Revolutionary Treatment of Depression
It seems incredible that a successful form of psychological therapy could be based on telling people their thoughts are mistaken. And yet that is partly how cognitive therapy works.
This type of therapy has easily overtaking Freudian-style psychotherapy in recent decades to become the most popular form of treatment for depression, phobias and many other common psychological problems. The founding father of cognitive therapy is Aaron T. Beck a psychologist not well known to the lay public, but widely revered amongst psychologists. One of his studies is the third nomination for the Top Ten Psychology Studies.
Cognitive therapy was originally developed for the treatment of depression. In his work with patients Beck developed the idea that at the heart of depression lay one or more irrational beliefs (Beck, 1963). Here are a few examples:
- Over-generalisation. Drawing general conclusions from a single (usually negative) event. E.g. thinking that failing to be promoted at work means a promotion will never come.
- Minimalisation and Maximisation. Getting things out of perspective: e.g. either grossly underestimating own performance or overestimating the importance of a negative event.
- Dichotomous thinking - Thinking that everything is either very good or very bad so that there are no gray areas. In reality, of course, life is one big gray area.
These irrational beliefs took the form of 'automatic thoughts' which seemed to be accessible to conscious introspection. Beck thought depressed patients could be helped if therapists could challenge these irrational beliefs. At heart cognitive therapy encourages people to see that some of their thoughts are mistaken. By adjusting these thoughts it has been found that people's emotional distress can be lessened.
For many people he treated, and for the many more subsequently treated with his - and related techniques - his methods have turned out to be remarkably effective. It's no exaggeration to state that the ideas and techniques that have flowed from Beck's study and similar findings brought about a revolution in treatment for many psychological disorders.
Find out more about depressive thinking styles.
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All the nominations for the top ten studies in psychology are now in. It's time for you to vote for your favourite. Which one most captures your imagination? You can recap the runners and riders here, where you can also vote.
Reference
Beck, A. (1963). Thinking And Depression. Archives of General Psychiatry, 14, 324-33.
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Several coments about the accuracy of this post and the evidence-based nature of Beck's cogniitive therapy:
1) Aaron T. Beck is not a psychologist: he trained as a psychiatrist and has a MD.
2) While cognitive therapy has had impressive results, it is still contested whether the cognitive component actually is the active ingredient (ie., helping patients to notice their thoughts are irrational). Cognitive therapy also uses behavioural activation methods, such as activity scheduling, goal setting, and graded task assignment. Several recent randomised controlled trials comparing using just the behavioural activation approach against cognitive methods have found equivocal results in general, and better effects for the treatment of severe depression using behavioural activation.
3) Beck did not develop the behavioural methods of his cognitive therapy approach; these were part of the canon of behaviour therapy before Beck's classic study. Beck introduced a cognitive model of depression and suggested that treatment occurs through challenging irrational thoughts. However the research literature does not support this assertion as the active component of therapy.
4) Other cognitive researchers, such as John Teasdale, have found that challenging irrational thoughts per se may not be the process of change in cognitive therapy, but rather it is developing a distanced view of your thoughts that is useful. This can be done perhaps more efficiently by other methods than rational challenging: techniques such as mindfulness meditation and acceptance-based therapy (such as acceptance and commitment therapy).
Yes, Beck's approach was revolutionary at a time when psychodynamic therapy was the standard treatment offered. However it did not come "out of the blue" but was situated within and used ideas from the behaviour therapy tradition.
Anonymous, thanks for your detailed comment.
You present some good balancing factors. The only one I'd take issue with is when you say that Beck is not a psychologist! Technically you're right of course but let's not fall our over it...
I'm guessing you won't be voting for Beck then. So, what would be your nomination for your favourite psychology study of all time? All suggestions welcome...
Over-generalisation - Minimalisation and Maximisation - Dichotomous thinking... does this mean that the entire Republican party is clinically depressed? ;o)
" Over-generalization - Minimalisation and Maximisation - Dichotomous thinking"
I'm not confident these categories are original psychological discoveries or insights as much as they are informal logical fallacies restated in other terms.
