3. Cognitive approach to explaining depression

define depression

a mood disorder where an individual feels sad and/or lacks interest in their usual activities

DSM-5 distinguishes between major depressive order (severe, short-term) and persistent depressive disorder (long-term or recurring)

list emotional characteristics of depression

sadness

loss of interest in normal activities

feelings of worthlessness

feelings of hopelessness

low self-esteem

anger

list behavioural characteristics of depression

reduced/increased activity levels

more/less sleep

reduced/increased appetite

increased agitation and restlessness

list cognitive characteristics of depression

negative self-beliefs (sense of guilt, shame, worthlessness)

negative expectations about life, relationships, work, etc.

irrational negative thoughts

describe the basis of the cognitive explanation for depression

it is an individual’s negative thoughts, irrational beliefs, and misinterpretation of events that is the explanation of depression

describe Ellis’ ABC model (1962)

Ellis proposed that the key to mental disorders lay in irrational beliefs

A = activating event

B = belief which may be rational or irrational

C = consequence = rational beliefs lead to healthy emotions, whereas irrational beliefs lead to unhealthy emotions (e.g. depression)

source of irrational beliefs is musturbatory thinking (thinking that certain ideas must be true for an individual to be happy)

such ‘musts’ need to be challenged for good mental health

define musturbatory thinking

thinking that certain ideas or assumptions must be true in order for an individual to be happy

Ellis identified the three most important irrational beliefs:

1) I must be accepted by people I find important

2) I must do well, or I am worthless

3) the world must give me happiness, or I will die

describe Beck’s negative triad (1967)

Beck believed people are depressed because their thinking is biased towards negative interpretations of the world, and they lack a perceived sense of control

depressed people have acquired a negative schema during childhood (may be caused by parental/peer rejection) = negative schemas are activated whenever new situations are encountered that resemble the original conditions in which these schemas were learned

negative schemas lead to systematic cognitive biases in thinking (e.g. drawing false conclusions on the basis of one criticism) = faulty information processing

negative schemas and cognitive biases maintain the negative triad = this is a pessimistic/irrational cycle of negative views of three key elements in a person’s belief system (the self, the world, the future)

one strength of cognitive explanations for depression is there are real-world applications to therapy

cog explanations (e.g. Ellis’ ABC model) have been used to develop effective treatments for depression (CBT, REBT)

these therapies attempt to identify and challenge negative, irrational thoughts and have been successfully used to treat people with depression

Cuijpers et al (2013) found that CBT is consistently the best treatment for depression, esp when used alongside drug therapies

the effectiveness of CBT strengthens and supports cog explanations of depression

one limitation is there are alternative explanations for depression

the biological approach suggests that genes and neurotransmitters may cause depression

Zhang et al (2005) found depressed people more commonly have low levels of serotonin

also, drug therapies (e.g. SSRIs) which increase the levels of serotonin are found to be effective in treating depression = provides further support for the role of neurotransmitters in the development of depression

a diathesis-stress approach might be more suitable = suggests that individuals with a genetic vulnerability for depression are more prone to the effects of living in a toxic environment, leading to negative irrational thinking

suggests cog explanations are not the sole cause of depression

one strength is research support for cog explanations of depression

Boury et al (2001) found that patients with depression were more likely to misinterpret information negatively (cognitive bias) and feel hopeless about their future (negative triad)

Bates et al (1999) gave depressed patients negative automatic-thought statements = patients became more depressed (symptoms worsened)

these findings support the view that negative thinking leads to depression

however, it could be that depression causes negative thinking (rather than vice versa)

define CBT

Cognitive Behavioural Therapy which aims to change thoughts and beliefs (through changing schemas) in order to change behaviour in response to these thoughts and beliefs

state and describe 4 aspects of CBT

1) challenging irrational thoughts = Ellis’ DEF model

2) homework = clients are asked to complete assignments between sessions = these test the irrational beliefs against reality and allow the client to practise new rational beliefs

3) unconditional positive regard = therapists respects and appreciates the client whatever they say/do = aids the change in beliefs

4) behavioural activation = client is encouraged to participate in pleasurable activities that could bring about rewards and positive thoughts

describe Ellis’ DEF model

D = disputing irrational thoughts and beliefs

E = effects of disputing

F = feelings produced

REBT focuses on disputing irrational beliefs and replacing them with effective, rational beliefs:

1) logical disputing = whether the beliefs logically support the information

2) empirical disputing = whether the beliefs are consistent with reality

3) pragmatic disputing = emphasising the lack of uselessness of self-defeating beliefs

describe REBT

Rational Emotional Behavioural Therapy

a form of CBT developed by Ellis which aims to turn irrational thoughts into rational thoughts

based on the idea that many consequences are the result of faulty thinking (about selves and the world)

identifies irrational beliefs, then challenges these through reality testing

one strength of the cognitive approach to treating depression is there is research support for the effectiveness of CBT

March et al (2007) found that CBT was as effective as antidepressants in treating depression

Cuijpers et al (2013) reviewed 75 studies and found that CBT was more effective than no treatment, but CBT was especially effective when used alongside drug therapies

this strengthens the cog approach, but also suggests a diathesis-stress approach may be more appropriate for treating depression

one limitation for the cognitive approach to treating depression is that the effectiveness of CBT is limited by individual differences

Elkin et al (1985) found that CBT is less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change

patients with severe depression may not engage with CBT or not attend the sessions = CBT is ineffective for these patients

alternative treatments (e.g. antidepressants) do not require the same level of motivation and are immediate = therefore be more effective in these cases

this is an issue as CBT usually cannot be used as the sole treatment for severely depressed patients = drug therapies may allow patients to cope better (supported by Cuijpers et al (2013) study)

one limitation of the cognitive approach to treating depression is that CBT has an overemphasis on the role of cognitions as the primary cause of depression

CBT does not take into account other factors (e.g. social circumstances) which might contribute to a person’s depression

this means that for some people, CBT will not be effective = instead of challenging their irrational beliefs, they would be better off changing their circumstances