Depression and the cognitive model of emotional disorders (how does CBT…
Depression and the cognitive model of emotional disorders
What is the Diathesis stress model?
you're only vulnerable when negative cognitions are triggered
is there a cognitive vulnerability?
Beck said depressenogenic schema lays dormant until triggered by event
What did Miranda 80s find about patients with a history of depression?
no history vs history of depression
low mood positively correlates with dysfunctional attitudes in pps with history and not with the ones with no history
What did Dent 80s find about negativity of cognitions?
who remains depressed can be predicted by negativity of cognitions during depression
what did Segal 00s find about CBT vs pharmacotherapy?
CBT treated depressed have less of an increase in dysfunctional attitudes than drug treated post sad mood induction
What are the 5 aspects in Padesky's model
what are the overall evaluations of the cognitive models?
cognition is important in understanding depressive reactions to stressful events
there is substancial evidence to support the cognitive vulnerability hypothesis
the extent to which extreme global and negative views about the self are elevated by stressful events and low mood determines vulnerability to depression
perhaps too much emphasis is given to cognition and the social content is overlooked somewhat
Does rumination account for gender differences in depression?
depression rates are 2:1 women:men
Nolen found women are more likely to ruminate
when ruminations were partialed out gender differences disappeared
remination increases risk of depression
rumination correlates with self harm
men are more likely to fight off negative mood with distraction method
methods other than rumination lead to other pathologies
But do depressed patients see events in a negative way?
classified students as depressed or non-depressed
had them perform an ambiguous task
had positive feedback 30% or 70% of the time
depressed recalled less positive feedback than non dep
depressed recalled negative feedback more accurately than non dep
depressed remember negative memories quicker
when encoding negative words and relating them to themselves, depressed had better recall
meta analyses overwhelming conclusion that depressed report more neg cognition, dysfunctional attitudes
interacting cognitive subsystems
What did Teasdale 90s find about cognitive response to depressed mood and stressors?
that there are individual differences in the extent to and what negative thinking processes are activated depending on mood and stressors
does cognition have a causal effect on cognition?
dysfunctional cognition remains after depression is in remission
higher levels of dysfunctional cognition correlates with more likely relapse following recoevry
most studies show cognitive style of recovered do not differ from non-depressed
What is the basic idea of cognitive behavioural therapy?
What is some more evidence to support response style theory of depression
rumination predicts depression onset
rumination is a risk facto for other things too; eating disorder, substance abuse
rumination is a maladaptive emotion reaction an emotion dysregulation is an important cause of psychopathology
what factors contribute to the development of a deppressenogenic schema?
experience of loss eg parents / health
period of expecting loss
self-esteem lowering events eg bullying or critical parents
Is the schema selective?
what does this mean?
beliefs are retained despite disconfirming information
what is an example of measuring dysfunctional attitudes and schemata
the dysfunctional attitudes scale (Beck)
What is a self -schema?
beliefs about the self
What is a schema?
a structure for coding and evaluation stimuli which enables categorisation and interpretation of experiences in a meaningful way
What is the evidence for the hopelessness mode of depression? (Abraham, 80s; Rose, 90s)
some forms of depression are caused by hopelessness
hopeless cognitive styles correlate with personality disorders
What does the attributional reformation say is key? (Seligman, 70s)
perception of how events are caused is key
What is maladaptive attributional style?
the belief that negative events are attributed to internal stable causes
and positive events are attributed to external unstable causes
what are some facts about depression?
general rates have been changing over time
they have been increasing
it is a recurrent disorder
what % of people who have already had a depressive episode will have another within the 10 years following?
that is is one of the most prevalent mental disorders
does prevalence rate vary cross culturally?
industrialised nations have a higher rate of depression than non - industrialised nations
what is the estimated current prevalence in adults?
what is the USA life time prevalence rate?
does prevalence vary depending on gender?
depression is 2/3 times more common in women than men
does prevalence vary depending on age?
it used to be most common in the middle-aged but now its more common in the young
it has a high frequency of co-morbidity
with what in particular?
what are some key characteristics of depression according to the DSM?
