Depression

• Cognitive Approach to Explain Depression

  Ellis’s ABC model (1962) and Beck’s Negative Triad (1967)
• Ellis’ ABC Model

  A – Stands for activating event which may be a trigger or something happening in the environment.

  B – Stands for beliefs and this is the belief the person holds about the event or situation that has just occurred. This may be rational or irrational.

  C – Stands for the consequence and this is the consequence of what the persons belief is. In the context of depression, this is the emotion they experience although it can also affect behaviour.
• Mustabatory thinking

  believed to play a role in irrational beliefs as they form expectations for individuals and failure to meet these expectations results in negative thoughts which lead to disorders such as depression.
• behavioural characteristics of depression

  • reduction in activity levels
  • disruption to sleep and eating behaviour- loss of appetite
  • aggression and self harm
• emotional characteristics of depression

  • lowered mood
  • lowered self esteem
  • anger
• cognitive characteristics of depression

  • poor concentration
  • attending to and dwelling on the negative
  • absolutist thinking/ ‘black and white thinking’
• Aaron Beck (1967) proposed the

  cognitive explanation as to why

  some individuals are more

  vulnerable to depression than

  others.

  Beck suggested an individual's

  cognition creates this vulnerability
• Beck’s 3 part explanation

  1. Faulty information process- Cognitive Bias
  2. Negative Self Schema
  3. The Negative Triad
• 1. Faulty Information Processing

  when individuals with depression tend to focus on the negative aspects of a situation and ignore the positive.

  
  

  
  

  They are prone to distorting and misinterpreting information, a process known as cognitive bias.

  
  

  Beck detailed numerous cognitive biases, two of which include: over-generalisations and catastrophising.
• catastrophising

  exaggerating a minor setback and believe that it’s a complete disaster
• 2. Negative Self Schema

  People use schemas to interpret the world around them therefore, if a person has a negative self-schema they interpret the information about themselves in a negative way.

  
  

  
  

  could lead to cognitive biases
• 3. The Negative Triad

  1. Negative view of the world.
  2. Negative view of the future.
  3. Negative view of self.
• Beck’s Negative Triad Strengths

  • Strong supporting research. David Clark and Aaron Beck (1999) concluded that not only were cognitive vulnerabilities more common in individuals with depression but also preceded the depression.

  
  

  • Joseph Cohen et al (2019) who tracked the development of 473 adolescents, regularly measuring cognitive vulnerability. It was found that showing cognitive vulnerability predicted later depression.

  
  

  • Real world application. Allowed psychologists and therapists to understand cognitive vulnerability and apply it in treatments such as

  CBT.
• Beck’s Negative Triad Weaknesses

  
  

  • Beck's Cognitive Model only provides a partial explanation.There are some aspects of depression that are not particularly well explained by cognitive explanations.
  • 
    
  • Alternative explanations: Biological explanation suggests gene for neurotransmitter serotonin is 10x more common in individuals with Depression (Zhang et al 2005.)
  • 
    
  • Not all irrational thoughts are irrational. Alloy & Abrahamson (1979) found that depressed people had the 'Sadder but Wiser effect' where they gave more accurate estimates of the likelihood of disaster than those not depression.
• Ellis (1962) suggested a different

  cognitive explanation of depression.

  He proposed that good mental health

  is the result of rational thinking ,

  defined as thinking in ways that allow

  people to be happy and free from

  pain.
• Ellis’ ABC Model

  1. Activating Event
  2. Beliefs
  3. Consequence
• Activating event

  happen when we experience negative events and these trigger irrational beliefs.
• Beliefs

  Ellis identified a range of irrational beliefs that can be associated with the event.

  He called these 'musturbation' 'I must do….’

  
  

  In addition Utopianism is the belief

  that everything in life is fair.
• Consequences

  According to Ellis, rational beliefs lead to healthy emotional outcomes (acceptance), whereas, irrational beliefs lead to unhealthy emotional outcomes, including depression
• Ellis’ ABC Model Strengths

  1. Real world application. It lays the responsibility with the individual and allows them the power to change the way things are.
  2. REBT (a form of CBT) led by Ellis following the ABC model has been successful in treating depression and changing thought patterns.
  3. David et al. (2018) stated that REBT can both change negative beliefs and change the symptoms of depression.
  4. Taghavi et al (2006) 29 depressed patients compared to 34 normal controls. Measured irrational beliefs. Depression patients scored higher
• Ellis’ ABC Model Weaknesses

  1. It gives responsibility completely to the individual suffering with depression, which in turn could be seen to be blaming them.
  2. It only accounts for reactive depression, where the individual has had an activating event but does not account for endogenous depression, when the depression is not traceable to life events.
• cognitive behavioural therapy

  • cognitive element- assessment in which client and therapist work together to clarify problems

  .

