Treating Depression With Aaron Beck's Cognitive Therapy
Albert Ellis, Aaron Beck, and Donald Meichinbaum are major contributors to the “cognitive system." The assumptions that cognitive activity can be monitored, altered, and result in behavioral change are central to cognitive-behavioral therapies. Cognitive-behavioral therapeutic strategies combine cognitive restructuring, coping skills therapies, and problem-solving therapies.
Aaron Beck's Cognitive Therapy
While there are many cognitive approaches, Aaron T. Beck is recognized for the development of cognitive therapy. Cognitive therapy maintains that how people behave and feel are largely determined by how they think.
According to Aaron Beck (1995), conditions such as anxiety and depressive disorders occur, as people’s thinking shifts to themes of defeat, loss or danger. There are certain attitudes that predispose individuals to this negative bias in certain life situations. For example, a person who has experienced trauma from a physical attack may become apprehensive with even the slightest indication of a physical threat.
Cognitive therapists believe that many factors contribute to the development of dysfunctional cognition. These involve the interaction of individual genetic predisposition and their life experiences. Judith Beck (1995) explains that beginning in childhood, people develop a certain belief about themselves, their environment, and their core beliefs. These core beliefs and basic assumptions are called "schemas" that can either be adaptive or dysfunctional.
Judith Beck Talks About Cognitive Therapy and Depression
The Cognitive Model of Depression
Aaron Beck used the concept of a cognitive triad to explain depression. According to Beck, a person who is depressed has a negative view of him or herself, the world, and the future. As a result of this negative view, the person perceives of him or herself as being inadequate, abandoned, and worthless.
Aaron Beck claimed that depression occurs because the person views his or her future is also negative, and so there is the feeling that the problems will not get better. The person thinks that there is little or nothing he or she can do to cope with, or control the outcome of his or her experiences. This sense of hopelessness could lead to thoughts of suicide.
A common consequence of this negative mindset, is that depressed individuals are unwilling to commit themselves to set goals. Then dependence increases because they see themselves as not competent enough manage, and even attempting everyday tasks become overly difficult. With the high expectation of failure, they are indecisive, and this reflects physical symptoms of low energy, fatigue, and lethargy.
The Collaborative Focus of Cognitive Therapy
In cognitive therapy, the therapeutic goals focus on beliefs that include the patient expectations, evaluations and responsibility. The client is encouraged to carefully consider these beliefs and will gradually arrive at different views.
Schemata are identified and their usefulness and soundness are examined. This is to help clients recognize how their core beliefs influence their reactions to potentially disturbing events and encourage them to consider alternatives.
Cognitive therapy stresses the quality of the therapeutic relationship and successful counseling rests on the therapist’s ability to establish trust and rapport with clients.Therapists initiate active and interactive strategies with clients, as they seek to engage them in active participation through all stages of therapy.
The therapeutic relationship reflects collaboration, in which the therapist and client share the responsibility in solving the client’s problem. According to Beck and Weishaar (1995), cognitive therapists work effectively with diverse populations because they actively seek the client’s point of view throughout the process of therapy.
Common Cognitive Errors
One perspective of the client’s thinking that is explored during therapy is cognitive errors. The therapist helps the client to identify how his or her thinking could be in error when faced with specific situations. in the cases of cognitive errors, there is no evidence to support them. Below are some of the common cognitive errors and examples:
- All-or-nothing thinking
- Discounting the positives
- Jumping to conclusions
- Mind reading
- Fortune telling
- Emotional reasoning
- Making “should” statements
- Inappropriate blaming (Derubeis, Tang & Beck, 2001)
Dr. Beck Interviews a Depressed Woman
Cognitive Therapy Case Formulation
Cognitive therapy case formulation offers a hypothesis about the causes and nature of the presenting problem. It consists of five components:
- Problem List consists of a list of the client's difficulty including interpersonal, financial and occupational.
- Diagnosis is helpful in developing the problem List and for treatment planning.
- Working Hypothesis describes the relationship among the problems on the Problem List and consists of four sections including schemata and summary of the hypothesis.
- Strengths and Assets help the therapist to draw from the client's strength to design the necessary interventions.
