8 Key excerpts on "Cognitive Approach to Depression"

• 

  eBook - ePub

  International Handbook of Cognitive and Behavioural Treatments for Psychological Disorders

  • V.E. Caballo(Author)
  • 1998(Publication Date)
  • Pergamon

    (Publisher)

  Beck’s cognitive therapy was developed specifically in response to depression. The cognitive approach to the conceptualization and treatment of depression starts with the observation of common cognitive structures, processes, and products that appear to both mediate and moderate all instances of depression. The role of cognitions in depression is often misinterpreted to be one of simple linear causality: negative cognitions cause depression. If this were true, the implications for treatment would be further simple linear reasoning: positive thinking cures depression. Another misunderstanding of the CT model, is that the cognitive perspective implicates internal processes in depression to the exclusion of contextual events. The implication would be that a person could be depression-resistant regardless of events in the person’s life. The cognitive conceptualization of depression does not hold either of these simple causal models to be true. The cognitive perspective is a diathesis-stress model where life events, thoughts, behaviors and moods are inextricably tied to each other in a reciprocal manner. Cognitions, behaviors, and moods all serve feed-forward and feedback functions in a complex process of information processing, behavioral regulation, and motivation. Further, the cognitive perspective implicates early life events and learning in the creation of patterns of information processing. These patterns may both predispose persons to specific emotional vulnerabilities, and maintain emotional difficulties once behavioral, cognitive and mood patterns are initiated.

  Cognition is likely to be related to mediation (vulnerability) and moderation (expression and maintenance) of depression. Two levels of cognition are viewed as influencing these processes. These two levels can be easily described as deep cognitions, and surface cognitions, respectively.

  Deep cognitions are seen as predisposing vulnerability factors that mediate the development of depression. Deep cognitions have been given a number of labels. These include schema, attitudes, basic assumptions, and core beliefs all of which of stable, cross-situational, and basic components of cognitive organization. These components develop in response to early life experiences, through both social and operant learning, Schema may operate actively, determining a majority of the person’s daily behavior, or may be latent, triggered by specific events. They may be compelling and hard to resist, or non-compelling and easily countered or resisted. They guide the person’s selection of information to attend to or seek, guide pattern search procedures, and provide “default values” when information is missing. By directing the encoding and retrieval of information, they govern the person’s interpretation of experience,

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Cognitive Behaviour Therapy

  A Guide for the Practising Clinician, Volume 1

  • Gregoris Simos, Gregoris Simos(Authors)
  • 2014(Publication Date)
  • Routledge

    (Publisher)

  Indeed, Beck maintains that “cognitive therapy is best viewed as the application of the cognitive model of a particular disorder with the use of a variety of techniques designed to modify the dysfunctional beliefs and faulty information-processing characteristic of each disorder” (Beck, 1993, p. 194). Cognitive conceptualisation of depression According to Beck's cognitive specificity hypothesis (Beck et al., 1979) depressed clients have a different cognitive profile from those with other psychiatric problems, showing primarily themes of loss, defeat, and failure in their cognitive content. Their spontaneous verbal output typically reveals many examples of thinking (including metaphors and images) with a systematic negative bias. This is mirrored in clients' deeper, unspoken assumptions across many domains of their experience. Beck has especially called attention to the “negative cognitive triad” in depressed clients: a fairly unrelenting tendency to view themselves, the future, and their experience around them almost entirely in negative terms (Beck et al., 1979). Because of Beck's focus in the cognitive treatment of depression on identifying, evaluating, and modifying dysfunctional thoughts and deeper beliefs, some careless readers of his work are under the misapprehension that Beck assigns a causal role in depression to distorted thinking. When questioned, he has said that he would no more make that claim than to suggest that hallucinations and delusion cause schizophrenia (Beck et al., 1979). While Beck is careful to avoid saying with authority what exactly causes depression in the first place, since research itself has produced no definitive answers, he maintains that the mal-adaptive worldview of depressive clients helps to maintain most of the symptoms of depression as well as significantly interfering with their effective problem-solving of their many real-life problems (Beck et al., 1979)

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Clinical Psychology: Revisiting the Classic Studies

  • Graham C.L. Davey(Author)
  • 2019(Publication Date)
  • SAGE Publications Ltd

    (Publisher)

  more accurate perceptions of events. Later study has also highlighted features of depression which may play a maintaining role in the condition but which are not emphasised in Beck’s model. These include cognitive processes such as rumination (the repetitive and unproductive chewing over of thoughts), mental imagery (imagining distressing or disturbing scenes) and cognitive deficits (the tendency for depression to be accompanied by problems of concentration, attention and memory). Each of these limitations is examined in turn in this section, and implications for the cognitive theory of depression and for cognitive therapy are reviewed.

