The Cognitive Approach to Depression

The Cognitive Model of Abnormality Concentrates on Thoughts and Beliefs:

The cognitive approach assumes that behaviours are controlled by thoughts and beliefs. So, irrational thoughts and beliefs cause abnormal behaviours.

Several models explain how faulty cognitions can lead to depression. For example:

Ellis’s ABC model:

1. Ellis (1962) proposed the ‘ABC model’

2. The model claims that disorders begin with an activating event (A) (e.g a failed exam), leading to a belief (B) about why this happened

3. This may be rational (e.g. ‘I didn’t prepare well enough’), or irrational (e.g. I’m too stupid to pass exams’)

4. The belief leads to a consequence (C). Rational beliefs produce adaptive (appropriate) consequences (e.g. more revision). Irrational beliefs produce maladaptive (bad and inappropriate) consequences (e.g. getting depressed)

Beck’s negative triad:

• Beck (1963) identified a ‘negative triad’ of automatic thoughts linked to depression- negative views about:

  1. Themselves (e.g. that they can’t succeed at anything)

  2. The world (e.g. that they must be successful to be a good person)

  3. The future (e.g. that nothing will change)

The cognitive explanation of depression has strengths and weaknesses:

Strengths:

1. The cognitive model offers a useful approach to depression because it considers the role of thoughts and beliefs, which are greatly involved in problems like depression

2. Hollon and Kendall (1980) developed the Automatic Thoughts Questionnaire (ATQ) to measure the negative thinking associated with depression. Harrel and Ryon (1983) used the ATQ to compare negative thinking in 114 depressed and non-depressed participants. The depressed participants scored significantly higher (more negative thinking) than the other groups, supporting a correlation between negative thinking and depression

3. Cognitive therapies have often successfully treated depression

Weaknesses:

1. Faulty cognitions may simply be the consequence of depression rather than its cause. For example, depression may be caused by a chemical imbalance in the brain, which causes people to think very negatively

2. The person could begin to like he or she is to blame for their problems

CBT tries to change faulty cognitions:

Cognitive behaviour therapy (CBT) aims to identify and change the patient’s faulty cognitions. The idea is that patients learn how to notice negative thoughts when they have them and test how accurate they are. This is generally what happens during CBT:

1. The therapist and client identify the client’s faulty cognitions (thoughts and beliefs)

2. The therapist then tries to help the client see that these cognitions aren’t true, e.g. that the client doesn’t always fail at what they do

3. Together, they then set goals to think in more positive or adaptive ways, e.g. focusing on things the client has succeeded at and trying to build on them

4. Although the client may occasionally need to look back to past experiences, the treatment mainly focuses on the present situation

5. Therapists sometimes encourage their clients to keep a diary- they can record their thought patterns, feelings and actions

Advantages of CBT:

• CBT empowers patients- it puts them in charge of their own treatment by teaching them self-help strategies. This means there are fewer ethical issues than with other therapies like drug therapy

• DeRuebeis et al (2005) compared CBT and drug therapy as depression treatments in a placebo-controlled trial. Both treatments were more effective than the placebo after 8 weeks. Generally, the two therapies were similarly effective, but CBT may have been less effective than drug therapy in cases where therapists lacked experience

• Hollon et al (2005) compared participants from DeRuebis et al’s (2005) study after they were withdrawn from treatment (CBT and drug treatment), with participants who continued drug treatment. Participants who withdrew from CBT were significantly less likely than patients who withdrew from drug treatment to have relapsed after one year, and no more likely to have relapsed than patients who continued drug treatment

• Brandsma et al (1978) found that CBT is particularly effective for people who put a lot of pressure on themselves and feel guilty about being inadequate

Disadvantages of CBT:

• Cognitive therapies may take a long time and be costly. They may be more effective when combined with other approaches, e.g drug therapy

• As DeRuebis et al (2005) found, CBT may only be effective if the therapist is experienced. Patients whose therapists are still gaining this experience may be better off with drug therapy.

• The person could begin to feel like he or she is to blame for their problems