Cognitive approach for depression

• what does cognitive mean?

  ways in people feel
• what is depression?

  a mental disorder which causes sufferers to experience chronic low mood + energy levels
• what does the latest version of DSM categorise about depression?

  • major depressive disorder - severe but short term
  • persistent depressive disorder - long term/ recurring including sustained major depression (dysthymia)
  • disruptive mood dysregulation disorder - childhood temper tantrums
  • premenstrual dysphoric disorder - disruption to mood prior and /or during menstruation
• what are behavioural characteristics of depression?

  1. Activity levels - reduced levels of energy making them lethargic = withdrawals from work , education
  2. Disruption to eating and sleeping behaviour - insomnia + premature waking , hypersomnia , weight gain + loss
  3. aggression + self-harm - irritability
• what is psychomotor agitation?

  depression can lead to opposite effect of reduced activity levels where agitated individuals struggle to relax and may end up pacing up and down
• what are emotional characteristics of depression?

  1. Lowered mood - sadness alongside low self -esteem (worthlessness + emptiness)
  2. Anger - can be directed at self or others involving physical or self-harming behaviour (hence falls under behavioural aswell)
  3. Lowered self-esteem - extreme e.g self hate
• what are the cognitive characteristics of depression?

  1. Poor concentration - interference with work
  2. Dwelling on the negative - focused on negative = ignoring positive , bias on recalling positive events
  3. Absolutist thinking - black and white thinking
• what is a negative triad as an explanation for depression?

  Beck proposed a cognitive approach that contribute to becoming depressed which include 3 kinds of negative thinking

  1. view of world (no hope anywhere)
  2. view of future (reduce any hopefulness )
  3. view of self (enhance existing depressive feelings as they confirm existing emotions of low self-esteem)
• according to Beck, why is having a negative self-schema bad?

  they interpret all info about themselves in a negative way
• what is Ellis's approach to depression?

  he proposed a cognitive explanation that good mental health is the result of rational thinking as conditions such as anxiety and depression result from irrational thoughts
• how did Ellis define irrational thoughts?

  not as unrealistic and illogical thoughts but any thoughts that interfered with us being happy and free from pain
• how did Ellis use the ABC model to explain how irrational thoughts affect our behaviour and emotional state?

  A - Activating event

  irrational thoughts are triggered by a negative external event

  B - Beliefs

  the activating event leads to a range of irrational beliefs ('musturbation' and utopianism)

  C - Consequences

  when an activating event triggers irrational beliefs there are emotional and behavioural consequences
• what is 'musturbation'?

  belief that it is a major disaster when something does not go a certain way (catastrophising)
• what is utopianism?

  belief that life is always meant to be fair
• Strength: Beck's triad

  P - existence of supporting research

  E - Clark and Beck concluded that not only were cognitive vulnerabilities more common in depressed people but they preceded the depression

  E - shows there is an association between cognitive vulnerability and depression

  L - supports Beck's cognitive model of depression as a valid explanation for depression
• what is faulty information processing proposed by Beck?

  a cognitive distortion which shows when depressed people attend to the negative aspects of a situation and ignore the positives
• what are the 3 cognitive distortions/vulnerabilities proposed by Beck?

  • faulty info processing
  • negative self-schema
  • the negative triad
• Strength: Beck's Negative Triad

  P - application in screening in addition to treating depression

  E - Cohen et al concluded that assessing cognitive vulnerability allows psychologists to screen young people to identify those at high risks of developing depression in the future and monitoring them

  E - psychologists can prevent / treat the development of depression within young people

  L- understanding cognitive vulnerability useful in more than one aspect of clinical practice other than treatment =more effective
• Strength : ABC model

  P - real-world application in the psychological treatment of depression

  E - David et al provides evidence that REBT can both change negative beliefs and relieve symptoms of depression

  E - therapist can alter the irrational beliefs that are making the patient unhappy which can relieve their symptoms of low mood, reducing the severity of their depression

  L - REBT has real world value
• Limitation : ABC model

  P - only explains reactive depression and not endogenous

  E - for example , depression after a family member has died is classed as reactive depression as it is expected . Ellis would call this as the 'activating event'

  E - however not many cases are traceable back to a triggering event and the cause for the depression is not obvious - endogenous depression

  L - Ellis's model of depression is only a partial explanation as it is less useful for explaining other cases of depression
• what can cause a negative self schema ?

  • loss of parent (abandonment ,death)
  • rejection of peers
  • criticism by parents + teachers
  • physical + emotional abuse
• what is cognitive behavioural therapy?

  most commonly used psychological treatment for depression which aims to directly identify irrational and negative thoughts and to challenge these with more rational and positive thoughts
• what is the cognitive element of CBT?

  begins with an assessment where the client and therapist identify the problem and put together a plan e.g to identify where negative and irrational thought stem from
• what is the behaviour element of CBT?

  putting effective behaviours into place to change negative and irrational thoughts
• what is the central component of Beck's cognitive therapy for depression?

  challenging irrational and negative thoughts once identified to help the client test the reality of their negative beliefs (the negative triad)
• why does the cognitive therapist for depression gather evidence of their negative beliefs + thoughts ?

  to prove the client's statement is incorrect
• what does REBT extend ABC model to and why?

  ABCDE D=dispute and E= effect

  This is a treatment for depression developed by Ellis where the central technique of REBT is to identify and dispute irrational thoughts
• what did Elli's REBT consist of?

  REBT therapist would identify the irrational belief which would involve a vigorous argument which intends to change the person's irrational belief = link between negative life events and depression is broken
• what were some different methods of disputing Ellis came up with?

  Empirical - disputing whether there is actual evidence supporting IB

  Logical - disputing whether the IB logically follows facts
• what is the goal of behavioural activation?

  gradually decrease the individuals avoidance and isolation to increase their engagement in activities whihc improve mood e.g exercising
• Strength of CBT:

  P - lots of evidence supporting its effectiveness as a treatment of depression

  E - John March et al compared CBT to antidepressant drugs CBT group

  1. 81% -Antidepressants
  2. 81% - CBT
  3. 86% - combo all signif improved

  E - CBT just as effective + even more so when combined

  L - CBT widely seen as 1st choice of treatment to public health care systems e.g NHS
• Limitation of CBT:

  P - lack of effectiveness for severe cases + clients with learning disabilities

  E - Sturmey suggests that any form of psychotherapy is not suitable for this with LD

  E - bc some cases are very severe so indi cannot engage with CBT nor pay attention + complex rational thinking of CBT unsuitable for those with LD

  L - only be appropriate for a specific range of people
• Limitation of CBT:

  P - high relapse rates = higher costs

  E - cs assessed depression in 439 clients , 42% relapsed into depression within 6m and 53% within 12m

  E - benefits nto guaranteed to last long term do may be only effective for short-term

  L - CBT may need to be repeated periodically which may make it less cost-effective
• what are the 4 stages for CBT?

  1. Initial assessment
  2. Goal setting
  3. Identifying and challenging irrational thoughts
  4. Homework