  • Limitations to the role of cognition in depression
    • The pivotal role of cognition in depression has been questioned by some, on the grounds that comparative outcome studies of different psychotherapies have often found equivalent effects for CBT and alternative approaches that do not have a focus on changing cognitions. One study found CBT for depression equally effective even when the cognitive component was removed and only behavioural change was targeted (Jacobson et al., 1996). In addition, the role of enduring schemas that lie dormant when not depressed has been hard to demonstrate. No evidence of these enduring underlying cognitive structures was found in a longitudinal study of 998 people across one year. During the year 65 participants became depressed, but these individuals had no more depressive cognitions prior to the onset of depression than others who remained well (Lewinsohn et al., 1981).
    • Nevertheless, there is significant evidence that cognitive change precedes symptomatic change during therapy, supporting the idea that cognition and mood are intricately linked in the mechanism through which therapy works (Tang & DeRubeis, 1999).
  • ‘Depressive realism’
    • Some experimental studies suggest that depressed individuals can more accurately perceive negative events, whereas non-depressed individuals screen painful reality with an inaccurately positive view of events. For example, in one classic experiment depressed and non-depressed participants pressed a button which led intermittently to a light being illuminated. Depressed participants more accurately perceived the lack of control they had over illuminating the light, whereas non-depressed participants perceived a greater degree of control than they actually had (Alloy et al., 1985). Later studies suggest a more nuanced explanation of this result. When the degree of control over the light was increased, depressed individuals carried forward their perceived lack of control. Across conditions, therefore, the depressed participants were no more accurate in their perceptions than the non-depressed. Instead both depressed and non-depressed people had biased interpretations that fitted some situations but not others (Dykman et al., 1989). These findings imply that Beck’s concept of schemas as relatively stable overly negative structures may be simplistic (Power & Champion, 1986). The findings highlight a need for therapy to recognise that some negative lines of thinking are accurate and require action to change a situation, rather than action to re-evaluate the interpretation of events.

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Depression

  • Constance Hammen, Ed Watkins(Authors)
  • 2018(Publication Date)
  • Routledge

    (Publisher)

  The cognitive models of depression have stimulated very active research programmes over the last 40 years and the body of evidence is now consistent with a modified cognitive vulnerability perspective such that the extent to which extreme, global and overgeneralised negative models of the self, the world and the future, and abstract rumination are activated in response to negative mood and stressful events contribute to vulnerability to depression. Moreover, there is now robust support for a causal role of cognition in the development of depression from many prospective studies that have found that negative cognitive style, rumination, increased cognitive reactivity and overgeneralisation predict the onset, relapse and recurrence of major depression, and from the CBM work that demonstrates that cognitive biases influence mood and symptoms in the laboratory.

  However, some important methodological and conceptual issues still require resolution. The relationship between thought content, as assessed by self-report measures, and thought process, as assessed by information processing tasks, is not always clear, although progress is being made, for example, the relationships between self-reported rumination and information processing is being elucidated (Koster, De Lissnyder, Derakshan and De Raedt, 2011). Critically, the schemas hypothesised to underpin depressive vulnerability are inferred on the basis of thought content and thought process, rather than directly assessed.

  A further criticism emphasises the over-simplicity of the near-exclusive focus on internal cognition as the major diathesis in depression, to the relative neglect of the environmental and social context in which the person lives. For example, the lives of depressed people are often extremely stressful and deficient in resources (e.g., Coyne, 1992; Hammen, 1992). The role of interpersonal relationships including intimate, social and family relationships has not been fully integrated (e.g., Gotlib and Hammen, 1992), leading many to call for more integrative models that account for biological as well as personality, social, environmental and developmental aspects of depression. In subsequent sections and chapters, these alternative and integrative approaches are discussed.

