Cognitive Theory in the Treatment of Depression
What is depression? Depression is characterized by depressed mood, a loss of pleasure, difficulty concentrating, and feelings of worthlessness or guilt. Negative thoughts, or cognitions, are an important part of the symptoms of depression.
What causes depression? There are many different theories from different schools of thought about what causes depression and other mental illnesses. According to cognitive theory, thoughts and beliefs are the primary cause of depression.
Cognitive theory offers a model to explain human behavior and mental illness. Aaron Beck, a pioneer in cognitive theory, thought that childhood experiences lead to the creation of “cognitive structures” that guide our interpretation of future events.
According to cognitive theory, people take in and process information from the environment, which results in stored representations of our experiences and related beliefs. In cognitive theory, these mental models are referred to as schemas.
Schemas are cognitive shortcuts for navigating the world, shaping perceptions and interpretations. They are “a network of beliefs, assumptions, formulas, and rules… connected to memories relevant to the development and formation of such beliefs” (Beck, 1991).
Theses schemas are then reactivated in similar situations, and act as interpretive shortcuts. One benefit of this is our brain doesn’t have to work as hard, and it can fill in missing information. Most of the time, this is helpful, and doesn’t cause many problems. But, sometimes, relying on these cognitive shortcuts can result in errors.
According to this theory, early experiences are especially important because these cognitive models guide how all future information is processed. If one’s early experiences are adverse or extreme, the individual may develop biased schemas.
For example, according to this theory, depression is the result of early adverse experiences leading to the creation of a negative information processing bias. This guides the perception and interpretation of information though a negative, pessimistic, and distorted filter.
Depression is a consequence of a negative schematic bias across three domains, concerning the self, the world, and the future (Allen, 2005; Beck & Alford, 2009). Negative thoughts about the self include beliefs that one is “worthless, unlovable, and deficient.” Such persons consider themselves “deficient, inadequate, or unworthy.” Negative thoughts about the world include beliefs that the world is scary and overwhelming. Such persons view their life as a “succession of burdens, obstacles, or traumatic situations.” Negative thoughts about the future include beliefs that failure is assured, happiness is unattainable, and there is no use trying to change things. As such persons look ahead, they see a life of “unremitting hardship, frustration, and deprivation.”
When early experiences lead to the development of negative schemas and depression later in life, the individual may have poor insight into the source of their difficulty. Since schemas are pervasive, the depressed person is often unaware of their influence, or that his or her experiences are out of the norm. As such, the presenting problem of the depressed individual is sometimes somatic, such as a loss of appetite, fatigue, or difficulty sleeping.
Schemas tend to be strengthened over time, unless challenged. As schemas filter perceptions, the mind continues to build “biased “memories. These biased memories are then incorporated into further biased schemas. Schemas are then further strengthened by exposure to congruent experiences, as people seek out environments that conform to their view of the world.
Research has examined other specific schemas which may be important for the development and maintenance of depression. Persons who score high on measures of depression also tend to endorse statements suggesting the presence of enduring beliefs related to shame, inferiority, and expectations of abandonment and social isolation (Calvete, Estévez, López de Arroyabe & Ruiz, 2005).
Negative interpersonal schemas may be especially important for, and specific to, the development of depression (Dozois et al., 2009). Negative beliefs about emotions (such as their legitimacy, comprehensibility, and controllability) may also be important in the maintenance of depression, since such beliefs are related to poor emotional regulation skills and unhealthy coping methods. (Leahy, Tirch, & Melwani, 2012).
Schemas exist at a deep and enduring level, and are difficult to change. When navigating the world, the individual makes sense of every situation through an interaction between their schemas and their perception of the current circumstances. Beck called the results of the product of these interactions automatic thoughts. According to Beck, schemes relevant to the current situation “interact with the symbolic situation to produce the automatic thoughts” (Beck, 1991). Automatic thoughts are produced quickly, with few cognitive resources. Information is broadly categorized, and errors in perception and interpretation are likely (Beck & Haigh, 2014; Beck, 1991).
The depressed person is unable to assess a situation with accuracy, and is prone to jumping to negative conclusions even when the evidence does not support such a conclusion. For example, a person with strong negative schemas about the self may respond to challenging situations with automatic thoughts such as “I will fail,” or “This is hopeless.” When left out by peers, such a person may think “I am worthless,” or “I am unloveable.” A person with strong negative schemas about the world may respond to a setback with such automatic thoughts as “Life is too difficult,” or “No one will help me.”
Treating Depression with Cognitive Therapy
If schemes, and the automatic thoughts they generate, are responsible for depression, how do you go about treating depression? According to cognitive theory, treatment will involve:
Learning to recognize these automatic thoughts.
Challenging automatic thoughts by generating alternative explanations.
Some forms of cognitive therapy involve addressing the relevant core schemas driving the directly. Other forms emphasize other skills, such as:
Increasing mindfulness of emotion
Increasing toleration of negative emotions (through exposure to uncomfortable physical sensations, negative emotions, and emotional situations)
Decreasing avoidance of situations which might result in emotion
Decreasing unhealthy emotion-driven behaviors
Accumulating and/or scheduling positive experiences
In some cases of depression, the role of schemas and automatic thoughts may be less clear. According to cognitive theory, those issues are always at the core of depression, whether or not the client has sufficient awareness of these issues to be able to discuss them in therapy.
Therapists who subscribe to other schools of thought may disagree. Even amongst therapists who find cognitive theories and techniques helpful, however, the crucial questions is: what approach will bring relief to the client?
At FRTC, our therapists use cognitive techniques when treating depression and other issues, but we always choose and tailor our treatments for the unique needs of the clients.