Major Depression: Cognitive Model and CBT

Mood Disorder: Major Depression

Basic concepts and features of major depressive disorder

   Major depression is ranked among the top causes of worldwide diseases and as the most easily recognised mood disorder it is characterised as sad and depressed emotions experienced by a person for most days of the week for at least two months. Feelings after a traumatic event that only last for a few days does not fall under the category of major depression.

   Symptoms of major depression may include diminished pleasure in normal activities, physiological changes and cognitive deficits. For example, Barbara, a patient who suffered from major depression described, ‘I’ve been sad, depressed most of my life… I had a headache in high school for a year and a half… there have been difficult periods in my life when I wanted to end it … I feel really hopeless’ (Barlow, & Durand, 2015).

Cognitive Model

   Through increasing underlying knowledge of major depression, psychologists and psychiatrists have found that elements which contributed to its formation may include environmental impacts, biological influences and other risk factors.

   Aaron Beck, an American psychiatrists tried to explain the question of why humans get depressed and suggested that it was difficult to understand and raised the issue of whether it served a function (Broderick, n.d.).

   Beck first introduced and studied the cognitive model for depression. He investigated and observed people with depressive symptoms and found that they often view things in a negative way which contrasted to responses obtained from clinically normal people. He emphasised the role of the ‘cognitive triad, negative self-schemas and errors in logic’ (McLeod, 2015).

   Schemas develops from an early stage of life and refers to the general system of beliefs and expectancies based on our experience with the world from birth (Broderick, n.d.). Depression are generally results from negative schemas. The depressive self tends to view him or herself as worthless, useless and hopeless. He or she often bears the belief that ‘if I fail at something it means I’m a total failure’ (Beck, 2008). They have a negative bias and thoughts on the self, world and the future; and those three component interfere with each other and pose a negative effect leading to issues such as diminished ability to concentrate, slowing of body movements, etc.

   Beck also explained how depression was maintained and developed through this cognitive model.

First, schemas developed in individuals from a very early on stage in the life, this effects the individuals’ perspectives and ways in viewing and shaping the world and their expectancies for themselves through life experiences.

Secondly, schemas might be activated later on in life experiences by stressors (for example, losing a job or the death of a loved one). This negative stimulus contributed to the thoughts of worthlessness, guilt and hopelessness in individuals. Causing depression and cognitive bias. For example, one might fail at a job interview (stressor) and hence develop negative thoughts of him or herself being stupid and useless. 

   Research (Gotlib, et al., 2004) has shown that high depressive symptoms individuals showed a bias when looking at a sad facial expression when two faces were presented on the computer screen (a positive face and a negative face). This indicates that people who suffered from depression are more likely to engage in rumination (depressive thinking) and negative expectancies for themselves and their life. They also tend to have a memory bias where they have a more distinct memory for past events that were negative. According to this, psychologists and psychiatrists started to think whether altering their perspectives from negative to positive could be an effective treatment for major depression.

Cognitive-behavioural Therapy

   Researchers have found that both biological treatment such as medication and electroconvulsive shock therapy and psychological treatment such as cognitive-behavioural therapy can be effectively used as treatments for patients suffered from depressive symptoms.

   With reference to a study conducted by Brown University, Department of Psychiatry (Keller et al., 2000, p.1462); patients with a score of at least 20 out of 24 for the Hamilton Rating Scale for Depression were selected with two weeks of drug free period prior to the investigation. Patients were then separated into three groups. First group received nefazodone (medical treatment) with increasing dose of 100mg every week for 12 weeks. The second psychotherapy (cognitive-behavioural therapy) group received no medication and were instructed to attend a workshop where they performed tasks of solving social problems twice a week for 12 weeks. The third group had a combined treatment of both medication and psychotherapy.

Results showed that the overall rate for remission and satisfactory responses were 48 percent for both the nefazodone group and the psychotherapy group alone. Whereas the combined treatment group had a result of 73 percent. This highlighted a significant advantage of the combined treatment over the other two groups in treating depression effectively. Results also demonstrated how nefazodone produced a more rapid result then the psychotherapy group in the first 4 weeks whereas cognitive-behavioural therapy posed a greater effect in the next 8 weeks of the investigation.

