COGNITIVE PSYCHOTHERAPY:Â COGNITIVE MODEL OF DEPRESSION
According to Beck (1986), depression is characterised by the ‘cognitive triad’, reflecting the subject’s negative view of the self, the world, and the future. The depressed person sees himself or herself as deficient, inadequate, deserted and lacking in qualities that are essential for self-worth and happiness. The patient’s negative view of the world is reflected in beliefs that exorbitant demands have been put upon him or her, that there are insurmountable obstacles to achieving life goals, or that the world is devoid of pleasure or gratification. The individual perceives defeat and deprivation, an environment which is overwhelming, and being bereft of resources. The subject’s negative view of the future is apparent in beliefs that current troubles will persist indefinitely and may get worse, leading to ideas of suicide.
The motivational, behavioural and physical symptoms of depression are derived from these negative cognitive patterns. The observed ‘paralysis of will’ is due to an expectation of failure and the belief of one’s lack of ability to cope or to control the outcome of an event. So, there is the reluctance to commit oneself to a goal, and often a desire to avoid all challenges. Suicidal wishes also stem from pessimism and hopelessness, and often reflect a desire to escape uncontrollable, unbearable problems. The increased dependency often observed among depressed subjects reflects the negative view of the self as inept, and overestimation of the difficulty of normal life tasks, the expectation that things will turn out badly, and the desire that someone more competent will take over. Indecisiveness is similarly derived from the belief that one is incapable of making the right decision. The physical symptoms of depression – loss of energy, fatigue and inertia – are also related to negative expectancies. Work with depressed patients indicates that getting them to be active stops them slowing down and reduces their tiredness. It has also shown that proving their negative expectations wrong and demonstrating their physical ability has improved their recovery.
Negative thinking is an important process in depression. The tendency to think negatively often develops early in life through personal experience, learning from others and their attitudes. The schemata that leads to depression are maladaptive, negative and idiosyncratic, i.e. “I am a failure” or “Nothing works out for me”.
A person will become depressed when his personal threshold of coping is exceeded by one or more events so that the latent predisposition to depression due to his schemata is brought into play. As we have different thresholds and schemata, some will appear to cope with situations much better than others.
In depression the maladaptive schemata will cause cognitive distortions to arise.
COGNITIVE DISTORTIONS
- Arbitrary inference – drawing a specific conclusion in the absence of substantiating evidence or even in the face of contradictory evidence.
- a) Emotional reasoning (“I feel it therefore it must be true”).
- b) Jumping to conclusions.
- Selective abstraction – conceptualising an experience on the basis of a detail taken out of context, ignoring other more salient information.
- a) Mental filtering (dwelling on a negative detail).
- b) Disqualifying the positive.
- Overgeneralization – drawing a general rule from one or a few isolated incidents and applying the concept broadly to related or unrelated situations.
- a) Labelling (labelling someone in highly emotional terms when it is the behaviour you object                     to).
- b) “Should” statements (absolute rules used to motivate self or judge others).
- Magnification and minimisation – assigning a distorted value to an event, seeing it as far more or less significant than it actually is. This category includes “catastrophizing”.
- Personalisation – attributing external events to oneself in the absence of any such connection.
- Absolutistic, dichotomous thinking – categorising experiences in one or two extremes; e.g., totally good or totally bad.
Some subjects who are depressed may exhibit just a few of the above distortions while others may have most in their cognitions. It will be useful for you to think of real life examples of the above categories. This will help you understand and remember the concepts.
