Cognitive theory of depression can be discussed based on Beck’s Cognitive Theory. This theory has four bases. The first of these is the “negative triad -the world and its experiences, negative perception of the future-“, the second is negative automatic thoughts, the third is the formation of systematic errors in information processing and perception, and the fourth is the emergence of basic dysfunctional assumptions.
Negative Triple
The first element includes the person’s perception of himself as worthless, inadequate, morally or physically handicapped. The person blames himself for the negative events in the past and thinks that he is not liked by others. The second element of the negative triad is related to the patient’s negative perception of his relationships and experiences with his environment. He thinks that too much is demanded of him, that the world is full of insurmountable difficulties. Likewise, the future; darkness is perceived as a hopeless situation, pregnant with failures.
These negative cognitive concepts can explain almost all the symptoms that are characteristic of the depressive syndrome.
Automatic Thoughts:
The automatic emergence of negative thoughts is also an important aspect of the cognitive theory of depression. These dysfunctional thoughts arise quickly and automatically without the patient planning, judging, or thinking ahead. Automatic thoughts directly reflect more basic dysfunctional schemas or assumptions and are considered true by the person. These thoughts sometimes occur so quickly that the patient may not be aware of them. One of the first topics in cognitive therapy is to teach the person to capture these automatic thoughts and to show how these thoughts affect emotions and behaviors.
Systematic Errors:
One of the important factors in a person’s negative perception of himself, his environment and the future is the systematic mistakes made in information processing. Beck (1967, 1976) lists these errors as follows.
• Selective Detection: Perceiving a certain detail of a situation selectively while ignoring other important features
• Exaggeration: magnifying negative events
• Disdain: Don’t underestimate positive events.
• Overgeneralization: Extracting general rules from a single event
• Individualization: holding oneself accountable for daily mishaps
• All or Nothing Thinking: Events are perceived in two extremes such as black and white, very bad, extraordinary, good and bad
• Arbitrary Inference: Drawing some conclusions about the absence of or evidence to the contrary*
Dysfunctional Schemas
The fourth and most important concept related to the cognitive theory of depression is the basic dysfunctional assumptions. These assumptions or beliefs are highly unchanging and permanent characteristics that usually begin in childhood and develop throughout life. Examples of dysfunctional thinking are the belief that the individual needs the approval of others so that he or she can feel valuable no matter what he does, feeling obliged to be successful in every field to be considered successful, or believing that good things can be controlled in life. These kinds of ideas and beliefs are constantly supported by cognition distortions.
By perceiving events, schemas provide us with frames of meaning. Interpersonal relationships are largely based on shared schemas. To be able to store information in memory, to combine information from different sense organs, to remember information related to each other, is possible with the help of schemas. It takes many years for schemas to develop repeatedly and turn into automatically functioning mental units.
Features of Cognitive-Behavioral Treatment of Depression
Cognitive therapy, as defined by Beck et al. (1979), is an “active directive, time-limited and structured” approach. Underlying this approach is the theoretical view that an individual’s emotions and behaviors are largely determined by his interpretation and perception of the world. The main features of cognitive therapy are summarized below.
1. Structural: Each therapy session is planned as agreed between the patient and the therapist.
2. Active: Both the therapist and the patient actively participate in the therapy process. The therapeutic relationship is important.
3. Directive. The therapist conducts the interview.
4. Flexible: According to the course of treatment, appropriate techniques and homework are selected, taking into account the needs of the patient.
5. Theory-Based: Treatment is based on the cognitive theory of psychological disorders. It includes applications of various techniques according to an underlying rationale.
6. Short and Time-Limited: Patients are encouraged to develop independent coping methods.
7. Problem-Oriented: The focus is on understanding and eliminating the factors that perpetuate the problems.
Cognitive therapy can be perceived as a kind of problem solving method. Patients present with a variety of problems, including depression. Depressive thinking style prevents solving problems. Dealing with automatic negative thoughts is the path to the result, not the result. The aim of therapy is not only to help the patient think rationally, but also to find solutions to the patient’s problems by using cognitive-behavioral strategies. The first aim is to reduce symptoms, and in the long term to address life-related problems, thus preventing future bouts of depression.
Efficacy of Cognitive-Behavioral Therapy in Depression
In the literature, a large number of comparative studies have been published and are still being published on the short and long-term results and effectiveness of cognitive-behavioral therapy in the treatment of depression. Studies evaluating the results immediately after treatment show that cognitive behavioral therapy is at least as effective as tricyclic antidepressants (Feimell, 1989 and Blackburn, Davidson, & Kendel, 1990). In three separate follow-up studies on its long-term effectiveness, cognitive behavioral therapy was found to be more effective in preventing relapse than antidepressant drugs (Kovack et al., 1981; Slmons et al., 1986; Blackburn, Euson, & Bishop, 1986).
In a meta-analysis study conducted by Dobson in 1989 comparing twenty-eight studies, cognitive-behavioral therapy was found to be significantly more effective than behavioral, psychodynamic, nondirective, and other types of therapy. While many studies in the literature show that depressive patients get a response from cognitive-behavioral therapy, it is a fact that some depressed patients do not get an effective response from this therapy (Fenneil, 1989). It has been found that drug treatments have more effective and faster therapeutic effects, especially in severe depressions (Elkin et al., 1989). It is emphasized that pharmacotherapy and electro-convulsive therapy should be applied in severe depressions, especially in cases where the risk of suicide is high. On the other hand, studies have shown that cognitive-behavioral therapy is superior in preventing relapse in the treatment of chronic depression (Craig & Dobson, 1995).
Adequate research results have shown that the combined use of pharmacotherapy and cognitive-behavioral therapy in the treatment of depression is also more effective than pharmacotherapy alone or psychological treatments alone (Cralg and Dobson, 1995 and Elldn et al., 1989). Considering the results of this research, it can be concluded that the combined use of pharmacotherapy and cognitive-behavioral therapy is accepted as one of the effective strategies in the treatment of depression.