  • central task is to identify negative irrational thoughts that will benefit from challenge.

  
  

  • behavioural element- CBT works to change negative irrational thoughts and replace with more effective behaviours into place.
• beck’s cognitive therapy

  identify automatic thoughts about the world, the self and the future. (Negative Triad) once identified, these thoughts are then challenged.

  
  

  client is the SCIENTIST: they encourage client to investigate their beliefs.

  
  

  homework: clients might be asked to

  record when they enjoyed event or when people were nice to them.

  
  

  future sessions: client falls back into patterns of thought the therapist can use evidence to prove client’s thoughts are incorrect. Reinforcing positive beliefs.
• Beck’s CBT strengths

  •success rate of therapy: March et al (2007) compared CBT to antidepressant drugs and combination of both in 327 adolescents. 36weeks= 81% and 86% in combination group

  
  

  • CBT effective when used on its own

  and when combined with drug

  
  

  • widely seen as preferred

  choice of treatment on NHS
• Beck’s CBT weaknesses

  •lacks effectiveness for clients with

  learning difficulties and those that

  find motivation difficult

  
  

  • Sturmey (2005) suggests that in

  general, any form of therapy is not

  suitable for people with learning

  difficulties

  
  

  • suggests that it may

  only be suitable for certain range of

  people.
• • REBT extends Ellis's ABC model to ABCDE (D is for Dispute and E is for Effect)​
  • The main technique for REBT is to identify and challenge irrational thoughts
• How REBT works.

  •  client talks to their therapist about the fact that everyone hates them​
  • A REBT would challenge these thoughts and argue with the client, the argument would be a strong argument where they challenge the specific irrational thought ​
• There are different types of arguments identified by Ellis;

  • Empirical arguments: Disputing if there is real evidence to support the irrational belief​
  • Logical arguments: Disputing if there negative effect follows logically from the facts​
  • Pragmatic arguments: challenging how helpful or benefits of their thoughts. 
• behavioural activation

  • goal of behavioural activation is to work with individuals to gradually decrease their avoidance and isolation. ​
  • this should ideally increase their engagement in activities that have been shown to improve mood. E.G. exercise, going out to dinner  etc. 
• ellis' REBT strengths

  • Research support-Ellis claimed a 90% success rate for REBT after 27 sessions. Cujipers et al (2013) reviewed 75 studies to show CBT is superior to no treatment. ​
  • However, Ellis recognised therapy was not always effective when clients did not put revised beliefs into action (Ellis 2001)​
  • Support for behavioural activation-Babyak et al (2000) studied 156 depressed clients and they were split into aerobic exercise, drug treatment and both. Those in the exercise group had lower relapse rates.​
• ellis' REBT weaknesses

  • Individual differences -it is less suitable for those clients who have high irrational beliefs (Elkins, 1985)that are resistant to change. may not work for the most severe cases as the patients can’t motivate themselves to engage with the hard cognitive work of CBT.​
  • Alternative treatments-the most popular treatment for depression is antidepressants and drugs require less effort from patients​
  • Relapse rates- Shehzad Ali et al (2017) 439 patients for 12months. 42% relapsed within 6months 53% within a year 
• What is Depression?

  a mood disorder, where the suffering experiences low mood and low energy levels
• Robinson (1990) meta-analysis of different therapies for depression
• Elkin (1985) comparison of therapies for depression


  Found that CBT was significantly less effective for people who have high levels of irrational beliefs.
• March et al (2007)Depression: Treatment


  Compared the efficacy of CBT, antidepressants, and a combination. CBT and antidepressants both had an 81% success rate, whilst a combination had 86% success.
• Depressed people were found in a study by Hammen and Krantz to show more errors in logic the non-depressed patients, supporting the idea that depression is caused by irrational thinking