Cognitive Theory of Depression

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The cognitive triad

The cognitive theory of depression (also: cognitive model of depression ) is a psychological theory developed primarily by Aaron T. Beck . It tries to describe how depression works and forms the starting point and basis of cognitive behavioral therapy .

History of origin

The history of ideas from which the cognitive theory emerged can be traced back to the philosophers of the Stoa . Epictetus wrote in the Enchiridion : “People are not troubled by the things themselves, but by the opinions they have of the things.” In the 20th century, Alfred Adler's individual psychology challenged the patient to understand the patient in the context of his own conscious world of experience . Adler wrote in 1931: "We do not suffer from a shock from our experiences - the so-called trauma - but we turn our experiences into exactly what serves our purposes." Leon J. Saul, Franz Alexander , Karen Horney and Harry Stack Sullivan developed this approach further. Philosophical suggestions came from Immanuel Kant , Martin Heidegger and Edmund Husserl ; Karl Jaspers , Ludwig Binswanger and Erwin W. Straus turned this phenomenology into psychology. Jean Piaget's developmental psychology also had an influence .

Albert Ellis founded the actual cognitive theory in 1957 by linking the activating environmental event (A) via belief (B) with the emotional consequences (C). Michael Mahoney, Marvin Goldfried, Gerald Davison, Donald Meichenbaum , Alan Kazdin and Terence Wilson made further contributions to the theoretical conception .

The cognitive theory of depression was worked out by Aaron T. Beck in 1976. It was preceded by systematic clinical observations and experiments.

Differences from other theories of depression

Psychoanalysis

While classical psychoanalytic theory assumes that depressed people are driven by masochism or a need to suffer, the advocates of cognitive behavioral therapy have pointed out that scientific studies have not observed such a need to suffer in depressed patients. This made it all the more obvious to them in these patients:

  • their harsh self-criticism and their negative view of themselves,
  • the systematic negative interpretation of positive experiences that they have with the world and that lead to a negative view of the world,
  • their negative view of the future.

It seemed obvious to Beck and his colleagues that such a negative general perspective, which is apparently not corrected by reality tests, could be explained as a result of diverse and extensive cognitive distortions .

While classical psychoanalysis assumes that depression can be cured by freely associating the patient, cognitive behavioral therapy assumes that depressed patients should not be left to their own thoughts, because otherwise they will become deeper and deeper in the morass of their worries and their negative cognitions sink in.

behaviorism

Similar to the model of learned helplessness , depression is classic behaviorism as a dysfunctional behavior designed, the learned and therefore also again forgotten can be. In contrast to the model of learned helplessness, however, in behavioral theory, depression is attributed not to internal but to external factors, in particular to reinforcement , i.e. to the behavioral feedback that the patient receives from his environment.

In 1974, Peter M. Lewinsohn made the most important individual contribution to the behaviorist theory of depression. The core of his reinforcement-loss theory was the thesis that depression occurs when positive reinforcement recedes in a person's life; H. if he gets into external circumstances (e.g. isolation, change of social environment) that prevent him from continuing to receive the rewards for positive behavior that are indispensable for his willingness to perform and for his mental health. Lewinsohn also suspected that some patients are positively encouraged in their depression by the environment; B. when relatives make themselves available to them.

The cognitive theory of depression has little in common with this model. Its advocates assume that depression can be triggered by external factors, but fundamentally doubt that the course and appearance of depression is also determined by external factors . Rather, they see the determinants of depression in the patient's cognition , an internal factor that is not considered in the behavioristic approach.

Learned helplessness

The cognitive theory of depression has some similarities with the model of learned helplessness developed by Martin EP Seligman and Steven F. Maier in the late 1960s. Seligman has used methods similar to those used in cognitive behavioral therapy in the therapy of depression, in particular showing negative interpretations of the patient's experiences in life, verifying the correctness of such interpretations, and finding more accurate interpretations. Unlike Seligman, Beck considers it wrong and even dangerous to simply turn negative interpretations into positive ones by reframing ; it is all about the accuracy of the interpretation.

The cognitive theory of depression is also the opposite of the depressive realism of Lauren Alloy and Lyn Yvonne Abramson, who developed the thesis in 1988 that depressed people are “sadder but wiser”.

