The cognitive approach to explaining and treating depression: Beck’s negative triad and Ellis’s ABC model; cognitive behaviour therapy (CBT), including challenging irrational thoughts.

Define the cognitive approach to depression

The cognitive approach suggests that depression results from faulty cognition (so disturbances in thinking).

Define schemas

A schema is the mental framework for objects and events that work as shortcuts in understanding the world. This includes schemas about ourselves. Depression can result from our self-schemas being negative.

What is the general idea of Beck’s negative triad

It states that events are seen by the sufferer with a pessimistic/negative bias due to the development of negative schemas about the world, the self, and the future, mainly developed in childhood.

What are the 4 ways in which Beck identified ways in which those with depression engage in ‘faulty information processing’?

• overgeneralisation (problems in one situation being seen as a problem in others, mind reading)

• magnification of problems (seeing them as more important than they are)

• selective perception (focusing on the negative & negative attribution)

• absolutist thinking (all or nothing).

What is the premise of Elis’ ABC model?

The model states that people respond in different ways to stresses and challenges in life. He suggests that this difference depends on their beliefs, resulting in different consequences for different people.

What does the ABC stand for (Ellis)?

• The activating event (A) is the external situation that there will be a reaction to.

• The belief (B) is why the individual thinks that the activating event happened (rational or irrational).

• The consequence (C) is the behaviour and emotions caused by the person’s beliefs about the activating event.

  • In depression the activating event is blamed for the unhappiness felt.

What is Mustabatory thinking and what does Ellis suggest about it?

Ellis suggests that Musturbatory thinking (thinking in absolutes and that the world must be a certain way for us) is a common type of belief that leads to unhappiness.

Eval for the cognitive approach (Hammen and Krantz)

+They found support for negative cognitive distortions in depressed female undergraduates compared to a female undergraduate non-depressed control group when presented with a short story, with the depressed females showing more errors in logic when interpreting the narrative.

Eval for the cognitive approach (Grazioli & Terry)

+Found that in the 65 pregnant women assessed for negative attitudes. Post-partum, they were assessed for depressive symptoms. It was found that holding dysfunctional attitudes while pregnant predicted post-partum depression as a result of stress.

Eval for the cognitive approach (CBT/March et al)

+Cognitive explanations 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) who compared CBT with medication and found an effectiveness rate of 81% for both treatments, suggesting that the underlying cognitive theory that depression is due to faulty cognitions is valid as the treatment based on that idea is effective.

Eval for the cognitive approach (activation)

-Ellis’ ABC model emphasises that depression is caused by irrational beliefs about negative events in a person's life (reactive depression). Some however experience depression without any obvious activating event (endogenous depression) which Ellis' cognitive theory does not account for.

Eval for the cognitive approach (blame)

Placing the responsibility for depression in the hands of the patient could either empower the patient to help themselves or potentially be a cause of ‘blaming the victim’, especially if there are contributing factors like grieving or poverty.

Eval for the cognitive approach

There is significant evidence that biological factors play a large role in depression, with some people being genetically vulnerable and a neurochemical factor being apparent from the effectiveness of antidepressant medication. This means that the cognitive explanation cannot be a full explanation.

Explain the monoamine hypothesis

Our neurons communicate with each other using chemical messengers called neurotransmitters. One group of neurotransmitters which are involved in depression are the monoamines.

• dopamine, serotonin, noradrenaline, epinephrine, and histamine

Low levels of these neurotransmitters have been linked to depression.

What is the aim of CBT?

According to the cognitive approach, the cause of depression is negative/irrational thoughts. The aim of CBT is to challenge these thoughts.

CBT has been praised for targeting the root of the issue, rather than just masking symptoms.

Define thought-catching

Identifying and recording the patients automatic negative/irrational thoughts

List and define the 3 kinds of argument the psychologist may use

Logical argument - Arguing based on whether the clients thoughts make sense.

Empirical argument - Arguing based on actual evidence.

Pragmatic argument - Arguing based on whether the thinking is helpful or not.

Why might ‘homework’ be set in CBT?

• The patient can reality-test their irrational thoughts by carrying out homework tasks such as testing new ways of thinking/behaving and then evaluating the evidence with the therapist.

• Diaries may also be used as evidence. The main purpose of this is for the client to objectively assess the validity of their irrational belief.

Why are patients encouraged to take part in enjoyable activities?

Taking part in enjoyable activities that patients often avoid is a process called behavioural activation. It improves emotions and challenges irrational thoughts.

The more they go out and do things, the more opportunities there are for positive events and interactions to occur (evidence against irrational thoughts).

Briefly explain Ellis’ Rational Emotive Behavioural Therapy (REBT)

• Ellis’ ABC model is developed to the ABCDE model, with D being disputation of irrational beliefs, and E being effective change resulting from the changed beliefs.

• Intensive disputation (arguing against assumptions underlying irrational beliefs).

• These arguments can either be logical (do the beliefs make sense) or empirical (is there evidence for this belief).

What did March et Al find? (stats)

March et al (2007) compared three groups: those with medication only, those with CBT only, and those with both over 36 weeks using 387 participants. Found both CBT and medication alone had 81% effectiveness for depression alone and 86% when combined. 

• Suggests that CBT is as effective as medication.

Strengths of CBT as a treatment of depression

• Medications can have side effects so may not work for all patients - CBT more appropriate solution.

• CBT empowers the patient as they act as an engaged and active force in their recovery, whereas medication puts the patient into a passive role.

• Successful - positive impact on the wider economy. Fewer sick days & improved productivity

• Paykel, 2007, demonstrates that patients receiving CBT have lower relapse rates.

Weaknesses of CBT as a treatment of depression

• Not appropriate for severe patients as they are unable to engage with the difficult psychological work necessary. In these cases medication is more appropriate until they improve enough to engage in CBT.

• 16-20 sessions is a considerable investment of time and has considerable costs. This may mean that access is limited with limited funds making it a less viable treatment compared to cheaper and more accessible antidepressants.

• Primarily concerned with the way the patient thinks and behaves in the present. Some patients are aware there is a link between past trauma and their present depression - may want to spend time discussing their past and may become frustrated by focus on the present,  damaging the therapeutic alliance.

• May ignore the impact of genuine problems in the patient's life. If a patient has genuine problems, changing the way they think is unlikely to help if their circumstances don’t change as well