Cognitive Theories of Depression November 30 2005 Aaron T Beck MD Cognitions and Depression Beck 1963 Beck identified typical themes of thoughts that discriminated depressed and non depressed patients Low Self Esteem Self Blame Overwhelming Responsibility Desires to escape often suicidal ideation Cognitive Themes 1 Low Self Regard unrealistic downgrading of self especially personal attributes such as intelligence health ability to acquire love and friendship 2 Ideas of Deprivation I am alone unlovable unwanted and or have limited material resources 3 Self Criticisms and Self Blame reproaches for perceived shortcomings 4 Overwhelming Problems and Duties Overwhelmed by even small tasks 5 Self Commands and Injunctions Nagging should type thoughts 6 Escape and Suicidal Wishes Cognitive Distortions Depressed patients demonstrate systematic errors in thinking Arbitrary Inference forming an interpretation of a sit event or experience without factual evidence to support conclusion Selective Abstraction Focusing on detail taken out of context Overgeneralization Using deductive reasoning to form conclusion about self based on a single event Magnification Minimization error in evaluation that leads to exaggerate negative while downplaying positive Inexact Labeling Contributes to Magnification and is important to the affective response to event EX using words like destroyed clobbered instead of corrected an error Relation of Depressive Cognitions and Affect Cognitive Distortions lead to bad affect in depression The content of affect is usually congruent to content of cognitions Depressive affect usually is associated with ideas of personal inadequacies and deficiencies Distorted Cognition Affect Cognitions and Depression Theories and Therapies Beck 1964 Idiosyncratic cognitive structures or schemas become dominant during depressive episodes and dominate the thought process Schemas defined as a structure used form screening coding and evaluating impinging stimuli Beck 1964 pp 564 Schemas also called categories coding systems personal constructs modules and concepts Schemas are relatively stable cognitive structures and provide the conceptual framework while external stimuli fill in the details of our cognitions Schemas in Depression Influence of schemas reflected in the increasing prevalence of depressive ideas in thoughts Situations can be construed in a variety of ways the interpretation of a situation is based on active schema Depressive schemas displace more appropriate schemas because they are stronger than appropriate schemas and resulting interpretation will deviate from reality As depression progresses frequency and magnitude of cog distortions grows as idiosyncratic schemas become more and more dominant Schemas in Depression When depressive schemas are hyperactive this influences memory retrieval for past events i e only congruent memories are recalled Recent and past experiences are distorted to make it compatible with current schema Current thoughts and future predictions are all colored by current depressive schema Affect and Cognitions From clinical observations Beck hypothesized that affective responses are determined form how and individual structures his or her experiences Structuring of the situation is determined by schema s that are elicited by situation Circular Relation Once idiosyncratic schemas are active and produce affective responses these affective responses affect the schemas Productions Bower 1978 Productions are generalized stimulusresponse rules that can be affected by many variables When executed either overt behaviors or internal responses like retrieving beliefs from LTM and making them active in working memory Productions in Depression Bower 1978 Cognitions in Therapy As mentioned before distorted cognitions are automatic and seem highly plausible to depressed person The more the patient accepts the validity of the depressive thoughts the stronger the affective reaction So what can you do to change these thoughts Which is better for depression pharmacotherapy or psychotherapy Cognitive therapy for Depression Through focusing on distortions of reality and unrealistic attitudes patient can sharpen perceptions of reality and weaken depressive schemas Two fold process Identify appraisal and corrections of idiosyncratic depressive cognitions i e realistically evaluate the validity of the thoughts Neutralize effects of cognitions by stating precisely why it is wrong and by considering alternative explanations i e person not saying hello because they did not see you instead of because you are a loser Cognitive Therapy Aim of cognitive therapy is to modify schemas Doing so will modify how the patient interprets his or her experiences Go from deductive to inductive reasoning It works Abramson Metalsky Alloy Hopelessness Depression Some preliminary concepts Necessary cause Sufficient cause Contributory cause ALSO Proximal cause Distal cause Helplessness vs Hopelessness Seligman s 1975 original helplessness theory One cannot control outcomes proximal sufficient cause for depression Hopelessness theory 1 Negative expectations of highly valued outcomes AND 2 Helplessness Proximal sufficient cause How long can it last The more stable an attribution for a negative life event the longer the person will be hopeless and symptomatic BUT Needles Abramson 1988 People who make stable global attributions will also do so with positive life events and should also be particularly likely to become hopeful when confronted with a positive event Therapy Prevention Therapy 1 2 3 4 Attack hopelessness directly Attack proximal causes Modify hopelessness inducing environment Change person s own behavior that contributes to depressogenic events Prevention 1 MODIFY COGNITIVE DIATHESES 2 Lessen the stressors in environment Gotlib Neubauer 2001 Information Processing Approaches to the Study of Cognitive Biases in Depression Cognitive biases that produce depression Cognitive biases are sustained by negative life events Measurements of cognitive biases Goal Identify factors other than cognitive biases that distinguish individuals that are vulnerable to depression from non vulnerable population Self Report Measures Problems with self report measures of depression Report the content of the cognition instead of the process Cognitive processes are usually automatic thus not available for selfreport Information Processing Tasks to Assess Cognitive Function IP paradigms may provide a causal link
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