Treatments: CBT and drugs

Introduction: Helping People Get Better

In the last few lessons, we looked at how unipolar depression and addiction can affect people's lives. Now, we are going to look at how psychologists and doctors try to help. We will focus on two main ways to treat these psychological problems: Cognitive Behavioural Therapy (CBT) and Drug Treatments.

Think of it like fixing a bike: CBT is like teaching the rider how to avoid the potholes (changing how they think and act), while drugs are like putting oil on the chain to make the bike run smoother (changing the body's chemistry). Both have their pros and cons!

1. Cognitive Behavioural Therapy (CBT)

CBT is a "talking therapy." It is based on the idea that our cognitions (thoughts) influence our behaviour (actions). If we think in a negative way, we will feel and act in a negative way.

How CBT works for Depression

For depression, the goal is to stop the cycle of negative thinking.
1. Identifying irrational thoughts: The therapist helps the patient recognize "automatic negative thoughts" (e.g., "I’m a failure because I missed one goal").
2. Disputing and Challenging: The patient is asked to find evidence that proves these thoughts are wrong.
3. Behavioural Activation: The patient is encouraged to take part in enjoyable activities to improve their mood.

How CBT works for Addiction

For addiction, CBT focuses on the "triggers" that make someone want to use a substance or engage in a behaviour (like gambling).
1. Functional Analysis: Looking at what happens right before the addictive behaviour. What is the "trigger"? (e.g., Feeling stressed at work).
2. Skills Training: Teaching the patient how to cope with those triggers without the addiction. This might include social skills (saying "no" to friends) or stress management.

Quick Tip: Remember the study by Young (2007)? That study showed that CBT can be very effective for treating internet addiction! It’s a great piece of evidence to use in your exam answers.

Evaluating CBT

Strengths:
• Long-term skills: Unlike medicine, CBT teaches patients skills they can use for the rest of their lives to stay healthy.
• No side effects: You don't have to worry about feeling sick or dizzy, which can happen with drugs.
• Empowerment: It gives the patient control over their own recovery.

Weaknesses:
• Time and Effort: It can take months of weekly sessions. It isn't a "quick fix."
• Motivation: A person with severe depression might find it very hard to even get out of bed, let alone engage in a difficult therapy session.
• Cost: Because it requires a highly trained therapist for many hours, it is expensive for the NHS to provide.

Key Takeaway: CBT aims to change the mind. It is effective but requires the patient to be an active participant.

2. Drug Treatments

Drug treatments are based on the biological explanation. They assume that psychological problems are caused by a chemical imbalance in the brain.

Drugs for Depression

The most common drugs for depression are SSRIs (Selective Serotonin Reuptake Inhibitors).
• These drugs increase the levels of a neurotransmitter called serotonin in the brain.
• Serotonin is often called the "happy chemical" because it helps regulate mood.
• By blocking the "reuptake" (the brain soaking up the chemical too fast), SSRIs leave more serotonin available for the brain to use.

Drugs for Addiction

Drugs for addiction work in different ways depending on the problem:
• Withdrawal: Some drugs help reduce the nasty physical feelings someone gets when they stop using a substance (like methadone for heroin addiction).
• Reducing Cravings: Some drugs block the "high" or the "reward" feeling in the brain, making the addiction less tempting.
• Aversion Therapy: Some drugs make the person feel physically sick if they use the substance (like certain drugs for alcoholism), which trains the brain to avoid it.

Evaluating Drug Treatments

Strengths:
• Easy to use: It is much simpler to take a pill once a day than to attend a therapy session and do "homework."
• Speed: Drugs can sometimes start reducing symptoms faster than CBT.
• Cost-effective: Generally, a pack of tablets is cheaper for the health service than paying for a therapist's time.

Weaknesses:
• Side effects: Patients might experience nausea, weight gain, insomnia, or blurred vision.
• Treats symptoms, not the cause: Drugs might make you feel better, but they don't fix the original reason you became depressed or addicted. If you stop taking the drugs, the problem often comes back (this is called relapse).
• Dependence: Some people may feel they "need" the drug to function, which can be a problem in itself.

Key Takeaway: Drug treatments aim to change the body. They are a fast and easy way to manage symptoms but don't always provide a permanent cure.

Common Mistakes to Avoid

• Mixing up the terms: Don't confuse "Cognitive" (thinking) with "Biological" (physical/drugs).
• Ignoring the patient's role: Remember that CBT requires the patient to work hard, whereas drugs are a passive treatment.
• Thinking one is "better": In the real world, doctors often use both at the same time! This is called a holistic approach.

Quick Review: Which is which?

1. Which treatment uses "Functional Analysis"? (Answer: CBT for Addiction)
2. Which treatment increases Serotonin? (Answer: SSRIs for Depression)
3. Which treatment has a risk of side effects? (Answer: Drug treatments)
4. Which treatment was studied by Young (2007)? (Answer: CBT)

Note: For more information on why some people might be more prone to these problems biologically, see the chapter on "Explanations: genes, cognitive theory, learning theory" and the study by Caspi et al. (2003).