1. Over-generalization = Hasty generalization.
2. Minimalisation = Fallacy of division.
3. Maximisation = Fallacy of composition.
4. Dichotomous thinking = Either/or fallacy.
Beck's original treatment included activation to test automatic thoughts. The "behavioral activation" studies attempt to show the merit of action alone -- apparently apart from the mind or brain (cognition) -- in clinical treatment of depression. However, the cognitive revolution re-defined behaviorism in cognitive terms, so it is a false dichotomy to speak of "pure behavior" apart from the cognitive factors. Indeed, most sophisticated learning theorists think that the behavioral activation studies work through cognitive modification.
Well Brad, even if the cognitive revolution redefined behaviorism in cognitive terms, it does not mean that all behaviorists accepted this conceptual and philosophical change.
Radical behaviorism did not reject cognition/private events as important phenomena, just the idea that they are causal. The modern behavioral activation studies have been done by behaviorist researchers who continue to reject the cognitive modication account of change, instead focusing on contextual phenomena such as changes in schedules of reinforcement, rule governance, and transformation of stimulus functions.
If you want a "sophisticated" behavioral account of cognition, that is not situated within the philosophical and assumptive space of the cognitive revolution, try Relational Frame Theory. This theory can account for what happens in cognitive therapy in behavioral terms, linking it to basic science about language. This is something that so far cognitive therapy researchers have not been able to do.
You are wrong, Steve, to think that the "modern" behavioral activation studies "focus on" anything other than what they call the "instigation" of behavior, which is accomplished purely through verbal (cognitive) means.
Read the methods sections again, if you have read them previously. To "focus on" something in a psychological study typically means (at the very least) that it has been measured. However, in the studies to which you refer, there are no measures of contextual phenomena such as "schedules of reinforcement" or "rule governance" or "transformation of stimulus" functions. There is no functional analysis, so the behavioral activation studies are not actually behavioral.
In any case, operant formulations are not testable theories, as Skinner points out in his classic "Are theories of learning necessary." He makes the case that we do not need theory. Operant concepts are entirely tautological, or circular: How do we know reinforcement has taken place? Because response probabilities change. Why did response probabilities change? Reinforcement.
Pure operant ideas (including the modern ones) do not seem to work as scientific (i.e., falsifiable) theories. I have yet to find a single coherent novel prediction that can be derived from them.
sorry for posting on an ooold topic, but i am starting to learn about cognitive therapy, and as a layman, i find it fascinating.
the only problem i have with it is that it seems to assume that depression cannot have factual causes. what about say, having a post-breakup depression, can that be solved using this technique that assumes i have irrational thoughts? (after all, it is rational to grieve).
or is it that those kind of depressions too contain some irrational thoughts as factors?
~ganesh
Ganesh, cognitive therapy doesn't necessarily make any assumptions about causes. In fact as a style of therapy, it is much less interested in causes than other well-known styles.
The main focus is on styles of thinking and adjusting these to improve outcomes. Whether focussing on irrational thoughts is central would depend on the individual person.
Hello,
having worked as a Nurse Cognitive Behaviour Therapist for many years, I found a recent workshop on Behaviour Activation in Depression very useful and practical. Focussing on the consequences of actions and relating them to associated emotions was an experience more powerful than I had imagined, and, despite initial difficulties in wanting to explore cognitions, I found that the model flowed fluently and easily.
I use cognitive therapy psychology on myself and have since I was a teenager. I don't know where I got the idea, why I started doing it but part of me would think it'd be really fun to do a research project on it. I'd need to REALLY go back to school for that one though.
I don't use a therapist and it really can be a major issue at times being that there are times I'd actually need the professional help. The idea of someone else determining right and wrong for me very much so bothers me though and living in the US gives me the right to approach my problems however I please. So I weigh issues, decide where the right path is and find ways to continually reinforce what I want to know or believe. The problem I see with it is that it's very shaky, prone to failure in a psychological attack. When in doubt, I take a look at our extremely befuddled and complicated legal system to determine "Yes, that'd be OK" or "No, that wouldn't be OK". The law provides the guidance and if I can't decide something I just research more.
If I were anyone else, I wouldn't recommend it. It's almost a suicide mission because no one really knows how it's going to work - including myself. In cases that Ganesh is speaking of, it works beautifully. Just telling yourself over and over that you're over someone works wonders. Expressing the "lie" to your friends that you're over the person works too. At least, it works long enough for you to get attached to someone else instead. Messing with your own head can be a little fun, you know.