CBT for difficult-to-treat depression: self-regulation model

Barton, Stephen; Armstrong, Peter V.; Robinson, Linda; Bromley, Elizabeth H. C.

doi:10.1017/s1352465822000273

Cited by 3 publications

(3 citation statements)

References 93 publications

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“…A coloured dot indicates that the relevant component was delivered in that session. The components were derived from the self-regulation model of depression (Barton et al, 2023), delivered in the amount and sequence indicated by the emerging case formulation, not a pre-set protocol. More than one component could be delivered in any particular session.…”

Section: Process Of Therapymentioning

confidence: 99%

“…He requested further therapy to address the conflictual relationship with his father, and this article describes a subsequent long-term course of CBT that used a trauma focus to address this. In David's case, an individualised formulation was developed using the self-regulation model of depression (Barton and Armstrong, 2019;Barton et al, 2022;Barton et al, 2023). This sought to explain how historical trauma contributed to the triggering and maintenance of David's depressive episodes, through its impact on his self-identity.…”

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confidence: 99%

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Recurrent depression and relational trauma: a single case of memory processing

Barton,

Armstrong,

Meares

et al. 2024

tCBT

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Cognitive behavioural therapy (CBT) is an effective treatment for depression, but a significant minority of clients are difficult to treat, including those with histories of relational trauma. The model of Beck et al. (1979) proposes that adverse childhood experiences lead to negative core beliefs, and these create a susceptibility to depression. However, Beck’s model does not identify trauma as a subset of adverse experiences. An alternative view is that traumatised clients internalise conflicting representations of self and it is conflict, interacting with trauma memories, that creates a vulnerability for depression. In this formulation, methods from the treatment of post-traumatic stress disorder (PTSD) could be incorporated into the treatment of depression, to emotionally process trauma memories and resolve self-identity conflicts. The aims of this study were to: (1) report the treatment of a 67-year-old man with recurrent depression and a history of prolonged relational trauma, and (2) to explore how memory processing from the treatment of PTSD can be incorporated into the treatment of recurrent depression. A single case observational design was used in the long-term treatment of a depressed traumatised client. The client received 47 individual sessions over 19 months in routine clinical practice in a tertiary CBT service. He completed repeated measures of mood, memory intrusions and sleep disruption. The client responded well to treatment with clinically significant improvements across measures of mood, memory and sleep. The effects were sustained over an 18-month follow-up. Memory processing was successfully integrated into a high-intensity treatment for recurrent depression. This is a promising approach for depressed clients with histories of relational trauma. Key learning aims (1) To consider how imaginal reliving can be incorporated into CBT for recurrent depression, when relational trauma is present. (2) To consider the cognitive processing mode of depressed traumatised clients when appraising beliefs about self and others. (3) To consider vulnerability to depression based on intrusive memories and conflicting self-representations, not only core beliefs.

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Section: Process Of Therapymentioning

confidence: 99%

mentioning

confidence: 99%

Recurrent depression and relational trauma: a single case of memory processing

Barton,

Armstrong,

Meares

et al. 2024

tCBT

Self Cite

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show abstract

“…In CBT terms, depression initially forged ahead with the development of Beck’s cognitive therapy, but subsequently lagged behind possibly because of lags in theory development. Stephen Barton’s article (Barton et al ., 2023) considers CBT for difficult-to-treat depression and provides a theoretical context. Theory is also a major feature of the article from Mark Freeston (Freeston, 2023) considering how best to apply theory to generalised anxiety disorder.…”

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confidence: 99%