Depression as a mood disorder

In psychiatry, depression is often classified as an affective disorder , for example in ICD-10 , where you can find a place in the immediate vicinity. a. assigned to bipolar disorder . Beck thinks it is misleading to confine a disease that has such a wide range of aspects as depression to the affective, and wrote ironically that one could just as easily classify scarlet fever as a skin disease .

General

Beck describes depression with Mark Schreiber as a complex disorder that can include cognitive, affective, motivational, behavioral and vegetative symptoms. He considers the thought disorder to be the primary element in the chain of phenomena . On the ultimate cause of the disease - d. H. whether depression on z. For example, a hereditary disposition, faulty learning, brain damage, biochemical anomalies or similar decline - the cognitive model of depression does not contain any statements.

The cognition of a person based on settings or assumptions ( schemas ), which in turn from previous experiences have emerged. In depressed patients, these schemata are largely dysfunctional, leading to automated and stereotypical negative thoughts. Beck calls this occasionally of "thoughtless thinking" ( thoughtless thinking ). Patients are mostly unaware of the dysfunctional patterns of their thinking.

Beck makes the following assumptions:

  1. negative cognitive triad : The thoughts concern the self (“I am ugly”), the world (“Nobody loves me”) and the future (“It will remain unbearable”). The patient has a negative self-image, he judges himself as flawed, inadequate, worthless and not desirable. These thoughts go so far that the person concerned thinks he or she lacks the qualities needed to be happy. He also tends to underestimate and criticize himself. According to Beck and others (1975), people who are depressed are particularly prone to suicide when hope for a better future is lost.
  2. Schemas or dysfunctional beliefs : An example of a dysfunctional belief would be: "If nobody loves me, my life is meaningless." The cognitions mentioned go back to schemata that have arisen from past experiences. This concept explains why a depressed patient, despite objective evidence of positive factors in their life, maintains their painful and self-harming demeanor. Schemas are stable cognitive processing patterns that developed in childhood and adolescence. They can be inactive for a long time, but can be reactivated by certain environmental events (e.g. stressful situations).
  3. Cognitive distortions or errors : According to Beck, due to the schemata learned in childhood, incorrect information processing takes place in depressed people, which is similar to the child's thinking described by Piaget. The assumptions are one-dimensional, global, invariable, absolutizing or irreversible. Experiences are usually interpreted negatively, disappointments and defeats are predominantly perceived subjectively and expectations for the future are also negatively influenced. A change in the currently perceived situation is just as little accepted as possible, as is one's own participation in it.

The areas of depressive thinking: the cognitive triad

The depressive, d. H. Thinking, dominated by spontaneous and apparently uncontrollable negative cognitions, takes place in exactly three areas: thinking about the self ( self-image ), thinking about the human environment and thinking about the future . Beck speaks here of a cognitive triad (also "negative triad").

Self-image

Depressed patients see themselves as damaged, inadequate, sick, or disadvantaged, and tend to attribute unpleasant experiences to psychological, moral, or physical deficiencies inherent in themselves. They believe that because of these supposed deficiencies they are worthless and undesirable to others, and therefore underestimate and criticize themselves. Furthermore, they believe that because of these suspected deficiencies, they cannot experience happiness or satisfaction.

Many symptoms of depression can be understood as a direct result of the problematic cognitions that occur in the triad. Dependency (e.g. on an ex-partner) can be understood as a result of the patient's systematic underestimation of himself, who considers other people to be more competent and capable than himself.

Human environment

Depressed people tend to interpret their experiences in a negative way . They are under the impression that the world demands monstrous things from them and at the same time puts massive obstacles in their way. Experiences with the world are stereotypically recorded in categories of success / failure and of being granted / deprivation .

future

Depressed people tend to believe that their present troubles and suffering will never end in the future , and that any undertaking they might attempt will fail.

Symptoms that can be explained by the depressed patient's particular future picture include, among other things, paralysis of will , which can be described as a result of his pessimism and hopelessness (since he expects that his efforts will not be successful, he does nothing) . Desires for suicide are an extreme expression of one's desire to escape from a situation that appears unbearable and unalterable to him . Many physical symptoms (e.g., weight loss, insomnia) can be explained as the result of “psychomotor inhibition”, apathy, and low energy levels in the patient who believes that all efforts are doomed to fail.

