Depression

• The cognitive approach looks at how irrational thinking can lead to mental disorders.
• There are two examples of the cognitive approach, created both by Americans in the 1960s: Albert Ellis and Aaron Beck.
• Aaron Beck’s Negative Triad:


  Negative views about the world -> Negative views about the future -> Negative views about oneself
• Aaron Beck’s negative triad implies that depressed people have acquired a negative schema in childhood causing them to have a negative outlook on their life.
• The Self: “I’m undesirable”

  The World: “I understand why everyone hates me, everyone else is so much better than me“

  The Future: “ Things will never change for me”
• Beck suggests three parts to this Cognitive vunerability for depression…


  1. Faulty information processing - always seeing negatives rather than positives
  2. Negative self-schemas
  3. The negative triad
• Ellis’ ABC model:

  Negative event (A) -> Irrational belief (B) -> Unhealthy negative emotion (C)

  Negative event (A) -> Rational belief (B) -> Healthy negative emotion (C)
• A is for activating event - this triggers the irrational belief, and it is important to note that it is not the event that causes the depression.
• B is for belief - these can be rational or irrational, irrational beliefs can lead to depression.
• C is for consequence - Rational beliefs lead to healthy emotional outcomes whereas irrational beliefs lead to unhealthy emotional outcomes.
• Ellis’ Mustabatory Thinking:


  Thinking that certain ideas or assumptions must be true for an individual to be happy.
• The three most common examples of Mustabatory Thinking according to Ellis are…

  • I must be approved of and accepted by people I find important
  • I must do well or I am worthless
  • The world must give me happiness or I will die
• Strengths of the cognitive approach for depression:

  • Supporting research (Hammen and Krantz found that depressed patients made more errors in logic when asked to interpret material than not depressed patients) (Bates et al found depressed people who were given negative automatic thought statements became more depressed)
  • Practical applications (CBT)
• Limitations of the cognitive approach for depression:

  • Blames the patient for their disorder
  • Irrational beliefs may be realistic (Alloy and Abrahamson suggest that depressed people tend to have more accurate estimates of the world)
  • There can be realistic stressors that cause depression (e.g. losing your job)
  • It’s an incomplete explanation - only explains reactive depression, other forms can include hallucinations and mania which are not explained in this approach.
• The biological approach for depression has strong evidence that the disorder is linked to neurotransmitters and genes. Zhang et al found low levels of serotonin in those with depression.
• A cognitive treatment for depression is Cognitive Behavioural Therapy, and it aims to challenge irrational and maladaptive thought processes in their patients.
• CBT focuses on…

  • Affect - how the client feels
  • Behaviour - how the client acts
  • Cognition - how the client thinks
• Albert Ellis created a form of CBT known as Rational Emotional Behavioural Therapy (REBT), aiming to change irrational thoughts into rational ones.
• Ellis extended his ABC model to ABCDEF.
• In the ABCDEF model, Ellis added in three more stages. These were…

  • D - disputing irrational thoughts and beliefs
  • E - effects of disputing irrational thoughts and an effective attitude to life
  • F - the new feelings produced
• How to challenge irrational thoughts…

  • Logical disputing - do the beliefs logically follow the information?
  • Empirical disputing - are the beliefs consistent with reality?
  • Pragmatic disputing - are the beliefs useful to the individual?
• Both REBT and CBT therapy will set the client homework tasks to further their learning.
• Behavioural activation - the client is encouraged to become more active and take part in activities that used to be pleasurable.
• Strengths of CBT:

  • Research support - Ellis claimed a 90% success rate for REBT with an average of 27 sessions. (You have to want it to work!)
  • Support for behavioural activation - Babyak et al found that the group of depressed participants who exercised had significantly lower relapse rates than those who just took anti depressants.
• Limitations of CBT:

  • Individual differences - people who have high levels of irrational belief are less likely to respond to CBT treatment. (Elkin et al)
  • Some people don’t want a direct source of advice.
  • There may be realistic stressors, such as losing your house and having no where to live.
  • Alternative treatments - antidepressants can be used on their own or with CBT.
  • The Dodo Bird effect - Rosenzweig argued that all methods if treatment for mental disorders were equally effective.