Cognitive Theories of Depression November 30, 2005Aaron T. Beck, MDCognitions and Depression (Beck, 1963)Cognitive ThemesCognitive DistortionsRelation of Depressive Cognitions and AffectCognitions and Depression Theories and Therapies (Beck, 1964)Schemas in DepressionSlide 9Affect and CognitionsProductions (Bower, 1978)Productions in Depression (Bower, 1978)Cognitions in TherapyPowerPoint PresentationCognitive therapy for DepressionCognitive TherapyAbramson, Metalsky, & Alloy: Hopelessness DepressionHelplessness vs. HopelessnessSlide 19How long can it last?Therapy & PreventionGotlib & Neubauer (2001)GoalSelf-Report MeasuresInformation-Processing Tasks to Assess Cognitive FunctionIP Measurements of Cog. BiasResultsDiscussion PointsCognitive Theories of DepressionNovember 30, 2005Aaron T. Beck, MDCognitions and Depression(Beck, 1963)•Beck identified typical themes of thoughts that discriminated depressed and non-depressed patients. Low Self-EsteemSelf-BlameOverwhelming ResponsibilityDesires 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 WishesCognitive 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 AffectCognitions 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 stimulus-response 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 processIdentify, 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 conceptsNecessary causeSufficient causeContributory causeALSOProximal causeDistal causeHelplessness vs. Hopelessness•Seligman’s (1975) original helplessness theoryOne cannot control outcomes = proximal sufficient cause for depression•Hopelessness theory1. Negative expectations of highly valued outcomesAND 2. HelplessnessProximal sufficient causeHow long can it last?•The more stable an attribution for a negative life event, the longer the person will be hopeless and symptomaticBUT•Needles & Abramson (1988):People who make stable, global attributions
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