Thought schemes and depressogenic basic assumptions

Schemes

It is characteristic of depressed patients that they have certain attitudes through which they cause themselves pain and defeat. To explain why they maintain these - for them disadvantageous - attitudes even when they are refuted by counter-evidence, Beck draws on the concept of schemata .

He understands a schema to be cognitive patterns that a person follows when exposed to a certain environmental situation, dresses it in terms and reacts to it; Schemas are the form in which stimuli are shaped into cognitions. People categorize and rate their experiences through a matrix of schemes.

These schemes can differ greatly for different people, but are usually quite stable for the same person. In psychopathologies such as B. Depression is dysfunctional in certain schemas, with the result that the patient expresses certain environmental situations in a distorted way. Example: “NN doesn't greet me because he doesn't like me.” Alternative interpretations (“NN doesn't greet me because he doesn't wear his glasses and doesn't recognize me”) are systematically excluded.

Latency and activation

The dysfunctional schemata are shaped by experiences that preceded the depression. They usually remain latent; however, they can be activated in certain situations that are similar to the original situation.

Example: a dysfunctional scheme that arose after the death of a parent in childhood can be activated when the patient is abandoned by his spouse. Not everyone reacts to being abandoned with depression, only those people who are particularly sensitive to certain situations due to their cognitive organization.

About the ultimate causes of activation - d. H. Whether the activation occurs through psychological distress , a biochemical imbalance, hypothalamic stimulation or other factors - no statements are made in the context of the cognitive theory of depression.

It happens that a patient himself creates the situation that makes him depressed in the sense of a vicious circle . The depression may lead him to withdraw from close reference persons, who then criticize or reject him, which in turn increases his own tendency to withdraw. However, it is also possible that it was not the patient but a caregiver who started the process. Conversely, harmonious relationships with loved ones can cushion the onset of depression under certain circumstances. However, the degree to which caregivers influence depression varies greatly from patient to patient. In addition to obviously reactive depressions, there are also those in which there are no unfavorable external conditions.

The dysfunctional schemata become idiosyncratic and overactive in depression and, as the disease increases, they are also applied to situations with which they logically have less and less to do. In severe depression, the patient is completely engulfed by incessantly recurring, repetitive negative thoughts, and under certain circumstances it may hardly be possible to open his mind to other tasks. The patient more or less loses volitional control over his thinking, and the idiosyncratic organization of his cognition becomes autonomous.

Depressogenic basic assumptions

According to Beck, the automatic, situation-specific thoughts provide access to the underlying, more fundamental and cross-situation "depressogenic basic assumptions". Depressogenic beliefs are those dysfunctional beliefs that predispose a person to depression. The basic assumptions are not immediately conscious and can usually only be articulated by the patient after a long period of introspection. They are harder to see and work with than automatic thoughts. Beck lists some basic assumptions that dispose of depression, here are a few examples:

  1. To be happy, I have to be successful in everything I do.
  2. To be happy, I always have to be accepted by everyone.
  3. If I make mistakes it means I am incapable.
  4. I can not live without you.
  5. If someone disagrees with me, it means they don't like me.
  6. My worth as a person depends on what others think of me.

The thoughts of the negative cognitive triad reinforce the dysfunctional belief as well as vice versa.

Forms of cognitive bias

Depressed patients hold on to the truth of their negative concepts even when they are refuted by counter-evidence. This is due to systematic errors in reasoning. Beck identifies six types of cognitive bias in particular in depressed patients:

