The cognitive approach to explaining and treating depression: Beck’s negative triad and Ellis’s ABC model; cognitive behaviour therapy (CBT), including challenging irrational thoughts.


Cognitive Explanations

Beck’s Cognitive Triad

Beck’s cognitive explanation of depression comprises three components: cognitive bias, negative self-schemas and the cognitive triad.

Beck proposed that negative self-schemas and cognitive biases led to the cognitive triad; a negative view of ourselves, the world around us and the future.

  • Self: “I am worthless and inadequate.”
  • World: “Everybody hates me.”
  • Future: “I will never be good at anything.”depression-beck-negative-triad

Cognitive biases

Beck discovered that those with depression tend to overexaggerate and focus on bad events, whilst downplaying or ignoring positive ones. They are prone to cognitive biases through the distortion and misinterpretation of events and situations. Beck described the main cognitives biases as:

  • Arbitrary inference – drawing conclusions from insufficient/ no evidence.
  • Selective abstraction – drawing conclusions from just one of many elements of a situation.
  • Over-generalisation – making sweeping conclusions from a single event.
  • Magnification – exaggerating the importance of an bad event.
  • Minimisation – underplaying the importance of a positive event.
  • Personalisation – attributing negative feelings of others to oneself.

Negative Self-Schemas

A schema is a representation or model we create about aspects of ourselves and the world around us. They develop during childhood and onwards, based on our experiences. People with depression often create negative self-schemas based on information or criticism they may have received from parents, teachers or friends. A person with a negative self-schema is likely to employ the cognitive biases above.

Ellis’ ABC (Irrational Thinking) Model

Ellis decided to define good mental health as ‘rational’ thinking and depression as ‘irrational’ thinking. Ellis’ ABC model proposes that an activating event leads to beliefs about that event, followed by consequences. This process can either be rational or irrational.

ABC-model

  • A: Activating Event: A friend seems techy and snaps at you in class.
  • B: Belief: A rational belief might be to assume that your friend is having a bad day, as this is not usual behaviour for them. An irrational belief might be that your friend now despises you as you are an unworthy human being.
  • C: Consequence: A consequence of rational thinking might be that you give your friend some space for the day, or at lunchtime, gently ask them if they are ok. A consequence of irrational thinking thinking might be that you withdraw from the friendship and stop interacting with other people, believing that everyone hates you.

 

ELLIS

Evaluation of Cognitive Approach

  • A massive strength of the cognitive approach is the effectiveness of therapies based on this approach, such as Cognitive Behavioural Therapy (CBT) and Rational Emotive Behavioural Therapy (REBT, based on Ellis’ model). These treatments aim to change faulty thought processes to more positive ones and is relatively successful in helping people with depression. Success rates are usually around 40-50%.
  • It is not possible to establish cause and effect; are faulty thought processes the cause or effect of depression? It is possible that they are just a symptom.
  • Seligman’s research into ‘learned helplessness’ showed that animals (specifically dogs!) who could do nothing about their situation ‘learned’ to be helpless later on when they could do something about their situation. In Seligman’s research this was jumping over a divide to escape an electric shock. Dogs who had previously been unable to escape the fate of electric shocks, simply remained helplessly receiving shocks, even when they could do something about it. This research showed that the faulty cognitions associated with depression could be learnt.
  • Koster et al. (2005) examined the role of attention to negative stimuli in depression. It was found that depressed people took an average of 12ms to identify that a word was negative when it flashed up on a screen, compared to non-depressed students who only took 2ms. This supports Beck’s cognitive model as it shows that depressed people struggle to disengage from negative stimuli.

Cognitive-Behavioural Therapy

A therapy from the cognitive approach, actually based around the work of Beck, cognitive-behavioural therapy (CBT) is a person-centred form of psychotherapy used to work with the patient to try and overcome the symptoms of depression, rather than (or as well as) using chemotherapy.

Usually it takes place once a week and consists of at least five-to-twenty sessions, progress is reviewed at around 20 sessions. The therapy works to try and help the patient identify negative and unhelpful thoughts and to try and change them. This may involve drawing diagrams for the patients to try and show them the links between their thinking, behaviour and emotions. The rationale of CBT is that our thoughts affect our feelings and behaviour, and so by changing our thoughts, we can make ourselves feel better. Some forms of CBT also focus directly on changing behaviour.

The therapy is collaborative, the therapist and the patient will agree on what the patient wants to change. The therapist may then ask the patient to express their negative belief, for example, in relation to their social life. A depressed patient might believe that there is no point in going out as they won’t enjoy it: the therapist will try and respond by convincing them that they should try it and will in fact enjoy going out.

Stiles et al. (2006)
This study looked at cognitive-behavioural therapy and other therapies (one person-centred therapy and psychodynamic therapy) over a three-year period, in 58 NHS settings around the UK. They found that no therapy stood out as being more successful than any of the others, but they were all very effective: there were reductions in relapse rates and improvements according to self-report data. Whilst this study did not show CBT to be any more effective than other psychotherapies, it did prove the therapy to be effective at treating depression. [/message_box]

Evaluation

Strengths

  • The individual is helped to recognise any problems and taught how to overcome difficulties, so solutions will be more lasting than therapies outside the patient’s control, such as token economy programmes
  • Cognitive restructuring has been used successfully, for example in stress management – by having a sense of control and coping mechanisms, a person is better able to deal with stressful situations in real life
  • Studies such as Seligman et al. (1998) and Kuyken et al. (2008) have shown CBT to be particularly effective, especially when used alongside drug treatment

Weaknesses

  • The therapy relies on the assumption that the individual can change their own thought patterns and control their beliefs, so this isn’t a treatment which everyone will get results from
  • Whilst most studies support CBT as a treatment for depression, many studies have suggested a mix of therapies is more effective
  • A weakness of Beck’s cognitive model is that it may be depression which causes negative thoughts, not the other way around – and if this is the case, the therapy (based on the rationale changing thoughts changes behaviour) is not going to be effective

Brain2

Extension Resources

Here are some great TED Talks to give you a better idea of what it is like to experience clinical depression.