Cognitive Therapy for Depression
Cognitive Therapy for Depression
Psychological treatment of depression (psychotherapy) can assist the depressed individual in several ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Third, problem solving therapy changes the areas of the person’s life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in solving relationship problems.
At first glance, this may seem like several different therapies being used to treat depression. However, all of these interventions are used as part of a cognitive treatment approach. Some psychologists use the phrase, cognitive-behavioral therapy and others simply call this approach, cognitive therapy. In practice, both cognitive and behavioral techniques are used together.
Once upon a time, behavior therapy did not pay any attention to cognitions, such as perceptions, evaluations or expectations. Behavior therapy only studied behavior that could be observed and measured. But, psychology is a science, studying human thoughts, emotions and behavior. Scientific research has found that perceptions, expectations, values, attitudes, personal evaluations of self and others, fears, desires, etc. are all human experiences that affect behavior. Also, our behavior, and the behavior of others, affects all of those cognitive experiences as well. Thus, cognitive and behavioral experiences are intertwined, and must be studied, changed or eliminated, as an interactive pair.
Cognitive Therapy Information presented below:
* Brief History of Cognitive Therapy
* Cognitive Factors in Depression
* Summary of Cognitive Psychotherapy Approach
Brief History of Cognitive Therapy
Many people think that cognitive therapy is a relatively recent development in psychotherapy. However, Albert Ellis published, Reason and Emotion in Psychotherapy in 1962, and Aaron Beck wrote about, The Self Concept in Depression with D. Stein in 1960. To some extent, most or all of the psychodynamic and psychoanalytic theories of depression can be described as having cognitive components.
For example, Freud, in Mourning and Melancholia, published in 1917, suggests that melancholia (depression) can occur in response to an imaginary or perceived loss, and that self-critical aspects of the ego are responsible in part for depression. The main difference between these psychodynamic therapies and cognitive therapies lies in the motivational assumptions made by the therapists, and the techniques used to effect change. Psychodynamic theories presume that the maladaptive cognitions arise from specific internal needs (such as the need for affection, acceptance, sexual gratification, etc.), or from unresolved developmental conflicts from childhood. The cognitive therapists presume that the maladaptive cognitions may arise from faulty social learning, or from a lack of experiences that would allow adaptive learning (such as the development of coping skills) to occur, or from dysfunctional family experiences, or from traumatic events, etc. In other words, psychologists using a cognitive therapy approach recognize that psychological problems such as depression can develop from a variety of life experiences, depending on the individual.
In the 1970s, many psychologists began writing about cognitive aspects of depression, identifying different cognitive components that affected depression, and developing cognitive interventions to treat depression. From this base of theory and research came evidence that cognitive therapy was an effective, and perhaps is the most effective, intervention strategy for treating depression. Since the 1970s, the use of cognitive therapy with depression has increased tremendously, and the number of psychologists using cognitive therapy approaches for the treatment of all psychological problems has also grown. As a result, it appears that cognitive therapy has recently appeared on the scene, in only the past twenty years. But, all psychotherapy has cognitive components. One of the major differences between cognitive therapy and other therapy approaches is the treatment interventions used to change human cognitive experiences.
Cognitive Factors in Depression
* Identification of Skill Deficits
* Evaluation of Life Experiences
* Automatic thoughts
* Irrational Ideas and Beliefs
* Overgeneralizing or Catastrophizing
* Cognitive Distortions
* Pessimistic Thinking
Self-evaluation is a process that is ongoing. We evaluate how we are managing life tasks, and we evaluate whether we are doing what we should, saying what we should, or acting the way we should. In depression, self-evaluation is generally negative and critical. When a mistake occurs, we think, “I messed up. I’m no good at anything. It’s my fault things went wrong.” When someone is depressed, he/she tends to take responsibility for everything that goes wrong, and tends to give others credit for things that turn out fine. Psychologists assume that self-evaluation, in depressed individuals, is too critical, and feeds low self-esteem and a sense of failure.
Identification of Skill Deficits
Sometimes a depressed person may accurately identify a skill deficit. “I’m not good at telling people what I want from them.” This is usually coupled with negative self-evaluation, “therefore, it’s my fault that I didn’t get what I want.” However, in depression, the person assumes that he/she cannot learn how to do what is necessary to achieve a better outcome. The depressed person believes that he/she cannot learn how to act differently. Accurate identification of social skill deficits complicates depression, because it provides a reality base for the other irrational and exaggerated negative perceptions of the depressed person. If the skill deficit is real, then the depressed person assumes that all of the other negative self-assessments must be real too. Further, when depressed, a person is more likely to identify negative characteristics of self, and less likely to see the positive. The result is a long list of the “things I cannot do,” or “tasks I’m no good at,” or “mistakes I’ve made.” Psychologists help depressed persons identify their social skill deficits, and also help them develop a plan to improve those skills. This part of cognitive therapy is more behavioral, as the psychologist teaches the depressed person how to manage their life problems better.
Evaluation of Life Experiences
When depressed, a person will focus on minor negative aspects of what was otherwise a positive life experience. For example, after a vacation at the beach, the depressed person will remember the one day it rained, rather than the six days of sunshine. If anything goes wrong, the depressed person evaluates the entire experience as a failure, or as a negative life experience. As a result, memories are almost always negative. This is reflective of unrealistic expectations. Nothing in life ever works out just as you want. If we expect perfection, we will always be disappointed. Psychologists help you to develop realistic expectations about life, and help you determine what you need versus what you want. After all, most of the things that don’t work out are little things. And even when important problems develop, we can either resolve the problem, or regroup, recover, and start again, with hope for a better future. In depression, the hope is missing.
