Depression and Cognitive Behavioral Approaches
Depressive disorders; depression, indifference, reluctance and inability to enjoy; slowdown in behavior, progressive inhibition; All of them are characterized by pessimism, worthlessness, guilt regret thoughts. Along with psychophysiological functions such as sleep and appetite in the cognitive domain and sexual reluctance.
In DSM IV, the classification system of the American Psychiatric Association, depressive disorders are included in mood disorders. And classified as major depressive disorder, dysthymic disorder and otherwise unspoken depressive disorders. (APA 2004)
Among the depressive disorders, the most investigated is the major depressive disorder. The lifetime risk for major depressive disorder was 5-12% in men and 10-25% in women.
The use of pharmacological and psychosocial interventions in the treatment of depression is recommended (NICE 2009, APA 2010). The effectiveness of psychosocial interventions as well as pharmacological treatment in depression has been demonstrated. There are many therapeutic methods to treat depression. Some of those; Psychodynamic Therapy, Interpersonal Therapy (IPT), Cognitive Behavioral Therapy (CBT), Family and Couple Therapy, Humanistic-Existential Therapy and Problem Solving Therapy. In this article, we will examine these different views. The first is Beck’s Cognitive Theory.
Cognitive theories are based on erroneous cognitive processes in explaining mental disorders. One of the major theories emphasizing cognitive elements is Aaron Beck. Starting with Beck’s work in the 1950s; In the 1970s, the cognitive behavioral theory, which was named after Aaron Beck and Albert Ellis, increased its effect in the 1980s and turned into a cognitive revolution in the field of psychotherapy. Cognitive Behavioral Therapy (CBT) became clear in 1979 with the work of Beck and her colleagues. In the following years, its effectiveness in depression has been proven in several studies (Dobson 1989, Gloaguen 1998, Cuijpers 2014); it is also as effective as drug therapy (DeRubeis 1999).
Beck proposes four basic elements to explain the psychological structure of depression:
The cognitive triad consists of three basic parts that reflect the person, his / her life with his environment and his / her thoughts about his / her future. For example yhe first part of the trio is the person’s negative view of himself. One sees himself as inadequate, incompetent, defective and thinks that he has a problem. Because of this point of view, one can overdo himself in criticizing himself.
The second element of the cognitive triad is related to the negative perception of one’s relationships and experiences with his / her environment. For example, one thinks that the world is an unreliable place.
The other element, the thoughts about the future, is again negative and one thinks that the troubles or hardships of that moment will last forever.
Negative automatic thoughts
Automatic thoughts are the reason for the different reactions of people who experience the same situation. However these are in everyone, and people are often unaware of automatic negative thoughts. Automatic thoughts, thoughts that occur in the minds of individuals in a certain period of time, are images in the minds of individuals. According to cognitive behavioral theory, negative automatic thoughts form the basis of depression. The most important technique of cognitive therapy developed by Beck is to deal with these automatic thoughts and to reduce belief in these thoughts.
Schemes (basic beliefs)
Basic beliefs or schemes that are deeper than automatic thoughts are the combination of factors such as one’s previous experiences, attitudes of family members, friendship relationships, personality traits and it is very difficult to change them. According to Beck, people with depression develop negative schemes as a result of criticism of authority figures such as loss of parents during childhood or adolescence, various bad events, rejection of peers, and teachers. These diagrams take action when they encounter new events or situations that are closely or remotely similar to the situations in which they included.
According to Beck, some cognitive distortions that cause depression are: catastrophe, labeling, selective perception, exaggeration, over-generalization, personalization, arbitrary inference.
According to Beck’s (Beck 1976) cognitive theory, one’s childhood experiences lead to the formation of some basic thinking and belief systems, which are called ‘schemas.. The events that happen to one’s life lead to the activation of schemas that remain silent and also the emergence of negative thoughts, resulting in feelings of sadness, anxiety and anger.
According to Beck the thinking style of the depressed person is because of cognitive triad, and negative automatic thoughts that occur irrationally in therapy are the most common. These thoughts have an effect on a person’s mood. As depression increases, the intensity of negative automatic thoughts increases. As discussed in general terms above, the theory suggests that these negative thought structures in depression stem from the activation of personalized schemas and the aim of therapy is to try to improve the mood and perspective of the depressed person by opposing the power of negative schemes (Greenberg 2007).