When you think of 'cognitive', what are the thoughts that come to mind? Perhaps you think of the human mind, which leads you to think of things like 'thoughts' or 'beliefs', or maybe you think of 'memory' or 'learning'. You are correct whether you think of one of these or any other mental processes! Psychologists have attempted to understand mental dysfunction in more than one way, studying different approaches to illnesses to get a holistic picture. Today, let's understand the cognitive approach to depression - one of the most common mental illnesses.
Outline of the Cognitive Approach to Depression
Cognitive psychology explores all mental processes and functions – everything that happens in the brain, including decision-making, memory processes, learning, perception, thought processes, and attention.
It studies how people process and store the information they receive from their environment, draw conclusions, and react based on that information.
This study, then, allows researchers and psychologists to identify different ways by which mental illnesses can be treated. Let's take a look at how the cognitive approach is able to treat depression.
The cognitive approach to depression assumes that people with depression have maladaptive thought processes, e.g. they respond to stimuli in a negative or dysfunctional way, leading to the onset and maintenance of depression.
The cognitive Approach to Treating Depression
Within its framework, cognitive psychology helps us better understand ourselves and others. It gives psychologists a deeper insight into developing new ways to help people improve cognition. This deep insight has contributed to two ways depression can be explained: the cognitive approach: Ellis' (1977) A-B-C three-step model and Beck's (1967) cognitive triad.
These explanations allow professionals to develop a plan to help treat depression. But before we move on to depression treatments, let's discuss the explanations in more detail.
Albert Ellis' Cognitive Approach to Depression: the A-B-C Three-Stage Model
Ellis emphasised that a person's mental health can tip in either direction depending on their beliefs and assumptions about their life experiences.
Some people's assumptions about their life events are irrational and guide them to take inappropriate actions that affect their chances of living a happy and pain-free life.
Fig. 1 - Negative thoughts can lead to irrational interpretations of the situation, which contribute to an individual's overall beliefs and feelings
He suggested that it is not a single negative event that triggers depression but results from irrational thoughts triggered by negative events. Ellis proposed the three-stage A-B-C model, which explains how depression can result from irrational thinking.
The first component of the model is the activating event.
An activating event is an actual occurrence of a person's behaviour or attitude.
It is something that actually takes place, and while it doesn't lead to depression directly, it does contribute to it.
A girl is sitting with a group of classmates working on a project. She suggests something, but none of the group members immediately incorporates it into the project.
The second com[ponent of the model is beliefs. It is when any event that occurs is interpreted rationally or irrationally.
Simply put, beliefs refer to what someone believes about the event.
Let's take the above example and discuss both variations of interpretations.
Rational interpretation/belief: 'they must be very busy working just now and didn't have the time to respond yet.'
Irrational interpretation/belief: 'no one took my suggestion into account, it must be rubbish, and they are ignoring me.'
And the final component of the model is consequences.
Consequences are the emotional and behavioural repercussions of the event.
Irrational beliefs lead to unhealthy consequences. Again, keeping the above example in mind, let's see how.
Emotional consequence: the girl is hurt because the group didn't acknowledge her suggestion.
Behavioural consequence: she refuses to contribute to the project and causes self-esteem issues that later manifest into depression symptoms.
Note that the activating event does not directly lead to the consequences. It is a person's belief that causes the consequences.
Cognitive Approach to Depression: Beck's Cognitive Triad
Similar to Albert Ellis' cognitive approach to depression: the A-B-C three-stage model, Beck proposed that cognitive factors cause the onset of depression. However, both theories differ in opinion regarding which factors contribute to depression.
Beck's theory proposed a cognitive explanation of depression consisting of cognitive bias, negative self-schemas, and a negative triad.
Beck proposed that cognitive biases lead people with depression to misinterpret and analyse information distortedly.
Cognitive bias suggests that individuals with depression interpret everything negatively without considering positive reasons.
Beck has developed many cognitive biases, two of which are overgeneralisation and catastrophising. Let's take a moment to understand these better.
Overgeneralisation is when a person directly draws limitless conclusions from a small event.
Chances are, this has happened to you at some point, but you may not have realised. Let's take a look at a typical example.
Imagine you have an important job interview and didn't answer one question as best as you could. You might then overgeneralise this and think, 'I did not present myself well in the first interview. I will do badly in the following interviews and won't get the job.'
Catastrophising is when a person believes a minor mishap will result in a complete disaster.
Overgeneralisation and catastrophising may sound similar, but that's not the case; one is often a consequence of the other. Let's take a look.
