The Cognitive Approach and Depression

• Depression definition


  • A mood/affective disorder
  • Involves a prolonged and fundamental disturbance of mood and emotion
  • Involves generally low mood and loss of interest
• Emotional characteristics of Depression

  • Low mood (worthlessness, energy)
  • Low self-esteem (self-loathing)
• Behavioural characteristics of Depression

  • Low levels of energy, lethargic - in extreme cases cannot get out of bed
  • Disruption to sleep (insomnia/hypersomnia)
  • Appetite increase/decrease
  • Verbal aggression/physical aggression
• Cognitive characteristics of Depression

  • Poor levels of concentration
  • More negative thinking - ignore positives
• Cognitive approach key belief to explaining depression

  • Depression is seen as being caused by negative and irrational thought processes
  • Known as ‘cognitive primacy’
• What do depressed individuals tend to focus on in situations?

  Negative aspects
• What is an automatic cognitive bias in the context of depression?

  It is a tendency to process information in a negative way without conscious thought
• How do depressed individuals perceive small problems?

  They blow small problems out of proportion
• What does it mean to think in black and white terms?

  It means to see situations in extremes, without recognizing any middle ground
• What are schemas in psychology?

  Packages of ideas and information developed through experience
• How do schemas function in interpreting sensory information?

  They act as a mental framework
• How do depressed individuals use negative self schemas?

  They interpret all information about themselves negatively
• What is the negative triad in the context of depression?

  It is a pattern of negative views about the world, future, and self
• What results from negative biases and schemas in depressed individuals?

  They adopt the negative triad
• What are the characteristics produced by the negative triad?

  They produce the experience of depression characteristics
• Beck’s Cognitive Theory of Depression - Supporting Evidence AO3

  • Grazioli and Terry found that women with pre-existing cognitive vulnerabilities were more likely to develop post-natal depression than women without
  • Furthermore Clark and Beck conducted a meta-analysis of research on this topic and concluded there is evidence to suggest that cognitions come before depressive symptoms
  • Therefore all of the supporting evidence suggests that Beck in some way may be correct in the assumption of cognitive primacy
• Beck’s Cognitive Theory of Depression - Practical Application AO3

  • All cognitive aspects of depression, including the negative triad, can be identified and challenged in CBT
  • The therapist can challenge these thoughts and encourage them to be replaced with more accurate and positive thoughts
  • This is a strength because the explanation can be transferred into therapy and therefore helped to improve sufferers’ quality of life
• Beck’s Cognitive Theory of Depression - Doesn’t explain all aspects of depression AO3

  • Only seems to explain the basic cognitive symptoms but ignores emotional and behavioural factors
  • However depression is much more complex
  • Some depressed patients are deeply angry and suffer hallucinations which cannot be explained by Becks ideas alone
  • Therefore Beck’s theory cannot explain the more complex cases of depression
  • This suggests that it may be an incomplete explanation and ignores biological explanations (ex. role of serotonin) which have been associated with the cause of depression
• Ellis' ABC Model AO1

  A: Activating Event - ex. getting fired from your job, death of a family member

  B: Belief - these can be rational or irrational, ex. ‘I lost my job because they were overstaffed’ or ‘they always had it in for me’

  C: Consequence - rational beliefs lead to happy and positive emotion responses, whereas irrational beliefs lead to negative emotional responses which ay develop into depression
• Ellis' ABC Model - Real World Application AO3


  • REBT (Rational emotive behavioural therapy) designed by Ellis aims to alter irrational beliefs into rational beliefs by using the ABC approach
  • Further supporting evidence from David et al found it can change negative beliefs and relieve symptoms of depression suggesting it is an effective treatment
• Ellis' ABC Model - Only explains some cases AO3

  • Only explains reactive depression and not endogenous (no reason of cause) depression
  • Life events can cause reactive depression because we respond to negative life events
  • Some types of depression are not linked to life events and is difficult to identify the cause - this type cannot be explained by the ABC model
  • This means that Ellis’ model is a partial explanation for the cause of depression and can only explain some cases
• CBT as an approach to treat depression


  Cognitive approach aims to change the way a client thinks by challenging irrational and negative thought processes which will lead to a change in behaviour as a response to new thinking patterns - known as ‘thought reconstructing’
• Treating Depression - CBT

  1. Assessment where the patient and therapist work together to clarify the patient’s problems
  2. Identify automatic thoughts about world, future and self - known as ‘thought catching’
  3. Once thoughts are identified they must be challenged - test the reality of negative beliefs
  4. Homework may be set to record when the patient has enjoyed an event or when someone was friendly to them - referred to as ‘patient as scientist’ - helps investigate the reality of negative beliefs and use the record as evidence to prove patients statements are incorrect
• Treating Depression - REBT

  • Extension of the ABC model
  • D: Disputing irrational thoughts and beliefs - therapist challenges thoughts and encourages the client to think of alternative explanations or possibilities
  • E: Effect of the new beliefs and attitudes that emerge
  • Logical Disputing - does the belief make sense
  • Empirical Disputing - is the belief statistically consistent with reality
  • Pragmatic disputing - emphasises the lack of usefulness of an irrational belief
• CBT - Supporting Evidence AO3

  • March et al compared effects of CBT with antidepressants and a combination of the two in adolescents with depression
  • After 36 weeks 81% CBT group were equally improved as the antidepressent group (81%) and combined (86%)
  • Shows that CBT is just as effective as medication, helpful alongside medication and there is a good argument for making it first choice treatment in the NHS
• CBT - High relapse rate AO3

  • Seems to be effective in tackling symptoms of depression but there is an uncertainty of how long the benefits last
  • Early studies found 42% into depression within six months of ending treatment and 53% relapsed within a year
  • This means that CBT may need to be repeat more frequently which lowers its cost-benefit
• CBT - Lack of effectiveness AO3

  • Lack of effectiveness for severe cases and for clients with learning disabilities
  • Severe cases of depression may cause patient to be de-motivated and not be able to engage with CBT
  • May not pay attention to what is happening in the session (would be effective with medication)
  • This suggests that CBT alone wouldn’t be used as a sole treatment and may not be appropriate for a specific range of people with depression