
Depression
Depression is the most common mental health disorder worldwide. Many sufferers remain hidden within their homes, but the statistics reveal stark and alarming data.
In Italy, nearly 3 million people are affected by this psychopathology. According to the World Health Organization, depression ranks as the second most prevalent illness globally, following cardiovascular diseases.
Encouraging data from the American Psychiatric Association (APA) indicates that 80% to 90% of those treated respond well to pharmacological and psychotherapeutic interventions, demonstrating a significant reduction in symptoms.
Before understanding how psychotherapy can help overcome depression, it is essential to ask: What happens in the mind of a person with depression? What are the causes of depression?
There are several models for understanding and treating depressive disorders. In this article, we explore the cognitive-behavioural model.
How Depression Develops and Is Treated According to Aaron Beck’s Model
The first formulation of the cognitive model of depression dates back to 1967 when Aaron Beck, the founder of cognitive-behavioural therapy (CBT), published a seminal book on the subject. Since then, various cognitive theories about depressive disorders have been proposed, many of which align with Beck's model.
Beck’s cognitive-behavioural model of depression emphasizes the “cognitive triad.” A key characteristic of the depressed mind involves the presence of Negative Automatic Thoughts (NATs). These thoughts are termed “automatic” because they occur spontaneously.
In individuals with depression, the content of NATs can be summarized by the cognitive triad, representing a pervasive negativity towards:
Themselves (feeling inadequate and undervaluing their worth),
The world (interpreting interactions with others negatively, often feeling mocked or disdained),
Their future (predicting inevitable failure).
Cognitive Distortions or Biases
Another hallmark of the depressed mind is cognitive distortions—systematic errors in processing information that lead to incorrect interpretations of internal and external interpersonal realities. These thought processes defy empirical evaluation of situations.
The biases identified by Beck include:
Arbitrary inference: Drawing conclusions from inadequate or insufficient evidence.
Minimization and magnification: Downplaying or exaggerating the importance of events or situations.
Selective abstraction: Focusing solely on one negative detail while ignoring others.
Dichotomous thinking: Categorizing experiences into extremes, such as “all or nothing.”
Overgeneralization: Extending conclusions from a single event to similar others.
Personalization: Attributing events to oneself without valid evidence, often resulting in unwarranted guilt.
Depressogenic Schemas
Schemas are relatively permanent internal structures formed through an individual’s learning history. They shape the interpretation of events and influence emotional and behavioural responses.
Beck identifies depressogenic schemas as the cognitive core of depressive disorders, characterized by the cognitive triad. Stressful situations can trigger a chain reaction where negative views of oneself, others, and the future intensify depressive symptoms. These symptoms, in turn, reinforce the individual’s critical self-view and pessimistic perspective.
Maintaining Factors
Certain mechanisms stabilize and reinforce what might have been an isolated depressive episode. These are known as maintaining factors, including:
Secondary problems: Self-criticism and devaluation of oneself for being depressed.
Depressive rumination: A recurring, automatic thought process focused on one’s distress, hindering problem-solving efforts.
Social Environment
Depression often creates a vicious cycle involving the social environment. Behaviours of isolation and passivity can alienate others, leading to judgment and rejection, which further reinforce self-criticism and isolation.
Phases of Cognitive-Behavioural Therapy for depression
CBT treatment begins with collaboratively reconstructing the problem, identifying as many aspects as possible. Subsequently, the therapy addresses mechanisms maintaining depressive symptoms.
Key behavioural techniques include:
Weekly diaries to monitor activity levels,
Structured activity schedules developed jointly by patient and therapist.
Recognizing Automatic Thoughts
Changing automatic negative thoughts is central to CBT for depression. Techniques include logical analysis, questioning, evidence examination, and behavioural experiments. The goal is not to think positively but to develop more realistic thinking.
Challenging Cognitive Distortions
Patients learn to identify and question their unrealistic thinking patterns. This involves examining evidence, considering alternative explanations, and conducting experiments to test the validity of beliefs.
Problem Solving and Schema Evaluation
Depression often undermines problem-solving abilities, making situations appear insurmountable. CBT helps individuals develop problem-solving skills and evaluate the underlying schemas that give rise to automatic thoughts.
Managing Worry and Rumination
CBT provides tools to differentiate between unproductive worry and constructive planning. Techniques like mindfulness help patients focus on the present and accept difficult emotions, reducing the grip of depressive rumination.
Preventing Relapse
The final phase of therapy focuses on relapse prevention. Patients learn to recognize depressive states and develop strategies to manage mood dips, becoming their own therapists.
Conclusions
Collaboration and understanding are fundamental in CBT. Patients play an active role, working alongside their therapists to reframe psychological experiences and establish actionable goals.
Written by
Dr Elizabeth Moore, Psychologist
(consultation only in Italian)
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Bibliography
American Psychiatric Associatio,DSM-5-TR Manuale diagnostico e statistico dei disturbi mentali, Test Revision, Masson, Milano
Arieti S. Bemporad J. La depressione grave e lieve. L'orientamento psicoterapico, Ed Feltrinelli 1981
Beck A. Cognitive Therapy and Emotional Disorders, Internetional Universities Press, 1978
Canil M., Depressione sintomi e cura, 2016
Colombo G., Manuale di Psicopatologia generale, Cleup Ed. 2001
Freud S., Lutto e melanconia, Bollati e Boringhieri, 1917
Lisotti A., Sintomi cause e cura della depressione, 2015
External resources
If you wish to explore the topic of psychological manipulation further and find relevant articles and studies, consider these important academic and institutional resources
American Psychiatric Association.Link: American Psychiatric Association
Journal of Clinical Psychology.Link: Journal of Clinical Psychology
Cognitive Therapy and ResearchLink: Cognitive Therapy and Research