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Treating complex depression with cognitive behavioural therapy

Published online by Cambridge University Press:  01 December 2017

Stephen Barton ,
Peter Armstrong ,
Louise Wicks ,
Elizabeth Freeman  and
Thomas D. Meyer
Stephen Barton*
Affiliation:
Newcastle Cognitive and Behavioural Therapies Centre, Northumberland, Tyne and Wear Foundation Trust School of Psychology, Newcastle University
Peter Armstrong
Affiliation:
Newcastle Cognitive and Behavioural Therapies Centre, Northumberland, Tyne and Wear Foundation Trust School of Psychology, Newcastle University
Louise Wicks
Affiliation:
Newcastle Cognitive and Behavioural Therapies Centre, Northumberland, Tyne and Wear Foundation Trust School of Psychology, Newcastle University
Elizabeth Freeman
Affiliation:
Newcastle Cognitive and Behavioural Therapies Centre, Northumberland, Tyne and Wear Foundation Trust
Thomas D. Meyer
Affiliation:
Department of Psychiatry and Behavioural Sciences, McGovern Medical School, University of Texas HSC at Houston, TX, USA
*
*Author for correspondence: Stephen Barton, Newcastle Cognitive and Behavioural Therapies Centre, Northumberland, Tyne and Wear Foundation Trust, Newcastle upon Tyne, UK (email: Stephen.Barton@newcastle.ac.uk).
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Abstract

Cognitive behavioural therapy (CBT) for major depression is an effective treatment, but outcomes for complex cases, with co-occurring biological, psychological and social factors, are variable. Complexity factors can cause treatment to become diffuse, disorganized and over-complicated. At Step 3, disorder-specific protocols should be provided with therapy kept as simple as possible and delivered responsively, e.g. barriers to treatment should be tackled, ensure the client is well-prepared and seek to form a strong therapeutic alliance. At Step 4, if disorder-specific protocols have been ineffective, the priority is to formulate how complexity factors are interacting with the client's depression. An individualized formulation is used to carefully target these interactions. The treatment is still evidence-based and simple at the point of delivery, but there is greater emphasis on case-level interactions that are unique to each individual. Case examples are used to illustrate both approaches.

Keywords

depressionCBTNICEevidence-based practice

Information

Type
Special Issue: Complexity within Cognitive Behaviour Therapy
Information
the Cognitive Behaviour Therapist , Volume 10 , 2017 , e17
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Further reading

Binnie, J (2012). Using cognitive behavioural therapy with complex cases: using the therapeutic relationship to change core beliefs. Issues in Mental Health Nursing 33, 480–485.Google Scholar
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Clark, DM (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry 23, 318–327. doi: 10.3109/09540261.2011.606803 Google Scholar
DeRubeis, RJ, Hollon, SD, Amsterdam, JD, Shelton, RC, Young, PR, Salomon, RM et al. (2005). Cognitive therapy versus medications in the treatment of moderate to severe depression. Archives of General Psychiatry 62, 409–416.CrossRefGoogle Scholar
Garland, A (2015). Cognitive behavioural case formulation for complex and recurrent depression, pp. 119–142 in Tarrier, N and Johnson, J (eds) (2015), Case Formulation in Cognitive Behaviour Therapy: The Treatment of Challenging and Complex Cases. Routledge.Google Scholar
Goddard, E, Wingrove, J, Moran, P (2015). The impact of comorbid personality difficulties on response to IAPT. Behaviour Research and Therapy 73, 1–7.Google Scholar
Improving Access to Psychological Therapies (IAPT) Executive Summary (November 2016). NHS Digital, ISBN 978-1-78386-946-6.Google Scholar
Martell, CR, Dimidjian, S, Herman-Dunn, R (2010). Behavioral Activation for Depression: A Clinician's Guide. Guilford Press: New York.Google Scholar
McKay, D, Sookman, D, Neziroglu, F, Wilhelm, S, Stein, DJ, Kyrios, M, Matthews, K, Veale, D (2015). Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Research 227, 104–113.Google Scholar
Meyer, TD, Hautzinger, M (2012). Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year follow-up. Psychological Medicine 42, 1429–1439.CrossRefGoogle ScholarPubMed
National Collaborating Centre for Mental Health (2005) Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder (clinical guideline CG31), British Psychological Society and Royal College of Psychiatrists. Available at: https://www.nice.org.uk/guidance/CG31 (accessed 12 September 2017).Google Scholar
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Rittel, HWJ, Webber, MM (1973). Dilemmas in a general theory of planning. Policy Sciences 4, 155–169.Google Scholar
Tarrier, N, Johnson, J (eds) (2015). Case Formulation in Cognitive Behaviour Therapy: The Treatment of Challenging and Complex Cases. Routledge.Google Scholar
Waller, G, Turner, H (2016). Therapist drift redux: why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behaviour Research and Therapy 77, 129–137.CrossRefGoogle ScholarPubMed
Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Clark, DM (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry 23, 318–327. doi: 10.3109/09540261.2011.606803 Google Scholar
DeRubeis, RJ, Hollon, SD, Amsterdam, JD, Shelton, RC, Young, PR, Salomon, RM et al. (2005). Cognitive therapy versus medications in the treatment of moderate to severe depression. Archives of General Psychiatry 62, 409–416.CrossRefGoogle Scholar
Garland, A (2015). Cognitive behavioural case formulation for complex and recurrent depression, pp. 119–142 in Tarrier, N and Johnson, J (eds) (2015), Case Formulation in Cognitive Behaviour Therapy: The Treatment of Challenging and Complex Cases. Routledge.Google Scholar
Goddard, E, Wingrove, J, Moran, P (2015). The impact of comorbid personality difficulties on response to IAPT. Behaviour Research and Therapy 73, 1–7.Google Scholar
Improving Access to Psychological Therapies (IAPT) Executive Summary (November 2016). NHS Digital, ISBN 978-1-78386-946-6.Google Scholar
Martell, CR, Dimidjian, S, Herman-Dunn, R (2010). Behavioral Activation for Depression: A Clinician's Guide. Guilford Press: New York.Google Scholar
McKay, D, Sookman, D, Neziroglu, F, Wilhelm, S, Stein, DJ, Kyrios, M, Matthews, K, Veale, D (2015). Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Research 227, 104–113.Google Scholar
Meyer, TD, Hautzinger, M (2012). Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year follow-up. Psychological Medicine 42, 1429–1439.CrossRefGoogle ScholarPubMed
National Collaborating Centre for Mental Health (2005) Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder (clinical guideline CG31), British Psychological Society and Royal College of Psychiatrists. Available at: https://www.nice.org.uk/guidance/CG31 (accessed 12 September 2017).Google Scholar
National Institute for Health and Care Excellence (NICE) (2009). Clinical guideline CG90, Depression in Adults: Recognition and Management. Available at: nice.org.uk/guidance/cg90 (accessed 12 September 2017).Google Scholar
Rittel, HWJ, Webber, MM (1973). Dilemmas in a general theory of planning. Policy Sciences 4, 155–169.Google Scholar
Tarrier, N, Johnson, J (eds) (2015). Case Formulation in Cognitive Behaviour Therapy: The Treatment of Challenging and Complex Cases. Routledge.Google Scholar
Waller, G, Turner, H (2016). Therapist drift redux: why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behaviour Research and Therapy 77, 129–137.CrossRefGoogle ScholarPubMed
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