CBT fundamentals — structured clinical viva

You are the psychiatry registrar. A 41-year-old man with recurrent major depression has partial response to sertraline 150 mg daily. He lies in bed until noon, ruminates that he is a failure, and has stopped running and seeing friends. He asks for 'CBT instead of tablets'. Discuss the cognitive-behavioural model of depression, how you would formulate and structure CBT, when behavioural activation comes first, evidence comparing cognitive therapy and antidepressants, homework, therapist drift, and how you integrate medication rather than offering a false dichotomy.