Depression-Cognitive approach and treatment

Question 1

There are two ways in which depression is explained using the cognitive approach. Briefly outline these.

Answer 1

Ellis’ ABC model explains how depression occurs due to irrational thoughts and beliefs.
Activating Event
Beliefs
Consequences
Becks negative triad explains depression to be a consequence of negative cognitive schema and bias.

Question 2

Outline Ellis’ ABC model.

Answer 2

Ellis explains depression as a consequence of irrational thoughts and beliefs. Firstly, there must be an activating event in the environment that acts as a trigger, for example, falling over. This event involves the individuals beliefs about it and these may be rational or irrational, for example, you fell over because you can’t walk. What one believes about the event leads to consequences, such as feelings of worthlessness and depression.

Question 3

Define masturbatory thinking included in Ellis’ ABC model.

Answer 3

Masturbatory thinking refers to the idea that one will be happy when they achieve a certain goal. When the goal is not met, negative thoughts and depression persists.

Question 4

What is the major strength of Ellis’ model?

Answer 4

Real world applications. Ellis’ ABC model has influenced CBT that aims to identify and tackle negative thinking patterns. Evans et al argued that stronger negative thinking is associated with stronger forms of depression. Negative thinking may thus be a primary cause for depression as CBT is highly effective.

Question 5

Outline two limitations of Ellis’ ABC model.

Answer 5

The model blames the patient for thinking negative thoughts over the situation or the environment. They are seen as responsible, however it is not easy to think oneself out of depression. The research is based on correlational data which cannot be used to establish a cause and effect between two variables.

Question 6

What explanation effectively challenges Ellis’ ABC model as oversimplified?

Answer 6

The diathesis-stress model is better suited as it combines different factors. For example, biological factors such as low levels of serotonin may combine with genetic vulnerabilities that allow some to be more depressed than others.

Question 7

Beck argued that depression is a result of negative cognitive schema and cognitive bias. Elaborate on this.

Answer 7

Depression develops because of biased negative interpretations of the world and oneself as well as negative cognitive schemas (sets of beliefs and expectations that are pessimistic of the future)

Question 8

Outline the role of schemas in Becks explanation for depression.

Answer 8

Schemas develop due to negative experiences in childhood and thus events in later life that resemble these experiences trigger negative schemas. These are fueled by cognitive biases subsequently leasing in a misinterpretation of reality.

Question 9

Outline the two types of schema identified by Beck.

Answer 9

The ineptness schema causes one to have an expectation of failure while the negative self-blame schema blames one for their misfortunes. These constantly remind one of their worthlessness.

Question 10

State the cognitive biases which Beck outlined.

Answer 10

Arbitrary inferences (conclusions without evidence)
Selective abstractions (conclusions based on a selective piece of evidence)
Overgeneralisations (grand conclusions on self-worth)
Magnifications and minimisations (exaggerations or the underplaying of events)

Question 11

What is Becks ‘negative triad’?

Answer 11

The theory that the combination of negative schemas and cognitive biases leads to the maintenance of negative emotions around the self, the future and the world.

Question 12

Outline a study which shows that Cognitive Therapy provides immense support for the cognitive explanations for depression.

Answer 12

Butler and Beck reviewed 14 meta-analyses examining the effectiveness of Becks CT and found that it is more successful and has lower relapse rates than drug therapies.

Question 13

Stronger forms of depression are associated with stronger negative thinking. What does this suggest?

Answer 13

Evans et al suggests that because stronger depression cases display greater tendencies for maladaptive thinking, there is validity behind Ellis’ and Beck’s cognitive explanations for depression.

Question 14

What are the two general issues with cognitive explanations for depression?

Answer 14

They blame the patient for negative outlooks, however, Beck acknowledged that genetic vulnerabilities or negative events could influence their thinking.
Research is based on correlational data which cannot be used to draw the cause and effect between two variables.

Question 15

What is the general and most important strength of the cognitive explanation for depression?

Answer 15

It has led to practical world applications - treatment: CT and CBT that is more effective than drug therapies.

Question 16

CBT is the main treatment for depression assuming that maladaptive thoughts and beliefs cause and maintain ones depression and aims to identify and change these maladaptive thoughts and in turn shape behaviours. Briefly outline CBT

Answer 16

CBT works by replacing irrational beliefs, expectations and cognitive assessments people have of themselves, with positive and productive thinking that shapes behaviours which brake the depressive cycle. Behaviours encourage the patient to engage in rewarding experiences and activities in hope that these will affect their thoughts. It is short and last around twenty sessions involving challenging irrational thoughts and behavioural activation.

Question 17

How are irrational thoughts challenged in CBT?

Answer 17

The link between thoughts and emotions is recognised. Patients are encouraged to record emotionally activating events and think about the thoughts associated with these events and challenge these with positive thoughts. This is done though questioning whether the thoughts make sense, are logical, have evidence behind them and are pragmatic and helpful. Patients are thus encouraged to be objective and replace maladaptive thoughts with constructive ways of thinking.

Question 18

What does behavioural activation involve in CBT?

Answer 18

Activities that lead to positive rewards and alleviate depressive symptoms. These encourage enjoyable activities and challenge negative thoughts that prevent patients from being active.

Question 19

What are the major weaknesses of CBT?

Answer 19

CBT is costly and requires a trained therapist and therefore is not appropriate for everyone. The quality of the therapy depends on the quality of the therapist. Kuyken et al found that the quality can vary by as much as 15%
CBT may not be appropriate for severely withdrawn patients as their symptoms may worsen due to being overwhelmed.

Question 20

What are the advantages of CBT?

Answer 20

It does not involve side-effects such as heart problems and suicidal thinking. It treats the root cause of depression, making it a holistic and curative approach that has lasting benefits.
Evans et al - low relapse rates.
It is most effective in combination with SSRI’S