Cognitive approach to explaining + treating depression

• Explanations for depression: Beck's Cognitive Theory -

  some people's cognition makes them more vulnerable

  1. Faulty information processing: Absolutist thinking 'black and white'. Overgeneralisation - seeing a single negative event as a never ending pattern. Catastrophising - exaggerated/situations perceived as disasters.
  2. Negative self-schema's: interpret all info about ourselves in a negative way as schemas act as a mental framework developed through experience
  3. Negative triad: negative thoughts about the world, the future & oneself.
• AO3 Beck's explanation for depression -

  • Grazioli + Terry assessed65 women for cognitive vulnerability & depression before + after birth. Women high in cognitive vulnerability were more likely to suffer from post-natal depression supports theory of some people being more vulnerable.
  • RLA, all aspects of Beck's theory can be used in CBT including the negative triad. Therapists challenge faulty thinking which improves the patients quality of life.
• AO3 Beck's explanation for depression -

  • Too simplistic ignores complex emotions via machine reductionism. However reductionism does have a high scientific credibility and has led to treatment. However, a consequence of reductionism leads to an inadequate explanation for depression as it is a complex disorder.
• Ellis's ABC Model -

  forms from irrational thoughts

  • A = activating event (external event which triggers irrational beliefs)
  • B = belief (irrational belief)
  • C = consequence (emotional + behavioural)

  These are rational or irrational beliefs

  Rational = adaptive

  Irrational = maladaptive
• AO3: Ellis's ABC explanation for depression -

  • RLA, CBT therapists challenge irrational beliefs & improves their quality of life.
  • Machine reductionism explains some people's vulnerability but doesn't explain anger hallucinations or delusions. Too simplistic.
  • Depression may be caused by activating events e.g. reactive depression. Inadequate explanation as there is not always an activating event. May lead to a stigma for mental health.
• Treating depression: Beck's CBT -

  • Identify negative thoughts using the negative triad: world, oneself & future. Patient & therapist work together to challenge these irrational thoughts by discussing evidence. Tests the validity of these beliefs & homework may be set to prove their irrational thoughts.
• Treating depression: Ellis's REBT -

  • Developed his ABC model added D (Dispute) + E (Effective). Challenge irrational thoughts through dispute, the therapist will try to replace their irrational thoughts with more appropriate rational ones.
  • Types of Dispute -

  1. Empirical = find evidence to support beliefs
  2. Logical = does it logically make sense
  3. Pragmatic = the belief isn't useful to them
• CBT -

  • short-term treatment
  • aims to identify & challenge irrational thoughts

  1. initial assessment
  2. clarify issues
  3. goal setting/plan of action
  4. homework & continue practicing
• AO3 CBT -

  • Patients find it hard to articulate: fear of judgement, trauma. Getting to the session requires effort & motivation. Depression is characterised by low activity levels, homework may be draining.
  • More expensive than alternatives e.g. drugs & has a long waiting list up to 2 years.
  • CBT may not work for severe depression as it involves hard work & focus from patients. David (2005) found 30-40% of people were non-responsive to CBT.
• AO3 CBT -

  • Improves patients quality of life, may be able to go back to work, more productive, positive implications for the economy.
  • CBT can be delivered in many forms - convenience.
  • RS, 327 people diagnosed with depression they received either CBT, anti-depressants or both. After 36 weeks, 81% improved from CBT & anti-depressants. 86% for both. Supports use of CBT but using an interactionist approach may lead to the best treatment as it takes an eclectic approach to treatment.
• Discuss the cognitive treatment for depression -

  • general rationale of cognitive therapies: to change/modify negative schema/irrational thoughts, alleviates depression
  • Beck’s CBT: identification of irrational thoughts/negative triad (‘thought-catching’); ‘patient as scientist’ generate hypotheses to test validity of irrational thoughts; homework reinforcement of positive thoughts; cognitive restructuring.
  • Ellis’ rational emotive behaviour therapy (REBT) ABCDE model; rational confrontation/dispute (empirical and logical) challenging negative thoughts; behavioural activation.
• Discuss the cognitive treatment to depression -

  • therapy attempts to address cause, assuming root cause is irrational thought processes.
  • success may depend more on the quality of the patient-therapist relationship
  • cognitive therapies require commitment and motivation which may be a problem for depressed patients
  • over-focus on the patient’s present circumstances, some patients may want to explore their past
  • relies on patient self-reporting their thoughts, unreliable and difficult to verify.
  • comparison w alternative treatments e.g. antidepressants
• Challenging irrational thoughts -

  • rational confrontation; ABCDE model – D for dispute, E for effect (reduction of irrational thoughts); shame attacking exercises; empirical and logical argument (Ellis)
  • patient as scientist; data gathering to test validity of irrational thoughts; reinforcement of positive beliefs (Beck).