PSY 3310 Module 2 Cognitive, Behavioral and Biological Approaches Paper: CBT, Medication and Depression Example

Thoughts, Actions or Pills? Comparing Treatments for a Client With Depression

Student Name

Bachelor of Arts in Psychology, Thomas Edison State University

PSY-3310: Clinical Interventions and Disorders

Mentor Name

Month Day, Year

Thoughts, Actions or Pills? Comparing Treatments for a Client With Depression

Introduction

A client at our center, whom I will call Terrence, a composite of several clients with details changed, is a 34-year-old bus driver who for two months has felt down, slept badly, lost interest in hobbies and struggled to focus. His primary care doctor suggested an antidepressant; his sister urged him to see a therapist. He asked me, in the waiting room, which was better. I could not answer as a case aide, but the question is central to this module. This paper explains three approaches to treatment and what research says about choosing among them.

The Behavioral Approach

Behavioral approaches focus on observable behavior and the conditions that maintain it. In depression, people often withdraw from activities that once brought pleasure or a sense of accomplishment, which cuts off sources of reward and lets the low mood deepen. Behavioral activation helps clients schedule and gradually increase meaningful activities, tracking how mood changes. In anxiety disorders, exposure therapy helps clients face feared situations step by step until fear declines.

The Cognitive Approach

Cognitive approaches, developed by Aaron Beck and others, propose that distorted, negative thinking patterns maintain emotional problems. A depressed person might think, "I'm a failure; nothing will get better." Cognitive therapy teaches clients to notice these automatic thoughts, test them against evidence and develop more balanced alternatives. Cognitive behavioral therapy combines these cognitive techniques with behavioral methods such as activation and skills practice, and it is typically structured, time-limited and focused on present problems.

The Biological Approach

Biological approaches treat mental disorders as conditions involving the brain and body, and use medication and other physical treatments. Antidepressants such as selective serotonin reuptake inhibitors alter neurotransmitter activity and are widely used for moderate to severe depression. Biological views also emphasize genetic vulnerability and the effects of stress on brain systems.

How Well CBT Works

Hofmann et al. (2012) examined 269 separate meta-analyses covering CBT for a wide range of problems. Support was strongest for anxiety and somatoform conditions, bulimia, problems with anger and everyday stress. CBT generally performed better than control conditions and, in many comparisons, as well as or better than other treatments. The authors noted that the quality of studies varied and that fewer trials examined some populations, such as low-income groups.

Cognitive Therapy Versus Medication

DeRubeis et al. (2005) randomly assigned 240 adults with moderate to severe depression to 16 weeks of cognitive therapy, 16 weeks of the antidepressant paroxetine or eight weeks of a placebo pill followed by medication. At eight weeks, both active treatments outperformed placebo. By 16 weeks, response rates for cognitive therapy and medication were the same, 58 percent. The effectiveness of cognitive therapy depended on the experience of the therapists: it was strongest at the site with more experienced cognitive therapists. The trial challenged the belief that more severe depression requires medication.

CBT Compared With Other Treatments

Cuijpers et al. (2013) meta-analyzed 115 studies of CBT for adult depression. CBT produced a moderate to large effect compared with control conditions, though the effect was smaller after adjusting for likely publication bias. CBT did not differ significantly from other psychotherapies or from medication, and combining CBT with medication was more effective than medication alone.

Weighing the Options for Terrence

The evidence suggests that both cognitive therapy and medication are effective for moderate depression, and that combining them may produce better results than medication alone. Other factors matter: Terrence works split shifts, which may make weekly sessions hard; he is worried about side effects that could affect alertness while driving; and he prefers to "understand what's going on." These preferences point toward CBT, perhaps with medication if he does not improve.

Durability and Relapse

Research beyond these sources suggests that people who recover through cognitive therapy may have lower relapse rates after treatment ends than those who stop medication, because they keep the skills they learned. This consideration matters for a condition that often recurs.

Shared Decision-Making

The choice belongs to the client, guided by clinicians who explain the evidence, the time commitment, side effects and costs of each option. At our center, the intake clinician reviews these options with clients and coordinates with primary care physicians when medication is considered.

Behavioral Activation as a Simpler Option

Research has also tested whether the behavioral part of CBT is enough on its own. In some trials, behavioral activation alone performed about as well as full cognitive therapy for depression, which matters because it is simpler to learn and can be delivered by clinicians with less training. For a busy community center, a behavioral activation group could reach more clients than individual cognitive therapy.

Side Effects and Safety

Medication and therapy carry different risks. Antidepressants may upset the stomach, disturb sleep or affect sexual function, and young adults need monitoring for increased suicidal thinking early in treatment. Therapy has fewer physical side effects but requires time, effort and sometimes discomfort, such as facing avoided situations. Explaining these differences honestly is part of informed consent.

Measuring Progress

Whichever path Terrence chooses, his clinician would track symptoms with a brief depression questionnaire at each visit. If his scores have not improved after six to eight weeks, guidelines suggest changing or adding treatment rather than waiting longer.

Limits

Trials enroll carefully selected participants who may differ from community clients. Therapist skill varies, as DeRubeis and colleagues found. Terrence is a composite, not a real person.

Conclusion

Hofmann and colleagues showed that CBT is well supported across many conditions, DeRubeis and colleagues showed that cognitive therapy can match medication for moderate to severe depression and Cuijpers and colleagues found CBT comparable to other treatments, with combination treatment beating medication alone. For a client like Terrence, the evidence supports either path, and his preferences, schedule and concerns can guide the choice.

References

Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58(7), 376-385. https://doi.org/10.1177/070674371305800702

DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., O'Reardon, J. P., Lovett, M. L., Gladis, M. M., Brown, L. L., & Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62(4), 409-416. https://doi.org/10.1001/archpsyc.62.4.409

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440. https://doi.org/10.1007/s10608-012-9476-1