  1. Arbitrary inference : Inferences (“X doesn't like me”) are drawn from evidence that is either insufficient for the relevant conclusions or even excludes them.
  2. Selective generalization ( selective abstraction ): A detail is picked out of a bundle of clues, from which conclusions can be drawn (“Y did not shake hands with me when I parted, so he doesn't like me”); No conclusions can be drawn from much more obvious clues ("Y seemed pleased to have met me and we had a good, long conversation").
  3. Hasty generalization ( overgeneralization , hasty generalization ): Because of a single incident or due to a number of isolated incidents is established a general rule that is applied not only to similar situations, but also to those situations that the "original incidents" bear no resemblance .
  4. “ Magnification ” and “ minimization ”: Negative events are rated inappropriately high and positive events are downplayed in their importance. Example: “The fact that I got the contract signed with customer A is worthless. But the fact that customer B has not yet called back shows that I am a bad seller! "
  5. Personalization ( personalization ): The patient relates events without sufficient evidence to itself ( "My child has this year two bad grades in school I failed as a mother..").
  6. Dichotomous thinking ( absolutistic, dichotomous thinking ): The patient tends to classify all events into one of two complementary categories (e.g., spotless / flawed, pure / dirty, holy / sinful). The patient always sees himself in the negative side.

Further cognitive biases are mentioned in the specialist literature:

  2. Catastrophizing : The occurrence or significance of negative events is greatly overrated: "Something bad will definitely happen to my children!"
  3. Emotional evidence : The feeling is taken as proof of the correctness of the thought: "I feel that I am worthless, so that's how it is!"
  4. Labeling: An action is made into a comprehensive state of affairs, e.g. B: "I've lost - I'm an absolute loser!"
  5. Mind reading: Without asking, you think you know the thoughts of others: "The others think I'm a failure!"
  6. Tunnel vision (selective attention): Someone only sees a certain aspect of their current life: "If I have stress at work, then my life is botched!"

What these thought patterns have in common is that they - in the Piaget sense - can be described as "primitive". "Primitive" thinking is moralizing and denies:

  • that something can have multiple sides, e.g. B. that a person can combine good and bad qualities,
  • that between the extremes of black-and-white thinking lies a whole range of shades of gray,
  • that human behavior is situational, e.g. B. that certain actions are more difficult for someone in some situations, but easier in others,
  • that people can change and problems can be solved.

The thoughts that flood the consciousness of depressed people therefore tend to be extreme, negative, categorical, absolute, and judgmental; their emotional reactions also tend to be negative and extreme.

Automatic thoughts

According to Beck, the so-called “automatic thoughts” are of central importance for the patient's feelings and depressive symptoms. This is understood to mean cognitions that run rapidly, occur in a flash, appear subjectively plausible and occur involuntarily, which lie between an event (external or internal kind) and an emotional experience (consequence). The automatic thoughts are mostly distorted in the sense of the thinking errors described above. At the beginning of the therapy, the patient is mostly not aware of these automatic thoughts, but they can be made aware of them and are therefore accessible for therapeutic processing.

literature

  • Aaron T. Beck, A. John Rush, Brian F. Shaw, Gary Emery: Cognitive Therapy of Depression . The Guilford Press, New York 1979, ISBN 0-89862-919-5 .

Individual evidence

All references “Beck et al.” Listed below refer to: Aaron T. Beck, A. John Rush, Brian F. Shaw, Gary Emery: Cognitive Therapy of Depression . The Guilford Press, New York 1979, ISBN 0-89862-919-5 .