Not doing well in an interview and overgeneralising that one situation can lead you to believe, ' I will always mess up in interviews and never get a job.'
Cognitive Approach to Depression: Beck and Schemas
According to Beck, individuals struggling with depression tend to have negative self-schemas about themselves resulting from negative childhood experiences such as criticism or bullying. This negative self-image can be a cause of cognitive biases.
Schemas are knowledge packages that store information about the world and ourselves, developed from our experiences and the information we have learned. Schemas are used to guide future thoughts and behaviours.
Imagine someone being called ugly; the individual may assume they are ugly. In the future, the individual may perceive themself as ugly and hide away from others leading to the person isolating themselves and having low self-esteem. Both of these are characteristics that can manifest into depression.
Beck suggested that individuals living with depression have cognitive biases and negative self-schemas, which makes it difficult for them to view any situation positively. Together, these result in what we have discussed as the negative triad and occur automatically - especially if cognitive biases and negative self-schemas are present.
The negative triad implies a negative view of self, a pessimistic view of the future and the world.
Now that we have understood two explanations of the cognitive approach to depression, it's time to evaluate this approach!
Evaluation of the Cognitive Approach to Depression
Since we've discussed two different explanations for depression that fit under the cognitive approach, it would only be right to evaluate these separately to get a complete picture.
Cognitive Approach to Depression: The A-B-C Three-Stage Model by Albert Ellis
Ellis' ABC model significantly contributed to the treatment of depression, as it successfully combats negative, irrational thinking. Two types of this model include Cognitive Behavioural Therapy (CBT) and Rational Emotional Behavioural Therapy (REBT).
Does depression lead to irrational thinking, or does irrational thinking lead to depression?
Cognitive Approach to Depression: Beck's Cognitive Triad
Lewinsohn et al. (2001) studied adults in which they measured their self-esteem and depression-related cognitions for one year. He found that negative thinking was an existing risk factor in depression, supporting Beck's model. However, this was only for participants with intermediate scores for dysfunctional and negative attitudes, not those with very low or high scores.
The findings suggest something else except for the cognitive components theorised by Beck are at play, and therefore the theory can be assumed reductionist.
A reductionist theory is when a theorist reduces/ over-simplifies a theory to one component, ignores other important factors, and does not give the required holistic picture needed to understand something.
Okay, so we've understood and evaluated the explanations offered by the cognitive approach for depression, but how can it be treated?
Cognitive Treatment for Depression
In cognitive behavioural therapy, irrational and distorted thought processes are challenged to change the patient's behaviour based on the new thought pattern. Therapists help patients identify the negative patterns in their logic that make them depressed. Then, they guide them to use alternative ways of thinking and interpreting life events.
Many psychologists use the cognitive approach to treat psychological disorders or problems. Treatment of depression using the cognitive approach involves therapy to help change cognitive processes.
An example of how a client-therapist interaction in CBT may go is shown in the example below.
Identify maladaptive thoughts and behaviours, e.g. "when you talk, no one thinks your stupid; you are simply overgeneralising. In this case, if you notice your breathing change, then use the breathing-relaxation techniques we learned in our last session. I was hoping you could give this a go in your next class presentation. You can do this!"
Therapists often give clients homework so that they apply what they learn in sessions to real-life settings with guidance.
Cognitive Approach to Depression: Rational Emotive Behaviour Therapy
Rational emotive behaviour therapy (REBT) is a form of cognitive behaviour therapy that challenges irrational thoughts and beliefs by disputing them. The therapist confronts the patient by questioning the logic behind their irrational beliefs and replacing them with effective beliefs. Two ways of doing this are:
Challenging the logic behind the patient's beliefs with logic disputes, e.g., asking, 'Does this way of thinking about this situation make sense to you?'.
Using empirical disputation, the therapist looks for evidence to support the patient's belief, e.g., 'What evidence leads you to believe that your belief is true?'.
Fig. 2 - By challenging negative beliefs with the help of therapy, individuals can change how they interpret situations, which further helps them with their feelings
At the same time, in behavioural therapy, the therapist gives the patient homework to check their negative beliefs. The motive for this homework is for the patient to recognise their unrealistic beliefs and consider them false.
A person who feels anxious in social settings may be tasked with meeting two friends at a fair.
The idea with any form of therapy is that it's based on the individual's needs and what they want to achieve by the end of it. While there may be an overarching framework for what the different types of therapy tend to include, the characteristics of it are unique to each individual.
Cognitive Approach to Depression - Key takeaways
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