The cognitive approach to explaining and treating depression
The cognitive approach sees depression as occurring as a result of maladaptive (irrational) thought processes. Beck (1987) saw people becoming depressed through negative schemas (tendencies to perceive the world negatively), consisting of:
• ineptness schemas that make people with depression expect to fail
• self-blame schemas that make people with depression feel responsible for all misfortunes
• negative self-evaluation schemas that constantly remind people with depression of their worthlessness
and fuelled by cognitive biases (tendencies to think in particular ways) that make individuals misperceive reality in a negative way.
Negative schemas and cognitive biases maintain the negative triad, three pessimistic thought patterns concerning the self, the world and the future.
Ellis’ ABC model sees depression occurring through an activating agent (where an event occurs), a belief held about the event and a consequence involving a response to the event. Cognitive treatments are based on modifying maladaptive thought processes to alter behavioural and emotional states — for example, rational emotive behaviour therapy (REBT), which seeks to make irrational and negative thinking more rational and positive. Therapists help patients realise how irrational their thinking is and encourage them to practise more optimistic thinking by reframing, which involves reinterpretation of the ABC in a more positive and logical way.
Fig 4.6 Beck’s negative triad
Beevers et al. (2010) investigated whether brain areas associated with cognitive control were affected by emotional stimuli in participants with depression. Thirteen females with low levels of depression were compared with 14 females with high levels of depression. Participants were given 3 facial stimuli cues: happy, sad and neutral (as well as a control geometric-shape cue). A single cue was presented on a screen along with 1 of 2 target stimuli (either * or **). Time taken to recognise which target stimulus was presented was measured. Participants simultaneously had their brains scanned. Lower levels of activation were found in the high depression group in brain areas requiring cognitive control over emotional stimuli (when processing happy and sad faces) but no differences were found between the two groups in brain areas not requiring such cognitive control (neutral faces and geometric shapes). This supports the cognitive explanation that people with higher levels of depression have problems activating brain areas associated with cognitive control of emotional information.
• Boury et al. (2001) used the Beck depression inventory to monitor participants’ negative thoughts and found that people with depression misinterpret facts and experiences in a negative way and feel hopeless about the future. This supports Beck’s cognitive theory.
• Koster et al. (2005) showed participants a screen with positive, negative or neutral words on it. Then a square appeared on the screen and participants were asked to press a button to show where it was. He found that depressed participants took longer to disengage from depressive words than non-depressed participants. This supports the cognitive theory that depressives over-focus on negative stimuli.
• McIntosh & Fischer (2000) investigated whether the negative triad contains the proposed 3 distinct types of negative thought. They found no separation of negative thought, but instead a one-dimensional negative perception of self. This suggests that a negative triad of separate types of negative thought does not exist.
The explanation is supported by the existence of a wealth of research evidence supporting the idea of cognitive vulnerability being linked to the onset of depression, with people with depression tending to selectively attend to negative stimuli.
Cognitive therapies for depression have proven to be very effective compared to therapies based on other explanations, which suggests the explanation may have a higher validity than other explanations.
The explanation acknowledges that non-cognitive aspects, like genes, development and early experiences, can lead to negative thinking patterns, which then leads to the onset of depression. This gives the theory greater explanatory power.
The cognitive approach has difficulties in explaining and treating the manic component of bipolar depression, lessening support for the theory as an overall explanation for depression.
Most of the evidence concerning negative thought patterns and depression is correlational and does not therefore show that negative thinking causes depression. Beck believed it was a bi-directional relationship where depressed thoughts cause depression and vice versa.
The treatment aetiology fallacy argues that the fact that cognitive therapies are effective in treating depression does not necessarily give support to the cognitive explanation on which they are based.
Another effective cognitive therapy for treating depression is the treatment of negative automatic thoughts (TNAT), which, like REBT, works by restructuring maladaptive ways of thinking into more adaptive, rational ways of thinking.