Cognitive Etiology

Major Depressive Disorder

 The role of schema in depression
• It has long been recognized that people who feel depressed tend to think
depressed thoughts.
• It is commonly assumed that a depressed mood somehow leads to the cognitive
symptoms but this may not be the case
• Seen from the cognitive approach, the interpretation people give to their life
experiences influences their vulnerability to depression
• Depressed cognition, cognitive distortions, and irrational beliefs produce the
disturbances of mood characteristic of depression.
 Aaron Beck
• Founder of cognitive therapy.
• He argues that depression is rooted in what he called a patient's "automatic
thoughts"- that is, negative self-schemas organized around themes of failure
inadequacy, loss, and worthlessness.
• All these personalized thoughts are triggered by particular stimuli that lead to
emotional responses and they are seen as potential vulnerabilities for the
onset of depression.
 Beck's theory of depression has three
components:
• The Negative cognitive triad: depressed patients have negative views of the
self, the world and the future.
• They have negative schemas triggered by negative life events (dysfunctional
beliefs).
• They engage in cognitive biases - also referred to as "irrational thinking."
 Beck
• Beck argues that negative schemas can develop because of family problems, social
rejection by peers, poor school experiences or by having depressed members of the
family or close social circle.
• These schema are activated in depressed people whenever they are in a situation
which in any way resembles the situations in which the schema were created.
• Beck describes three typical schema that are characteristic of depressed people:
• an ineptness schema - that is, I always fail
• a self-blame schema - that is, it is my fault for anything that doesn't work out
• a negative self-evaluation schema - that is, I am worthless
 Beck's Six Types of Faulty Thinking
• Arbitrary inference: drawing conclusions based on little or no evidence.
• For example, when Mary does not immediately receive a text back from her boyfriend, she
concludes that he is cheating on her.
• Dichotomous thinking: An all-or-nothing approach to viewing the world.
• For example, you either love me or you hate me. I either have to be the best, or I am a
failure.
• Exaggeration: Also called magnification. Overestimating the significance of negative
events.
• For example, when a teacher gives you constructive feedback on an essay and you conclude
that "he thinks I am a terrible writer!"
 Beck's Six Types of Faulty Thinking
• Overgeneralization: Applying a single incident to all similar incidents.
• For example, when you have an argument with a friend and you think that this means that none of your
friends supports or care about you.
• Personalization: Assuming that others' behaviour is done with the intention to hurt or
humiliate you.
• For example, a friend throws a dinner party but you were not invited. You then assume that you were
intentionally not invited so that he could hurt your feelings.
• Selective abstraction: Drawing conclusions by focusing on a single part of a whole.
• For example, focusing on the fact that you earned a low grade on one of your quizzes this semester,
without focusing on the fact that overall you have an "A" (or "7") in the class.
 Key Studies
• Alloy et al (1999)
• Joiner et al (1999)
 Evaluation
• Overall, it is not clear if depression is caused by negative thinking patterns or
if these patterns are merely the consequence of having a depression.
• If a negative cognitive style causes depression then replacing negative
cognitions with positive thinking patterns could improve the patient’s
condition.
• This is exactly what CBT (cognitive-behavioural therapy) tries to do.
 The role of rumination in depression
• Dysfunctional beliefs and self-schemas may not be the only cognitive factors
that lead to depression.
• Nolen-Hoeksema has found that women are more likely to amplify
depression by ruminating about their feelings and their possible causes - that
is, they think a lot about how they feel and try to understand the reasons they
feel the way they do.
 Nolen-Hoeksema (2000)
• Found that both men and women who ruminate more following the loss of
loved ones are more likely to become depressed and to suffer longer and
more severe depression than those who ruminate less.
• According to the researcher, rumination appears to more consistently predict
the onset of depression rather than the duration, but rumination in
combination with negative cognitive styles can predict the duration of
depressive symptoms.
 Farb et al (2011)
• Showed 16 formerly depressed patients sad and neutral movie clips and tracked
their brain activity using a fMRI. They compared this to 16 healthy controls.
• All participants filled out questionnaires measuring their adaptive as well as
maladaptive cognitive modes in the face of emotional challenges. They also
measured the severity of depression in the patients.
• The researchers calculated correlations between emotional reactivity (neural
responses to sad vs. neutral film) in patients after the scanning and subsequent
relapse status over an 18 month follow-up period.
 Farb et al (2011)
• The prediction was that activity in the medial prefrontal cortex predicted relapse.
• The results supported the hypothesis: ten of the 16 patients had relapsed into
depression during the 18-month follow-up period.
• Faced with sadness, the relapsing patients showed more activity in a frontal region
of the brain, known as the medial prefrontal gyrus.
• These responses were also linked to higher rumination: the tendency to think
obsessively about negative events and occurrences.
• The healthy participants showed activity in the visual cortex.
 Farb et al (2011)
• This study suggests that there are important differences in how formerly depressed
people respond to emotional challenges that predict future well-being.
• Ruminating in order to analyze and interpret sadness may actually be an unhealthy reaction
that can perpetuate the chronic cycle of depression.
• The researchers themselves argue that the study is limited in its ability to
conclusively determine the neural predictors of depressive relapse due to small
sample size and a limited number of scans.
• It is important that the findings be replicated in order to determine their reliability.
• If more evidence is found that this pattern of thinking leads to depression, prevention
strategies can be developed.
 Evaluation of cognitive etiologies of
depression
• Strengths
• CBT, a therapy based on Beck's theory, has been highly successful in treating patients.
• There is a wide variety of research that supports the thinking patterns of people living
with depression.
• There is biological support (e.g. Farb et al) for the theory of rumination.
• Helps to explain gender differences in the prevalence of depression.
• Explains the role of cognitive processes as mitigating factors in depression - explaining
both depression and resilience to stressful life events.
 Evaluation of cognitive etiologies of
depression
• Limitations
• The question of bidirectional ambiguity: depression can make thinking more negative, and
negative thinking can probably cause and certainly worsen depression
• It is not possible to isolate cognitive factors from biological and social factors.
• The Aetiology-Treatment fallacy. Just because a therapy leads to improvement, this does
not determine the cause of a disorder.
• Nolen-Hoeksema's theory has been challenged for temporal validity. Has society changed
over time and made the theory less valid?
• It is not possible to accurately measure "rumination" or "maladaptive schema."