that you have a minimum of 5 of the following symptoms within a 2 week period. 1 must be either depressed mood or loss of interest / pleasure
psychomotor agitation / retardation
insonmia / hypersomnia
feeling worthless or guilty
significant weight loss
loss of interest / pleasure
recurrent thoughts of death
diminished ability to think / concentrate / indecisiveness
symptoms don't meet criteria for another disorder
symptoms must cause distress or change normal functioning
symptoms are not directly due to substance or medication
What study is the learned helplessness model of depression based on? Seligman (70s)
animals were exposed to a shock which occurrence was either controllable or uncontrollable
what 3 changes in functioning were found?
how does depression arise?
from a perspective that important environmental changes cannot be controlled
What is the idea behind Beck's cognitive model of depression (70s)
that three levels of dysfunctional cognition characterise depression
what are they?
the cognitive triad (negative automatic thoughts about the self, world and future
faulty information processing
black and white thinking
negative self schema
what are some factors associated with chronic depression?
it is often associated with the cluster c personality disorders
what is the cluster c?
the anxious fearful cluster
what disorders does it include?
early life trauma
loss of a parent
it has an early age of onset
in what form?
what is dysthymia?
persistant mild depression
when in partiular?
adolescence - mid 20s
What is the evidence for maladaptive attributional style? (Mezalis, 00s; Hu, 10s)
a large meta analysis found that controls have a self serving attributional style that patients with psychopathological disorders (esp depression) do not have
meta analysis showed overwhelming support of maladaptive attributional style in psychopathoolgy
What are the characteristics of CBT?
uses socratic questioning
involves frequent feedback
what are the aims?
be aware of causal issues relating to cognition in depression
be aware of cognitive model for emotional disorders and the principles of CBT for depression
be familiar with cog models of depression
What are the three levels of cognitive structure?
negative automatic thoughts
What does the ruminative response scale measure? (Nolen)
the frequency at which people think certain thoughts when depressed eg analysation
meta cognitive model of depression (Nolen, 90s)
What are participants who endorse emotion focused rumination less likely to engage in?
active structure problem solving
What is the ruminative response style?
behaviours and thoughts that repeatedly focus on attention on one's depressive symptoms and their implications
Why do people ruminate?
to work out their problems
What does distractive response style involve?
turning one's attention away from one's depressive symptoms and causes
What is the rumination style?
What does the content of rumination represent?
automatic negative thoughts
What are effective distractive responses?
engrossing activities with a high probability of positive reinforcement, activity alone not enough
What is the evidence to support response style theory of depression (Nolen, 90s)
a study that induced a depressed state and then assigned participants to one of four conditions
read sentences focused on self-questioning and emotions
read factual sentences
sort country names according to industrialisation
sort positive and negative traits according to self-description
What did the study find?
distracting conditions lead to decreased depressed mood
activity will see more on a decrease in depressed mood than passive
R were more depressed than prior
DA group were less depressed than prior induction
Core beliefs (schemas)
What are core beliefs?
deep cognitive structures representing how we understand self, world and others
What does activation of core beliefs result in?
high emotion with persistant repetitive bias themes in thoughts
How do the "rules" work?
if... then... - they guide daily actions
What are the in nature?
What are the goals of CBT?
help client construct a more balanced view of self, world, future
construct a model of the interactions between thought, feeling, biology, and behaviour
change links that maintain issues
What are the general principles of CBT for depression?
collaborative: work together for common goals
use of experiments
highly structred eg homework
provide rationale to understand problems
What are the key techniques for CBT in depression?
behavioural changes, changing hyppthesis
cognitive change, addressing thinking errors, guided discovery, allows to test the role of thinking
examples, daily diary, though records
how does CBT tackle specific cognitive distortions?
catastrophising - whats the worst?
overgeneralising - be specific
mind reading - ask self evidence?
labelling - doesn't mean that
self-blame - don't
cant stand it - can
filtering - consider whole picture
black and white thinking - look for grey
What are some techniques in cognitive therapy?
change rules / core beliefs
role play to explore changes in behaviour and changes in feelings
how is depressed mood measured?
What does CBT today look like?