  Stressful events and circumstances and their role in depression

  It is a common observation that most depressive episodes are preceded by bad things happening to the individual. In addition to establishing this association empirically, much of the research in recent decades has addressed an additional critical question: because most people do not develop a depressive episode even when negative events occur, why do some people have such reactions while others do not? Moreover, there are questions about what kinds of stress are most likely to trigger depression. There is also great interest in the dynamic relationships between stress and depression over time and course of disorder, and the bidirectional association between stress and depression. Finally, in recent years, much of the current research has begun to address the complex issue of how does stress precipitate depression in those who are vulnerable.

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Coping with Depression

  A Guide to What Works for Patients, Carers, and Professionals

  • Costas Papageorgiou, Hannah Goring, Justin Haslam(Authors)
  • 2011(Publication Date)
  • Oneworld Publications

    (Publisher)

  This kind of therapy focuses on changing the content of your thoughts or what you think. However, in recent years there have been several new developments in the understanding and treatment of depression within the cognitive therapy field, which as yet do not have the same degree of research evidence supporting them as standard cognitive therapy. Some examples include metacognitive therapy 5 and acceptance and commitment therapy. 6 Some of the most recent developments in our psychological understanding and treatment of depression have focused on changing how you think instead of what you think, and relate to the process of depressive rumination. 7 A review of this new and important area of research is beyond the scope and goals of this book, as is a description of all the new developments within cognitive therapy. However, key references are provided in the chapter notes for the interested reader. Other more specific developments within the cognitive therapy field, such as mindfulness-based cognitive therapy, for preventing relapse and recurrence of depression are discussed in chapter 9. Key points covered in this chapter Cognitive theories of depression focus on the role of negative thinking in depression, and view depressed mood as resulting from negative thoughts, or negative interpretations of events. Beck’s theory is the most widely known cognitive theory of depression and emphasizes the role of negative automatic thoughts, thinking biases and underlying beliefs in depression. Negative automatic thoughts are negative thoughts about oneself, the world or the future

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  The Psychological Treatment of Depression

  • J. Mark G. Williams(Author)
  • 2013(Publication Date)
  • Routledge

    (Publisher)

  Chapter 10

  The cognitive theory of depression revisited

  Although it was not until the late 1960s and 1970s that experimental clinical psychologists started seriously to develop theories about the onset and maintenance of depression, even from these early theoretical writings there emerged a controversy about the necessity to postulate cognitive mediators. There are two forms of this debate, the first, with which we shall not be concerned here, is the philosophico-theoretical issue about the status of ‘private events’ and their explanatory power.

  The other debate is that between those who believe that cognitive events precede and cause the emotional disturbance, and those who believe that the emotional disturbance can be explained on other grounds (biological or behavioural) and see cognitive distortions and negative self-talk as a product or correlate of the emotional disturbance.

  Now this debate is crucial. If cognitive events are an epiphenomenon, accompanying though not playing a causal role in affective disorders, it would make less sense to devote years of research to how best to change cognitive styles or habitual self-talk strategies. Like ointment on a chickenpox rash, such treatment may soothe but have little prospect of treating the underlying disorder. Of course cognitive therapies do work (see Chapter Four ) but it may be that they are inadvertently affecting other more significant subsystems. Let us then examine the status of the aetiological cognitive thesis.

  Just to complicate matters further there are also two forms of the aetiological thesis. Let us call them the ‘precipitation theory’ and the ‘vulnerability theory’. The first is a ‘state’ theory and argues that moment-tomoment fluctuations in mood may in part be accounted for by the thoughts, images, and memories that occur to the individual. Controlling the nature, frequency or intensity of these thoughts and images will thereby affect the mood that is consequent upon them. The vulnerability theory argues that long-lasting styles of thinking (e.g. attributional style, tendency to selectively abstract or think dichotomously) occur prior to and render a person vulnerable to depressive breakdown in the face of stress. Although often confused under the general title of cognitive theory of depression, these theories are quite distinct and ought to be discussed separately. We shall consider the evidence for each in turn.