  1. ↑ a b c Beck et al. (1979), p. 8
  2. ↑ Alfred Adler: Why do we live? Fischer, Frankfurt / M. 1979, p. 21 .
  3. ↑ a b c Beck et al., P. 9
  4. ^ Albert Ellis: Outcome of employing three techniques of psychotherapy . In: Journal of Clinical Psychology . tape 13 , 1957, pp. 344-350 . Albert Ellis: Reason and emotion in psychotherapy . Lyle Stuart, New York 1962. Albert Ellis: Growth through reason: Verbatim cases in rational-emotive psychotherapy . Science & Behavior Books, Palo Alto 1971. Albert Ellis: Humanistic psychotherapy: The rational-emotive approach . McGraw-Hill, New York 1973.
  5. ↑ Beck et al., P. 10
  6. ↑ Aaron T. Beck: Cognitive Therapy and the Emotional Disorders . International Universities Press, New York 1976.
  7. ↑ Aaron T. Beck: Thinking and depression: 1, Idiosyncratic content and cognitive distortions . In: Archives of General Psychiatry . tape 9 , 1963, pp. 324-333 . Aaron T. Beck: Thinking and depression: 2, Theory and therapy . In: Archives of General Psychiatry . tape 10 , 1964, pp. 561-571 . Aaron T. Beck: Depressinon: Clinical, experimental, and theoretical aspects . Hoeber, New York 1967 (reprinted "Depressions: Causes and Treatment," Philadelphia: University of Pennsylvania Press, 1972).
  8. ^ Richard C. Friedman: The depressed masochistic patient: diagnostic and management considerations - a contemporary psychoanalytic perspective . In: Journal of The American Academy of Psychoanalysis and Dynamic Psychiatry . No. 1 , 1991, p. 9-30 , PMID 2061139 . Seymour Fisher, Roger Greenberg: Freud scientifically reappraised: Testing the theories and therapy . John Wiley & Sons, New York 1996, ISBN 0-471-57855-X .
  9. ↑ a b Beck et al., Foreword
  10. ↑ Beck et al., P. 7
  11. ↑ Rashmi Nemade, Natalie State Reiss, Mark Dombeck: Psychology Of Depression- Behavioral Theories. Retrieved October 24, 2017 .
  12. ^ Peter M. Lewinsohn: A Behavioral Approach to Depression . In: RJ Friedman, MM Katz (Ed.): Psychology of depression: Contemporary theory and research . Wiley, Oxford, England 1974, p. 157-178 .
  13. ↑ Learned Helplessness. Retrieved November 5, 2017 .
  14. ^ Lauren B. Alloy, Lyn Yvonne Abramson, Depressive realism: four theoretical perspectives . In: Lauren B. Alloy (Ed.): Cognitive processes in depression . Guilforde Press, New York 1988, ISBN 978-0-89862-706-0 , pp. 223-265 .
  15. ^ Aaron T. Beck: Clinical, Experimental, and Theoretical Aspects . Harper & Row, New York 1967, ISBN 0-8122-1032-8 ( limited preview in Google Book Search). Beck et al. (1979), p. 18
  16. ^ Mark T. Schreiber: Depressive cognitions . In: American Journal of Psychiatry . tape 6 , 1978, p. 1550 .
  17. ↑ Beck et al. (1979), p. 18
  18. ↑ Beck et al. (1979), p. 19
  19. ↑ Beck et al., P. 3
  20. ↑ Beck et al., P. 4
  21. ↑ Beck et al., P. 5
  22. ↑ a b c d James N. Butcher, Susan Mineka & Jill M. Hooley: Clinical Psychology . 13th edition. Pearson Studium, Munich 2009, ISBN 978-3-8273-7328-1 , pp. 299 ( limited preview in Google Book search).
  23. ^ Frank Wills: Cognitive Therapy according to Aaron T. Beck: Therapeutic Skills compact . tape 7 . Junferman, Paderborn 2014, ISBN 978-3-95571-133-7 , pp. 120 ( limited preview in Google Book search).
  24. ^ Saul McLeod: Cognitive Behavioral Therapy. Retrieved October 26, 2017 .
  25. ↑ a b c Beck et al., P. 11
  26. ↑ a b c d Beck et al., P. 12
  27. ↑ Beck et al., Pp. 12f
  28. ↑ a b Beck et al., P. 13
  29. ↑ a b Beck et al., P. 16
  30. ↑ Beck et al. (1979), p. 20
  31. ↑ Beck et al. (1979), p. 17
  32. ↑ Beate Wilken: Methods of Cognitive Restructuring . A guide to psychotherapeutic practice. 5th updated edition. Kohlhammer, Stuttgart 2010, ISBN 978-3-17-021324-1 , pp. 28 ff . (Kohlhammer-Urban-Taschenbücher 466).
  33. ↑ a b Beck et al., P. 14
  34. ↑ Beate Wilken: Methods of Cognitive Restructuring . A guide to psychotherapeutic practice. 5th updated edition. Kohlhammer, Stuttgart 2010, ISBN 978-3-17-021324-1 , pp. 25th ff . (Kohlhammer-Urban-Taschenbücher 466).
  35. ^ Jean Piaget: Le jugement moral chez l'enfant . Librairie Felix Alcan, Paris 1932.
  36. ↑ Beck et al., P. 15