Cognitive approach to depression

• Cognitive explanations for depression

  The cognitive approach suggests that depression results from faulty cognitions and negative thinking about events
• Schemas


  • Mental framework for objects and events that work as shortcuts in understanding the world
  • Includes schemas about ourselves
  • Depression can result from our self-schemas being negative
• Beck's negative triad


  Events are seen by the sufferer with a negative bias due to the development of negative schemas about the world, the self, and the future
• Cognitive distortions in Beck's negative triad

  • Overgeneralisation- problems in one situation being seen as a problem in others
  • Magnification of problems - seeing them as more important then what they are
  • Selective perception - focusing on the negative
  • Absolutist thinking- all or nothing
• Ellis' ABC model


  • Activating event (A) is the external situation that there will be a reaction to
  • Belief (B) is why the individual thinks that the activating event happened (rational or irrational)
  • Consequence (C) is the behaviour and emotions caused by the person's beliefs about the activating event
• Musturbatory thinking


  Thinking in absolutes and that the world must be a certain way for us. Leads to unhappiness
• Support for cognitive distortions in depression: Grazioli and Terry (2002) assessed 65 pregnant women for cognitive vulnerability and depression before and six weeks after birth. They found that the women judged to have been high in cognitive vulnerability were most likely to develop postpartum depression.
• Cognitive explanations for depression have been used to develop successful and widely used CBT and REBT treatments. The success of these treatments is shown by March et al (2007). Suggests that the underlying cognitive theory that depression is due to faulty cognitions is valid as the treatment based on that idea is effective.
• March et al (2007) found CBT and medication had 81% effectiveness for depression alone, and 86% when combined
• Cognitive explanation cannot explain manic phases or anger management issues in some depressive patients
• Biological factors play a large role in depression, so cognitive explanation cannot be a full explanation
• Cognitive behavioural therapy (CBT)


  Focuses on identifying and challenging irrational thoughts, and setting activities to change behaviours
• Beck's CBT


  1. 16-20 week program focusing on present experiences and issues

  2. Trains patient in thought-catching (identifying and recording automatic negative/irrational thoughts)

  3. Challenges and reconstructs negative thoughts to avoid distortion

  4. Patient reality-tests irrational thoughts through homework and evaluation

  5. Encourages enjoyable activities to improve emotions and challenge irrational thoughts
• Rational Emotive Behavioural Therapy (REBT)


  • Develops Ellis' ABC model to ABCDE, with D being disputation of irrational beliefs, and E being effective change resulting from the changed beliefs
  • Characterised by intensive disputation (arguing against assumptions underlying irrational beliefs)
• CBT is not appropriate for severely depressed patients who are unwilling/unable to engage with the psychological work
• 16-20 sessions of CBT with a professional is a considerable investment of time and cost
• CBT empowers the patient as an engaged and active force in their own recovery

  Antidepressant medication places the patient in a passive role
• The success of CBT has likely had a positive impact on the wider economy through fewer sick days and improved productivity