- Treatment Plan includes goals that are ways to solve the problems on the Problem List. Each goal has specific interventions to help to accomplish the goal.
Treating Depression with Cognitive Therapy
The beliefs that the client reports relating to him or herself, the future, and the world, are examined during the treatment of depression. The therapist uses the cognitive triad to identify areas that cause the client emotional distress. Features such as feelings of sadness, lethargy, and suicidal ideations relate to one or more of the three domains.
Start of Therapy
At the start of treatment, there are several goals for the treatment of depression, which include assessment, giving the client an understanding of cognitive therapy, and dealing with patient’s hopelessness. Assessment includes administering the Becks Depression Inventory to measure the level of depression. At this stage, intervention is aimed at the client’s hopelessness and involves working through some tasks that clients find difficult to attempt.
During the middle stage, there is a shift from the client's symptoms more to his or her pattern of thinking. There is also the emphasis is on clients reinforcing the skills they learned in the early stages of therapy. For example, the clients use the Daily Record of Dysfunctional Thoughts (DRDT) to keep records of situations, thoughts, and emotional reactions. The therapist reviews the DRDT with the client and helps him or her to see how he or she could attempt different analyses of his or her automatic thoughts.
In the final stage of therapy, the therapist reviews the gains that have been made by the client. At this time the therapist emphasizes the client’s ability to handle problems on his or her own, by placing more responsibility on the client for his or her treatment. Another focus in this stage is the prevention of relapse, by helping clients anticipate future events that could be challenging to cope with.
Cognitive techniques are to change cognition, and this, in turn, will change affect and behavior. Specific cognitive techniques include:
- Decatastrophizing: This technique is also known as the "what if" technique, and assist the clients to identify problem-solving strategies to prepare them for the things they fear.
- Reattribution: This helps clients to consider the alternative causes of events in order to assign responsibility where it is due.
- Redefining: This enables clients to move from believing that a problem is beyond their personal control.
- Decentering: This helps anxious clients who feel that they are the center of attention to examine the logic behind these thoughts.
Cognitive therapy often uses behavioral methods to achieve its goals of cognitive change. Behavioral techniques are used to challenge maladaptive beliefs and encourage new learning. It is also used to teach clients skills such as relaxation techniques, behavior rehearsal, and scheduling activity.
Since these behavioral techniques are geared towards promoting cognitive changes, the clients’ perceptions, thoughts, and conclusions are explored after each behavioral activity. Below are some behavioral approaches that are used in cognitive therapy.
- Homework: This gives clients the opportunity to apply the cognitive principles they learn in therapy sessions in the time between sessions.
- Hypothesis testing: What is the evidence that the automatic thoughts are true, or not true?
- Behavior rehearsal and role-playing: Useful skills are practiced, that the client use in life situations
- Activity scheduling: This provides the structure and encouragement the clients need for them to carry out activities.
- Graded task assignment: Clients are given assignments that move from non-threatening to more difficult tasks
You can move from depression to a more satisfying way of life.
Do you think that Cognitive Therapy is an effective treatment for depression?
Putting it All Together
Cognitive therapy maintains that how people think about themselves, the future, and the world underlie symptoms of depression. However, through the collaborative efforts between the therapist and the clients, and the use of cognitive and behavioral strategies, more adaptive functioning can gradually be restored, and clients can enjoy a balanced life.
References and Further Reading:
Beck, A. T. & Weisher, M. E. (1995). Cognitive Therapy. In Corsini, R. J & D. Wedding (Eds.) Current Psychotherapies (129-261). Itasca, IL: F.E. Peacock publishers, Inc.
Beck, Judith, K. (1995) Cognitive Therapy: Basics and beyond. New York: The Guildford Press
DeRubeis, R. J., Tang T. Z., & Beck A. T. (2001). Cognitive Therapy. In Dobson, K. S. (Ed), Handbook of cognitive-behavioral therapies (349-392). New York: Guilford Press.
Dobson, K. S., & Dozois, D. J. A. (2001). Historical and Philosophical Bases of Cognitive-Behavioral Therapies. In Dobson, K. S. (Ed), Handbook of cognitive-behavioral therapies (3-39). New York: Guilford Press.
© 2013 Yvette Stupart PhD