This study contributed to the conclusion that a combined treatment of medication and cognitive-behavioural therapy had a significant advantage over the two treatments on their own.

Another study conducted by the University of Geneva Psychiatric Centre (Burnand, 2002, p.585) also investigated the effectiveness of combined treatment for major depression compared to an antidepressant medication alone. 95 patients (21 withdrawn were not included in the results) were randomly assigned to either a combined treatment group (experiment) or a group which received clomipramine (control) only. The psychodynamic therapy (cognitive-behavioural) involved elements of empathy and emotional expressions, insight facilitations and reinforcement of new interpersonal bonds. The aim of this therapy was to transfer and alter patient’s negative views about their selves, the world and their future into a positive perspective, based upon Beck’s cognitive model.

Three psychiatrists assessed the severity of depression for all patients participated after a period of ten weeks (with SCID, HDRS and a Health-Sickness Rating Scale). Results have demonstrated and highlighted that a combined treatment of antidepressant medication and a psychodynamic therapy was more efficient in treating patients with major depression. Results were consistent when investigators repeated with controlled age, gender, and initial severity of depressive symptoms.

As concluded, psychotherapy emphasised and enhanced responses to antidepressant medication in assisting and providing a better and healthier mental health in patients. Thus making it a more effective treatment comparing to medication alone.

Throughout these two studies, we can summarise that a combined treatment of both medication and psychotherapy is the most effective approach for patients suffered from high depressive symptoms. As it alters their way of seeing the world and the future and gains confidence within themselves which allows them to think and respond positively to obstacles encountered in life.

Conclusion

    Major depression as one of the top causes of worldwide diseases should be treated seriously with higher recognition and awareness among the population. An effective treatment of depression can validly reduce suicide rates and promote a healthier mental health among people. A combined treatment of medication and cognitive-behavioural therapy transforms patients mind from negative biased to positive minded. Effectively reducing negative self-schemas with evidential support obtained from various investigations performed around the world.

Reference

A       Journal Articles

Aaron T. Beck. (2008). The Evolution of the Cognitive Model of Depression and its Neurobiological Correlates. The American Journal of Psychiatry, 165(8), 969-977.

Martin B. Keller, M.D., James P. McCullough, Ph.D., Daniel N. Klein, Ph.D., Bruce Arnow, Ph.D., David L. Dunner, M.D., Alan J. Gelenberg, M.D., … John Zajecka, M.D. (2000, May 18). A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression. The New England Journal of Medicine, 1462-1470.

    Yvonne Burnand, Ph.D., Antonio Andreoli, M.D., Evelyne Kolatte, M.D., Aurora Venturini, M.D., & Nicole Rosset, Ph.D. (2002). Psychodynamic Psychotherapy and Clomipramine in the Treatment of Major Depression. Psychiatric Services, 53(5), 585-590.

Sandro Pampallona, ScD; Paola Bollini, MD, DrPH; Giuseppe Tibaldi, MD; Bruce Kupelnick, MA & Carmine Munizza, MD. (2004). Combined Pharmacotherapy and Psychological Treatment for Depression: A Systematic Review. Arch Gen Psychiatry, 61(4), 714-719.

B       Lecture Slides

Dr. Broderick J. PSYC1023 Abnormal Psychology, lecture 1, Week 11: Mood Disorders (2) [Lecture PowerPoint slides].

Dr. Broderick J. PSYC1023 Abnormal Psychology, lecture 2, Week 11: Mood Disorders (2) [Lecture PowerPoint slides].

Dr. Broderick J. PSYC1023 Abnormal Psychology, lecture 3, Week 11: Mood Disorders (2) [Lecture PowerPoint slides].

C        Websites

McLeod S. (2015). Psychological Theories of Depression. Retrieved from Simply Psychology website: <http://www.simplypsychology.org/depression.html>

Ball J. (n.d.) Thinking your way out of Depression. Retrieved from <http://www.blackdoginstitute.org.au/docs/CBT_JillianBall.pdf>

D       Text book

David H. Barlow & V. Mark Durand (2015). Depressive Disorders. In Tom Klonoski (Ed.), Abnormal Psychology: An integrative Approach (7^th ed.) (pp.217). Stamford, USA: Cengage Learning.