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  A Cognitive-Behavioural Approach to Clients' Problems (Psychology Revivals)

  • Michael J. Scott(Author)
  • 2015(Publication Date)
  • Routledge

    (Publisher)

  6 Cognitive Therapy for Depression

  DOI: 10.4324/9781315718323-6

  Cognitive therapy for depression represents a systematic therapeutic development of the ancient notion that 'People are disturbed not so much by events as by the views which they take of them' (Epictetus, 1st century AD). In this chapter the practice of cognitive therapy for depression is described. A necessary first step is of course to check initially that the client is depressed according to the self-report measures and diagnostic systems described in the previous chapter. For those new to cognitive therapy it is particularly useful to add the Dysfunctional Attitude Scale (DAS, Weissman and Beck 1978) - see Appendix C - to the standard assessment measures. The DAS contains forty items answered on a seven-point scale from 'totally agree' to 'totally disagree'. The items provide a wide (but by no means exhaustive) sample of the depressogenic silent assumptions often found amongst depressed clients such as 'If I do not do as well as other people it means I am an inferior human being' and 'I am nothing if a person I love doesn't love me'. Much of the emotional distress of clients in particular situations is reducible to one of these forty silent assumptions. A therapist aware of a client's response to these items prior to therapy can be on the look-out for their manifestation in the distressing situations the client relays or records. The completed DAS can provide the novice therapist with a shortlist of salient depressogenic assumptions that will probably need modification if the client is to overcome depression and perhaps even more importantly avoid relapse. It has to be borne in mind however that there can be many more dysfunctional silent assumptions than those contained in the DAS.

  Therapy usually involves fifteen to twenty individual sessions over a twelve-week period. In the first few weeks sessions are often arranged twice weekly. The rationale for this is that the therapist can thereby more easily prompt the client to overcome the inertia characteristic of depression. Anything that involves an effort in terms of behaviour and thinking tends to be avoided by the depressed person. From a practiced point of view therapists can find it difficult to provide twice-weekly appointments, and in the Ross and Scott (1985) trial of cognitive therapy the clients who were given individual cognitive therapy were seen on a weekly basis and this still proved effective. Indicating to clients at the outset what the likelihood of 'success' of the treatment will be is important in motivating the client. On the basis of studies of cognitive therapy it seems reasonable to claim that four out of five patients completing CT will recover from depression by the end of the sessions - and for the most part treatment gains will be maintained. To help ensure treatment gains are maintained, clients should be told they will be offered at least three or four booster sessions in the year following completion of treatment. Initially it is advisable to contract with clients for four or five sessions and then perform a stock-taking exercise. There is evidence to suggest that how clients are faring after four or five sessions of cognitive therapy is predictive of the short and long-term outcome of therapy (Fennell and Teasdale 1987)

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Dealing with Depression

  Five Pastoral Interventions

  • William M Clements, Richard L Dayringer(Authors)
  • 2014(Publication Date)
  • Routledge

    (Publisher)

  Burns concludes: “Our research reveals the unexpected: Depression is not an emotional disorder at all! … Every bad feeling you have is the result of your distorted negative thinking” (1992, p. 28). Sadness, he maintains, comes without thought distortion. It involves a flow of feeling and has a time limit. But it never results in a lessening of self-esteem. Depression is frozen and tends to persist or recur indefinitely, and always involves loss of self-esteem (1992, p. 232).

  Characteristics of Cognitive Therapy

  Cognitive therapy is an active, structured, psychoeducational, collaborative dialogue, as opposed to a passive client monologue. Counselees are taught the cognitive theory that has been described previously. These activities proceed best when the cognitive therapist exemplifies the basic therapeutic characteristics of warmth, genuineness, and openness, and is adept at empathically listening to and understanding the client’s uniqueness. Although cognitive therapists need to be critical thinkers, they do not merely engage clients in arid intellectual debate, nor do they harangue clients into agreeing with the therapists’ points of view. Cognitive therapists strive to build a trusting, mutually respectful relationship with their clients as the foundation for the use of cognitive techniques.

  Prior to beginning treatment, cognitive therapists typically give counselees a rather comprehensive diagnostic evaluation. This is to rule out an underlying organic disorder that may be causing the client’s dysphoria, such as hypothyroidism, hypoglycemia, diabetes, epilepsy, or postconcussive syndrome. Or, the depressed affect may actually be secondary to an even more primary psychological disorder, such as obsessive-compulsive disorder or borderline personality disorder. Furthermore, the severity of the depression as well as the degree of suicidality is assessed using the Beck Depression Inventory. In serious cases, medication and/or hospitalization may be indicated.

  Clients are educated into the cognitive approach to therapy beginning with the first session. Client problems and treatment goals are mutually agreed upon with the therapist who maintains flexibility in structuring treatment programs. Therapists establish an important precedent by asking counselees to suggest items for the agenda for each session. The therapist suggests other items, then asks for feedback on the overall plan for each session.

  Sign up to read

  Learn more about book