ABSTRACT
Although theories about the aetiology, precipitation and maintenance of depression differ from each other, the treatment techniques predicted to be effective by the various models tend to converge. That is not to say that there are only a few methods used. On the contrary, I shall list over twenty techniques which have been applied, usually grouped in some multifaceted procedure, to clinically depressed patients. But each of these techniques could be argued to be affecting a subsystem of several of the psychological models outlined in Chapters Two and Three. In this chapter I should like to overview these procedures and the evidence for their effectiveness. In addition, I wish to discuss three other issues. First, the supposed commonality in procedures and in the factors mediating recovery. Second, the evidence for whether there exist any indications and contra-indications for the use of cognitive-behaviour therapy with depressed patients, or any evidence on which technique to use with which patient. Finally, the relationship of cognitive-behaviour therapy to pharmacotherapy will be discussed. In an early paper Whitehead (1979) outlined four general, though distinct, rationales from which cognitive and behavioural strategies were derived:
That the depressive behaviour per se constitutes the disorder and can be modified by suitable manipulation of reinforcers.
That depressive behaviour is a result of (or is maintained by) a reduced rate of positive reinforcement and that this reinforcement should be reinstated by a suitable manipulation.
That depressed individuals fail to respond because they believe themselves to lack any control over their environment. Treatment should be directed towards demonstrating their capability for such control.
That depression results from people's negative view of themselves and their circumstances and treatment is directed towards correcting this misconception.
