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PSYCHOPATHOLOGY- the cognitive approach to explaining and treating…
PSYCHOPATHOLOGY- the cognitive approach to explaining and treating depression
the cognitive approach to explaining depression
CA states that depression is due to irrational thoughts resulting from maladaptive internal mental processes
schema: mental framework based on experience. allow us to quickly process large amounts of sensory info and make automatic responses and assumptions. negative schemas result in automatically negative cognitive biases
Beck's negative triad
believed there was 3 schemas with a persistant automatic negative bias
THE SELF- self-schemas, like feeling "inadequate"
THE WORLD- thinking people are "hostile"
THE FUTURE- thinking things "will always turn out badly"
this can lead to avoidance, social withdrawal and inaction
the negative triad develops in childhood but provides the framework for persistant biases in adulthood, leading to
cognitive distortions
cognitive distortions
overgeneralisation- one negative experience results in an assumption that the same thing will always happen
selective abstraction- mentally filtering out positive experiences and focusing on the negative
Ellis's ABC model
A) activating event. can be anything that happens to anyone
B) belief. people who arent depressed the belief about A is rational, people with depression have irrational beliefs
C) concequences. irrational beliefs lead to negative concequences
mustabatory thinking
this means the concequence of not accepting we dont live in a perfect world.
the fact that we fail to reach unrealistic goals, people dont behave how we expect them to or an unexpected event happens which ruins our plans and leads to disappointment
evaluating the cognitive approach to explaining depression
POSITIVES-
Grazioli and Terry- assesed thinking styles of 65 women before they gave biirth and 6 weeks after. found that those with neg thinking styles more likely to develop post natal depression, especially with woman who had infants with a difficult temprament. supports the idea that faulty thinking leads to depression, but also that there is a diathesis-stress mechanism to Beccks theory- negative thinking is a vulnerability triggered by aversive life experiences like motherhood
the cognitive theories that explain depression have led to highly effective cognitive therapies. CBT effective rate of 81% after 36 weeks, the same as drug therapy. this being successful suggests the underlying cognitive explanations are valid
NEGATIVES-
many people with depression experience anger and people with bipolar depression experience manic. these features are hard to explain with these theories like negative schemas, because theyre resistant to change.
family studies and genetic research suggest predisposition to depression is inherited, likely genes that influence the activity of neurochemicals like serotonin. effectiveness of drug treatments such as SSRIs suggests theres a bio aspect to depression
cognitive theories depend on the assumption that thoughts are irrational. maybe depression is a reasonable response to challenges like poverty. maybe people without depression have a cognitive bias- selectively perceiving the world in a positive light, overly positive self evaluations and unrealistic optimism. people with depression see the world without this positive bias
the cognitive approach to treating depression
both Beck's CBT and Ellis's REBT attempt to change negative schemas and challenge irrational thoughts through cognitive restructuring
Beck's CBT
patient is treated as a scientist for their own brain. they generate tests and hypothesis about the validity of their irrational thoughts. when they realise their thoughts dontmatch reality this will change their schemas and the irrational thoughts will be discarded
thought catching- identifying irrational thoughts coming from the na=egative triad of schemas
homework tasks- these include keeping a diary used to record negative thoughts and identify situations that caused negative thinking
behavioural activation- taking part in things they used to enjoy
Ellis's rational emotional behaviour therapy
development of ABC model, D= dispute E= effect.
dispute- therapist confronting irrational belief. empirical arguments challenge the client to provide evidence for their irrational beliefs while logical arguments show the patient the beliefs dont make sense
Effect- reduction of irrational thoughts restructure beliefs and lead to bettwe concequences in the future
shame attacking exersises- client performs a behaviour they fear doing infront of others. shows they can act against emotions and cope with an unpleasant experience and survive other peoples disapproval. see that most people dont actually care about what we do
the main difference between the two is that Beck's CBT- client is helped to figure out the irrationality of their thoughts by themselves. In REBT- therapist explains irrationality directly through a disputation
evaluating cognitive treatments for depression
POSITIVES-
March (2007) randomly assigned 327 depression patients to 1/3 groups. CBT, drug therapy (SSRI- fluroxitine), both. after 36 weeks, the singluar conditions both had effectiveness of 81%, CBT had more reduction in suicidal events than drug therapy. best results came from combination - effectiveness of 86% and fewer suicidal treatments than either treatment alone.
some people with depression are too depressed to engage with the demands like completing homework . drug therapy might be needed to stabilise before CBT therapies
CBT assignes an active role to patients- giving them the responsibility to overcome their depression
POSITIVE- this gives patients empowerment and gives a sense of personal efficacy- taking control and making positive changes
NEGATIVE- can also say that this is victim blaming and suggests depression would go away if people just thought differently - could lead to the feeling of shame .
NEGATIVES-
both could be overly focused on the present and how to restructure current cognitive processes. clients might want to talk about past traumas. also reinterpreting present experiences might not improe the present situation and concerns about current problems might not be irrational
CBT can take months to complete and is expensive but many prefer it because it addressed the root cause and lacks side effects. cbt effective in long term, people can return to work so people believe from a cost benefit analysis that its worth the expense