Cognitive approach explaining and treating depression Flashcards
Depression
Depression can be defined as ‘a mood disorder that causes a persistent feeling of sadness and loss of interest’.
We all experience low mood from time to time but this does not necessarily amount to depression. The symptoms of depression are complex and will vary greatly between individuals. Generally speaking, individuals with depression feel sad, hopeless and lose interest in activities they once enjoyed.
The cognitive approach to explaining depression
The cognitive model of abnormality is based on the idea that irrational thoughts and beliefs are the cause of abnormality. Irrationally negative thinking has been suggested as the cause of depression.
There are two examples of specific cognitive explanations of depression: Ellis’ ABC model and Beck’s negative triad.
Ellis’s ABC model
Ellis used the ABC model to explain how irrational thinking affects our emotional state and our behaviour.
A refers to an ACTIVATING EVENT
B is the BELIEF SYSTEM which may result in a rational or
irrational belief
C is the CONSEQUENTIAL EMOTION which may be healthy or unhealthy
For example, if an individual fails an important exam (A) but believes that they must always succeed and that this is a major disaster (B), this will lead them to feel badly about themselves/depressed (C).
It is important to remember that it is not the activating event that is responsible for the development of depression but the way the individual perceives or thinks about that event.
Ellis suggested that an irrational belief system lies in thoughts that are focussed on ideas such as ‘should’, ‘ought’, ‘must’ and are associated with the feeling that we are not quite reaching perfection.
I ought to be a better friend
I must get an A* in this exam
I should be earning more money
Beck’s negative triad
Beck suggested that depressed individuals feel as they do because their thoughts are biased towards negative interpretations of their lives and feel as if they have no control.
The person develops a negative view of their lives because of three types of negative thinking – the negative triad. This triad that Beck refers to is a pessimistic and irrational view of three key elements in a person’s belief system:
1. Negative views about oneself
2. Negative views about the world
3. Negative views about the future
Beck suggested that this pessimistic and irrational view comes from negative schemas and cognitive biases.
Depressed people have developed a tendency to adopt negative schemas. A schema is a ‘package’ of ideas and information about a particular thing developed through experience. Schemas help us to interpret the world but they can lead us to make over-generalisations and sweeping conclusions (cognitive biases).
In childhood, negative schemas develop providing a negative framework for viewing events pessimistically. In adulthood these become biases such as overgeneralisation (after failing one psychology test, the response is ‘I will never be able to do psychology) ; magnification (making a mountain out of a molehill); selective perception (paying attention only to those things that support the negative schema)
For example, as a child you may be told by your teachers that you are useless and therefore adopt a negative self-schema. Due to this negative schema, all new information about ourselves will be interpreted in a negative way. Even when we are faced with positive feedback, this information is either ignored or interpreted in a way that ‘fits’ our schema.
Evaluation of the cognitive approach to explaining depression, strength
A strength of this approach is that it has evidence to support it. For example, Grazioli and Terry (2000) assessed pregnant women for cognitive vulnerability (negative cognitive biases) and depression before and after giving birth. They found that those women judged to be high in cognitive vulnerability were significantly more likely to suffer from post natal depression. This supports the cognitive approach as it demonstrates a link between distortions in thinking and depression
Another strength is that the cognitive approach has generated a successful therapy as a practical application. Cognitive Behavioural Therapy attempts to correct irrationally negative thoughts and replace them with more positive, rational thoughts. This is a strength because it is an effective therapy for depression and so it supports the idea that irrationally negative thinking is the cause of this disorder (as well as helping the economy!).
Evaluation of the cognitive approach to explaining depression, weakness
However, a weakness of the cognitive explanation of depression is that it cannot explain all depression. For example, the symptoms of bipolar depression include periods of mania, major depressive disorder is often associated with periods of anger. The cognitive approach cannot effectively explain the links with mania and anger and only focuses on explaining the downturn in mood . Furthermore, another weakness is that it is very difficult to determine cause and effect between an individual’s thought processes and depression. It is not clear whether irrationally negative thinking is the cause of depression or the result of depressive behaviour. For example, a depressed person might not have had negative thoughts before but being depressed might make them interpret events negatively. These are both weaknesses because the cognitive approach might not be explaining depression fully.
This approach could be criticised for being limited as it cannot account for the wealth of biological evidence that might explain also depression i.e. low levels of serotonin. Nor can it account for the evidence that suggests the environment might cause depression, i.e. those living in inner cities are more likely to suffer from depression . It is more likely that several factors are involved in causing an individual to become depressed, thoughts and beliefs being only one of the contributory factors. This is a weakness as it means that it cannot offer a complete explanation of depression.
Cognitive behaviour therapy (CBT)
CBT aims to treat depression by altering the irrationally negative thoughts that the cognitive approach believes create the condition. It sets out to help the person to have more rational and positive thoughts and in doing so, helps to improve their emotions and thus their behaviour.