Self-talk is a way of describing all the things we say to ourselves all day long as we confront obstacles, make decisions, and resolve problems. Self-talk is not “talking to yourself” in a literal sense, although it sometimes does involve talking out loud (depending on the person). There is a myth, that when you talk to yourself, it is a sign of “craziness” or mental illness. That idea stems from the “voices” or auditory hallucinations experienced in severe forms of mental illness, such as schizophrenia. When a person hears voices, he/she thinks it is someone else talking to them. The self-talk we are describing here is not like that at all. We all engage in self-talk. Usually, it is part of our thinking process, or what we call “stream of consciousness.” As we are presented with problems, or decisions, we might think, “Okay, how do I handle this?’ or “This looks like it is difficult, I better ask for help.” or “I know how to fix this!”
Self-talk is not bad, or wrong, or a sign of psychological problems. It is normal. But, negative self-talk prevents us from solving problems, and can contribute to a variety of psychological problems, including depression. When faced with a problem, if our self-talk is negative, it can immobilize us. “I can’t do this, I’m just going to foul it up again” or “I’ll probably get fired after they see how incompetent I am.” Psychologists help depressed individuals identify negative self-talk, and also teach them how to challenge these negative statements, and how to replace them with positive self-talk.
Automatic thoughts are repetitive, automatic self-statements that we always say to ourselves in certain situations. They can be positive or negative. Psychological problems develop when our automatic thoughts are consistently negative. They are automatic, because they are not the result of an analysis of the problem, they are a “knee-jerk” reaction to specific situations. For example, in social situations, do you always presume the other person dislikes you, or thinks you are stupid? When automatic thoughts control our emotional response to people, problems, and events, we ignore evidence that contradicts the automatic thought. If we cannot ignore it, we explain the evidence in terms of the automatic thought.
For example, if we talk to someone and they smile, they are really laughing at us, rather than being pleased to see us. The automatic thoughts create an expectancy of something negative. Since many things in life are vague, and can be interpreted in many ways, we learn how to negatively evaluate the world, so it agrees with our negative automatic thoughts. Psychologists help you to identify your negative automatic thoughts, and how to develop positive challenges to those negative ideas.
Irrational Ideas and Beliefs
Albert Ellis first presented the idea that irrational beliefs are at the core of most psychological problems. We could also call these beliefs unrealistic, incorrect, or maladaptive. Psychologists have also suggested that these ideas are irrational because they are not logical, or are based on false assumptions. Some examples of irrational beliefs:
I cannot be happy unless everyone likes me.
If I do what is expected of me, my life will be wonderful.
Bad things don’t happen to good people.
Good things don’t happen to bad people.
In the end, bad people will always get punished.
If I am intelligent (or work hard), I will be successful.
What makes these ideas irrational, or maladaptive, is the belief that they are always correct. Sure, working hard will increase your chances for success, but success is not guaranteed. But, there are times when we do everything right, and we still don’t get what we want. For some people, this leads to the conclusion that they are lazy, no good, incompetent, or weak. The result is a loss of self-esteem, and sometimes, depression. Psychologists help you to identify your irrational ideas, and also how to evaluate which ideas are irrational and which are not. Finally, the ideas need to be changed to reflect the real world.
Overgeneralizing or Catastrophizing
Catastrophizing is a negative overgeneralization. It is “making a mountain out of a mole hill!” For example:
* One person at work does not like you, and tells you, so you know it’s not mistaken judgment. You then assume no one at work likes you, or you assume that you must be a terrible person if he/she does not like you.
* You make a small mistake on a project, and assume that you will be fired when the boss finds out.
* You try your hand at a new hobby, and it does not turn out well. You conclude, “I’m no good at anything.”
We all make mistakes. If you overgeneralize one, or even a few mistakes, to the conclusion that you are bad, incompetent, or useless, you might become depressed. Psychologists help you identify and change negative overgeneralizations.
Cognitive distortions are another way of describing the irrational ideas, overgeneralizing of simple mistakes, or developing false assumptions about what other people think about us, or expect from us. We are distorting reality by the way we are evaluating a situation. The concept of cognitive distortion highlights the importance of perceptions, assumptions and judgments in coping with the world. Psychologists help us determine what evaluations are distortions by providing objective feedback about our evaluations of the world, and by teaching us how to change the way we are perceiving problems.
Pessimistic thinking does not cause depression, but it appears to be easier to become depressed if you tend to view the world with considerable pessimism. After all, pessimism is a tendency to think that things won’t work out as you wish, that you won’t get what you want. Pessimism feeds the negative cognitive distortions and self-talk. On the other hand, optimism appears to create some protection from depression.
Hopelessness is a central feature of depression, along with helplessness. If you view your world as bad, filled with problems, and don’t think you can do anything about the problems, you will feel helpless. If you don’t believe your life will improve, if you think the future is bleak, then you will begin to feel hopeless. Pessimism encourages these negative assessments of your life. Optimism prevents you from reaching those conclusions. In fact, psychologists have researched ways to learn how to be more optimistic, as a way of fighting depression.
Summary of Cognitive Psychotherapy Approach
First, remember that we cannot present cognitive psychotherapy in one web page, or in a few paragraphs. But, the essence of cognitive therapy is the assumption that irrational thoughts and beliefs, overgeneralization of negative events, a pessimistic outlook on life, a tendency to focus on problems and failures, and negative self assessment, as well as other cognitive distortions, promote the development of psychological problems, especially depression. Psychologists use cognitive therapy to help you identify and understand how these cognitive distortions affect your life. Cognitive therapy helps you to change, so that these issues will not rule your life. If you are feeling overburdened, that life is not working for you, and you don’t know what to do next, talk to someone who can help, consult a psychologist.
Reviewed by Lindsay 03-09-10