activity scheduling, social skills training, and assertiveness training are used
to remediate behavioral deficits that contribute to and maintain depression (e.g., social
withdrawal, loss of social reinforcement). Finally, within the physiological domain, patients with
agitation and anxiety are taught to use imagery, meditation, and relaxation procedures to calm
their bodies
Effectiveness of Cognitive Behavior Therapy for Depression
Since cognitive therapy was first formulated by Beck (9), numerous studies have demonstrated
the efficacy of cognitive therapy for depression. The first landmark study conducted by Rush and
colleagues in the late seventies (10) demonstrated that cognitive therapy was more effective than
tricyclic antidepressant therapy in patients suffering from clinical depression. In contrast with
previous outcome research which demonstrated that psychotherapies were no more effective than
pill-placebos and less effective than antidepressant medications, the Rush et al. study was the
first to show that a psychosocial treatment was superior to pharmacotherapy in the treatment of
depression (11). Further, a follow-up study conducted twelve months post-treatment showed that
relapse rates were lower among patients who received CT (39%) versus those who received
antidepressant medication (65%), although this difference did not reach statistical significance
(12). In the two decades since the initial trial, many controlled trials have been undertaken to
replicate these findings. Although many experts now believe that the Rush study was sufficiently
flawed to negate study findings (11), many qualitative and quantitative reviews now conclude
that cognitive therapy: 1) effectively treats depression, 2) is at least comparable, if not, superior
to medication treatment, and 3) may have lower rates of relapse in comparison to medication
treatments (11,13-17). As a result, cognitive therapy has gained widespread acceptance as a first-
line treatment for depression, and cognitive behavioral therapy is one of only two
psychotherapies included in the guidelines for the treatment of depression published by the
Agency for Health Care and Policy Research (AHCPR).
When should behavior modification techniques be implemented?

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Before introducing an intervention, several things must take place. First, it must be established
that there is, indeed, a behavior problem. Factors which may influence or cause a student’s
behavior, such as a medical condition, language difficulties, or cultural differences, must be
investigated. Additionally, input from other staff and from parents is necessary in establishing
which behavior is problematic. Second, a functional analysis needs
Conclusion
Segal et al. (2002) show that 85% of people who experience major depression will on average
relapse into depression for four episodes of twenty weeks over their lifetime. Combining this
with the prevalence of depression in society today, it is imperative to know what effect the
various approaches have to help solve the problem. Carr (2006) notes that the relapse rates for
people who have received both medication and CBT is between 20-35% as opposed to 50-80%
for those on medication alone during follow-up studies. Shipley and Fazio (1973) conducted
studies that found there was little placebo effect in CBT treatment as beneficial effect was not
determined by the initial expectancies of the participants. This makes CBT very useful to a
skeptical general public about using medication or those who have not benefited from other
forms of psychotherapy in the past. In a study on clinical patients as opposed to volunteers,
Morris (1975) found that significant change can occur in patients in a very short time frame, so
long as a critical number of sessions (six sessions in this study) are conducted. It is findings like
these that make CBT very attractive to business. This attractiveness to business was backed up
very strongly by Lord Layard’s (2006) report estimating that depression costs the British
economy up to £12 billion per year. It was also estimated in this report that half of those
suffering from depression could be cured using CBT for approximately £750 each. This is
exactly the amount of money that these people will cost the economy each month while they are
out sick. Given the robustness of the CBT approach as outlined above, it seems clear that CBT
needs to be part of the suite of tools that are used to tackle society’s problem with depression.
Finally, when deciding on an intervention, the least intrusive and restrictive intervention deemed
likely to be effective should be chosen. For example, if a student is likely to respond to verbal
praise in increasing assignment completion behavior, it would be unnecessary, and perhaps even
detrimental, to implement a token economy in changing this behavior. It is also important to
include positive programming as part of any type of behavioral intervention. For many students,

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inappropriate behavior may be the only behavior in a student’s repertoire which has been
effective in meeting his or her needs. Positive programming serves to increase the options in a
student’s repertoire and provide more choices for the student. Finally, it is important to
remember that it is the behavior which is troublesome, not the student. It is important to make
this distinction even though in some cases a student may seem to continually try your patience.
Separating the student from his or her behavior will help prevent and dissipate negative feeling
that you may have about a student and help make you and your intervention more effective.
References
Cangelosi,J.S.(1988).Classroommanagementstrategies:Gainingandmaintainingstudents’
cooperation.NewYork:Longman,Inc.

8. 7 | P a g e L Y S O N P H I R I
Kerr,M.M., & Nelson,C.M.(1989). Strategiesformanagingbehaviorproblemsinthe classroom(2nd
ed.).NewYork:MacMillan.
O’Leary,K.D.,& O’Leary,S.G. (1977). Classroommanagement:The successfuluse of behavior
modification(2nded.).NewYork:PergamonPressInc.
Zirpoli,T.J.,&Mellow,K.J.(1993). Behaviormanagement:Applicationsforteachersandparents.New
York: MacMillan.
Beck,A.T. & Rush,J.A & Shaw,B.F. & Emery,G. (1979), ‘AnOverview’inBeck,A.T.&Rush,J.A & Shaw,
B.F.& Emery, G. (ed) CognitiveTherapyof Depression,Guilford.
Beck,A.T. (1976), ‘Treatment of depression’ in,Beck,A.T.(ed) Cognitive Therapyandthe Emotional
Disorders,Penguin.
Carr, C. and McNulty,M. (2006), ‘Depression’inCarr,C. andMcNulty,M, (ed) The Handbookof Adult
Clinical Psychology,Routledge.
Ellis,A.(1987), citedinWalen,S.R.,DiGiuseppe,R.& Dryden,S.A PractitionersGuide toRational-
Emotive Therapy,Oxford.P138.
Layard, R. (2006) The DepressionReport,The LondonSchool of Economics.
Morris, N.E.(1975), ‘Outcome Studiesof CognitiveTherapies’inBeck,A.T.&Rush,J.A & Shaw,B.F.&
Emery,G. (ed) Cognitive Therapyof Depression,Guilford.
Segal,Z.,Williams,M.& Teasdale,J.(2002), citedinCarr, C and McNulty,M. The Handbookof Adult
Clinical Psychology,Routledge.P304,P306.
Seligman,M.E.P.(2002),‘How PsychologyLostItsWay and I FoundMine’inSeligman,M.E.P.(ed)
AuthenticHappiness,NicholasBrealey.
Shipley,C.R.,andFazio,A.F.(1973) ‘Outcome Studiesof Cognitive Therapies’inBeck,A.T.& Rush,J.A &
Shaw,B.F.& Emery,G. (ed) CognitiveTherapyof Depression,Guilford.