Stage 1 of CBT: identifying irrational thoughts
Technique 1: Thought catching
CBT begins with a thorough assessment in which the patient and the therapist work together, through verbal discussions, to clarify the patient’s problems and identify patterns of negative and irrational thinking. Sometimes this is referred to as ‘thought catching’. They identify goals and put together a plan to achieve them.
A form of CBT based on Beck’s negative triad involves the therapist identifies and challenges automatic thoughts about the world, the self and the future. The therapist often sets homework assignments to encourage the person to try to deal with real-life situations and concentrate on changing their irrational beliefs to more realistic ones. For example, the client could be asked to keep a thought diary to identify where negative thinking is occurring and, can later be used as to evidence on which to evaluate their thoughts
Stage 2 of CBT: Challenging irrational thoughts
Once the patient’s problems and irrational thought processes have been identified the therapy works to challenge and dispute these irrational thoughts by gathering evidence of their truth.
Ellis’ ABC model can be extended to ABCDEF in a form of CBT called Rational Emotive Behavioural Therapy (REBT). D refers to DISPUTING irrational thoughts and beliefs E refers to the EFFECTS of disputing these thoughts F is the new FEELINGS (emotions) that are produced
For example, the patient might talk about how unlucky they have been or how unfair things seem. The therapist helps the person to examine and dispute these beliefs to find out if they are rational – reflect reality. The patient’s thoughts (or hypotheses) are rationally confronted by disputing them.
Technique 2: Disputing
There are three methods of disputing:
- They consider whether there is any evidence for their thoughts and beliefs in a
process of empirical disputing (e.g. ‘do you have any examples of times when you have suffered bad luck?’), - Whether they are useful beliefs in pragmatic disputing (e.g. ‘does considering yourself an unlucky person help you in any way?’)
- Whether they are sensible ways to think in logical disputing (e.g. ‘is it reasonable to think that your life is particularly unfair?’.
Effective disputing allows the person to move from catastrophising (‘No one will ever like me’) to more rational interpretations of events (‘my friend was probably thinking about something else and didn’t even see me’.) This in turn helps them to feel better, and eventually become more self-accepting
Stage 3 of CBT: Practising new thoughts and behaviours to change thinking
Technique 3: Role Play
The therapist role plays situations during the therapy sessions to help the person try to challenge their typical ways of thinking and to practise replacing irrational thoughts with more rational ones.
Technique 4: Behavioural Activation
The idea behind this is to identify mood triggers, what activities make us feel sad or happy, and then encourage the client to engage in behaviours that ‘lift’ mood. The therapist might a set the client goals to increase their social contact and engage in activities that they used to enjoy. For example, a client might have previously enjoyed going to the gym, but may have stopped going as their depression worsened. The therapist might suggest re-joining and attending once a week, to help with improving their mood and increasing their social network.
Evaluation of CBT, effectiveness
A strength of the therapy is that research has shown that it is an effective treatment for depression. One study compared 327 adolescents aged between 12 and 17 suffering from major depression. The effects of CBT were compared with a drug therapy. 80% of the participants responded well to both treatments showing that CBT is as effective a treatment as drug therapy. Furthermore, Smith and Glass (1977) did a meta-analysis of therapies and found that CBT had the second highest success rate out of 10 different therapies (second to SD).This is a strength because CBT might be a better option than drug treatments in some cases.
A weakness of the therapy’s effectiveness is that how effective is seems to be could only be down to the quality and competence of the therapist. Research has shown that as much as 15% of the variance in outcome may be attributable to therapist competence. This is a weakness because, depending on the therapist, CBT may help some individuals with depression but others will have less success.
Evaluation of CBT, appropriateness
A weakness of the therapy is that it may not be an appropriate therapy for all people with depression. CBT is a therapy that requires a considerable amount of motivation and effort on the part of the individual being treated. The process of challenging thoughts and beliefs is difficult and takes time. Also, as it is a ‘talking cure’ it may not be appropriate for all clients, as they need to have the ability to rationalise and talk about their thoughts and feelings. For those suffering from severe depression it might be very difficult to complete CBT without combining it with medication. This is a weakness because some individuals are not able to cope with the demands of the therapy so it is not always of value.
Further to this, there are alternative treatments for depression. Drug therapies (e.g. anti-depressants) require little motivation and effort on the part of the individual with depression. If an individual is highly distressed and cannot focus on the demands of CBT, it might be beneficial to use anti-depressants alongside CBT for the best outcome. This is a weakness because CBT alone may not be appropriate for all sufferers.
A further weakness of the therapy is that it ignores the circumstances in which a patient is living e.g. poverty, poor housing. The therapy focuses so closely on what is happening in the mind of the individual it may fail to appreciate the impact of the person’s environment and the significance of activating events. This is a weakness because CBT might demotivate people to change their situation. Something that could be helpful and address what is really causing their problems.
