IB Psychology HLTopic 1 — Prevention and TreatmentPaper 1 & 2Cognitive approach~10 min read
Using CBT to Treat Depression
This is where Beck’s model stops being a theory. If depression is held in place by the negative triad, then treatment means catching those thoughts, testing them against reality, and building better ones. That is CBT, and it is the most widely used psychological treatment for depression there is.
📘 What you need to know
CBT is the most widely used psychological treatment for depression and is a practical application of Beck’s cognitive theory.
The focus is on the here and now rather than the past.
The goal is to help clients identify, challenge and replace irrational thoughts from the negative triad, while building independence.
Techniques include cognitive restructuring, guided discovery, journalling, behavioural activation, relaxation, role-play and homework.
A course usually runs 5–20 sessions, weekly or fortnightly, each lasting 30–60 minutes.
March et al. (2007): after 36 weeks, 81% improved on SSRIs, 81% on CBT, and 86% on the two combined.
The same study found suicidal thinking decreased in the CBT and combination groups but not significantly in the SSRI-only group.
What actually happens in the sessions
Technique
What it involves
Cognitive restructuring
Turning negative thoughts into more balanced, workable ones
Guided discovery
The therapist questions irrational thoughts and beliefs rather than simply contradicting them
Journalling
Recording thoughts, feelings and behaviours between sessions so patterns become visible
Behavioural activation
Scheduling activity to get the client moving again and reduce procrastination
Relaxation techniques
Deep breathing, muscle relaxation and visualisation
Role-play
Practising difficult or anxiety-provoking situations in a safe setting
Homework
Recording positive events, which are then discussed in the next session
Guided discovery is the one worth understanding properly. The therapist does not tell the client their thought is wrong — they ask questions until the client finds the evidence themselves. That is what builds the independence to keep doing it after therapy ends.
Research support: March et al. (2007)
Aim: to compare the effectiveness of CBT, SSRIs (fluoxetine), and CBT and SSRIs combined, for treating adolescents with MDD.
Participants: 327 adolescents aged 12–17 with diagnosed MDD, from 13 locations across the USA.
Procedure: participants were randomly assigned to an SSRI group, a CBT group, or a combined group. They were interviewed and their responses measured using the Children’s Depression Rating Scale (CDRS), where a score above 40 indicated MDD was present and below 28 indicated remission. The study ran for 36 weeks.
Results: 81% improved in the SSRI group, 81% in the CBT group and 86% in the combination group. Suicidal thinking decreased in the CBT and combination groups, but not significantly in the SSRI-only group.
Conclusion: adolescents respond well to CBT and to combined therapy. Combining treatments may improve the safety of medication as well as its effectiveness.
The 5-point gap for the combination group is worth less than the finding the bars cannot show: the two treatments were equal on improvement but not equal on everything that was measured.
Read past the headline bars. If you only quote 81 / 81 / 86, the obvious conclusion is that it barely matters which treatment you choose. The safety finding changes that conclusion completely, and it is the reason the study is still cited. A good answer uses both results together.
Evaluation of CBT for MDD
Strengths
Non-invasive. There are no drugs and no side effects, unlike biological treatments.
Individualised. Sessions can be tailored to the client, letting them progress at their own pace and accounting for individual differences.
It targets causes. By changing the thought patterns that maintain depression, it offers protection against relapse rather than only lifting current symptoms.
Strong evidence. March used random allocation, a standardised rating scale with clear cut-off scores, 13 sites and a 36-week follow-up.
Limitations
The here-and-now focus may not suit everyone. People who need to work through past trauma to recover may not be well served by a present-focused therapy.
It requires certain skills. Some people struggle with talking therapies due to lack of confidence, willingness, or verbal and intellectual demands, which limits how useful it is for all.
Access and cost. Trained therapists, appointment time and waiting lists are real barriers, whereas a prescription is not.
Culture bias. The focus on individual thinking patterns and one-to-one therapy may not reflect how depression is experienced or treated in collectivist cultures.
Self-report and rating scales introduce social desirability bias and practice effects over a long study.
EXAM QUESTION
Compare and contrast two treatments for one disorder. [22]
This is the question the whole sub-topic has been building towards, and March gives you the evidence for both sides in one study.
Step 1: outline both treatments brieflySSRIs and the reuptake mechanism; CBT and the negative triad. Two or three sentences each.Step 2: compare on effectiveness using March81% / 81% / 86% after 36 weeks, plus the difference in suicidal thinking.Step 3: contrast on the practical dimensionsCost, access and waiting lists favour drugs. Side effects, relapse prevention and addressing causes favour CBT.Step 4: bring in reductionismDrugs work at the biological level, CBT at the cognitive level. Combining them is closer to a holistic approach.Conclusion the evidence actually supports: combined treatment
Link to concepts
Measurement
March’s study was longitudinal, running over 36 weeks, so progress could be measured at set points against a baseline. That gives it good ecological validity, because real change was tracked over real time rather than in a single snapshot. The trade-off is that participants were self-reporting on a rating scale, which invites social desirability bias and a practice effect as they got used to filling in the same questionnaire.
Change
Depression is not a stable, lifelong condition, and this study reflects that: the same young people were measured repeatedly because the disorder shifts. Any treatment judged on a single measurement risks catching a moment rather than a trend.
💡 Exam tip
Name the CDRS and its cut-off scores. Precise measurement detail is exactly what “evaluate the methodology” questions want.
Always report the safety finding alongside the 81 / 81 / 86 figures.
Learn the session structure (5–20 sessions, 30–60 minutes). It is concrete and easy to include.
Random allocation across 13 sites is a genuine design strength. Say why it matters.
The sample was adolescents only, so be careful generalising to adults.
Use the reductionism page to frame your conclusion. Combined treatment is the practical form of holism.
⚠ Common mix-up
Saying CBT beat SSRIs on improvement. They tied at 81%.
Confusing the CDRS cut-offs. Above 40 means MDD present, below 28 means remission.
Describing CBT as focused on childhood. It works on the here and now.
Calling CBT “not invasive” and stopping there. Explain why that matters: no drugs, no side effects.
Generalising adolescent results to everyone. The sample was 12 to 17 year olds.
Forgetting homework. Work between sessions is a defining feature of CBT, and drop-out often starts there.
This topic deals with real and difficult experiences. If any of it feels close to something you are going through, talking to someone you trust, a school counsellor or a doctor is a good next step — and it is exactly what the research on this page supports.
That completes Topic 1: Health and Wellbeing. A good revision route is to work back through the three sub-topics as one argument — what causes a disorder, how common it is, and what we do about it. Start again at How Genes Contribute to Depression and see how much more of it clicks the second time.
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