How might you explain Beck’s (1960) ‘cognitive model’ to a person who is depressed and about to start a course of CBT?

There are many options for treatment of depression, each with varying degrees of success, invasiveness and duration.  Although the most common treatments are psychiatric drugs, many prefer not to take this route and cognitive behavioural therapy offers a non-invasive approach (McHugh, R.K et al. 2013).

Aaron T Beck is considered one of the pioneers of cognitive therapy, which largely supplanted psychoanalysis as a psychotherapeutic clinical practice and is regarded as a more scientific approach (Brandon G.A. 2008). The cognitive model devised by Beck forms the basis for cognitive therapy which falls under the broader framework of cognitive behavioural therapy and targets the roles of cognitive processes in depression and other mental health disorders. Early in the development of his model, Beck proclaimed that the situation does not govern the emotion but the thoughts do and these are often illogical or irrational thoughts with little grounding in the facts of reality. He also stated that cognitive therapy based methods must undergo clinical trials to evaluate their efficacy.

Beck’s model was initially built upon defining an accurate explanation of depression and then targeting the primary symptoms, which would consequently resolve the secondary symptoms (Beck et al., 1979). He devised a cognitive triad for depression comprising negative thoughts about oneself, the world and the future, basing this on extensive experience treating depressed patients during which he noticed their negative expressions revolved around this triad. What became apparent was that patients with depression tended to react immediately to an event with a negative thought. This he termed ‘negative automatic thoughts’ and would typically be directed towards one of the cognitive triads and maintain the vicious cycle of depression. The aim was to guide the patient towards an alteration of aspects within their schema that are responsible for illogical negative thought processes, thus encouraging the patient to evaluate the event based on evidence rather than applying their domineering schema which caused the depression.

Core beliefs represented within the schema are integral to Beck’s cognitive model as he believed these to form the bedrock for an individual’s cognitive triad perspectives. The model also indicates negative automatic thoughts as being attributable to the schema and core beliefs contained within it. Hot thoughts, which often trigger a cascade of subsequent negative feelings, can often be traced back to core beliefs. The cognitive model incorporates these as a means for addressing the negative inclination of the schema and patients undergoing CBT may typically address hot thoughts to reinterpret the root cause cognitions which negatively shaped their schema. Hot thoughts often arise from biased, illogical and erroneous information that can mislead an individual into dysfunctional attitudes and behaviour. The cognitive model provides a framework for CT/CBT practitioners to work with their patient to address the patient’s schema, negative automatic thoughts and biases with the aim to modify these and thus shifting their cognitive triad towards a less negative stance. In turn this alleviates symptoms of depression in thoughts, feelings and behaviour.

The cognitive model allows one to put a particular negative thought pattern into a framework of analysis. For example, the thought “I am a failure and will never amount to anything”. When incorporated into Becks model can be considered to be a phrase that has undergone significant cognitive distortion. By examining the facts rather than the biased opinion, the patient can re-evaluate the origin of the thought back to its root and examine the evidence rather than the distorted viewpoints which may have led to this negative conclusion.

Beck also concluded that memories of negative events could be retrospectively modified by replaying the memory in a non-negative sequence which in turn can rectify the attached emotion and behaviour. He even formulated a depression inventory comprising of a multiple-choice questionnaire for measuring the extent of depression in individuals, which is amongst the most commonly used psychometric surveys and aids in the identification and challenging of negative automatic thoughts.

The cognitive model developed by Beck has been a steadfast clinical approach for modelling a range of psychopathological disorders including depression. Many clinical studies have proven CBT, which is part based on Becks model, to be similarly effective to medication treatments for alleviating depression and also displays an increased response rate when compared to most alternative psychotherapies (Vos, T. et al. 2004). CBT also has a longer lasting post treatment effect, even more so than anti-depressant medication which is entirely palliative and often requires chronic sufferers to remain on medication indefinitely. Furthermore, CBT can be used in conjunction with anti-depressant medication for enhanced therapeutic outcome, particularly amongst severely depressed unipolar patients (Johnsen, T.J. & Friborg, O. 2105).

 

 

Brandon G.A.(2008). Cognitive-Behavioral Therapies: Achievements and Challenges. Evidence Based Mental Health. 2008 Feb; 11(1): 5–7.

Beck, A. T. (1970). The core problem in depression: The cognitive triad. Science and Psychoanalysis, 17, 47–55.

Beck, A. T., & Steer, R. A. (1987). Manual for the revised Beck depression inventory. San Antonio, TX: Psychological Corporation.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.

McHugh, R.K., Whitton, S.W., Peckham, A.D., Welge, J.A., & Otto, M.W. (2013). Patient Preference for Psychological vs. Pharmacological Treatment of Psychiatric Disorders: A Meta-Analytic Review, J Clin Psychiatry. 2013 June ; 74(6): 595–602

Johnsen, T.J., Friborg, O. (2105). The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis. Psychology Bulletin. 2015 Jul;141(4):747-68. doi: 10.1037/bul0000015. Epub 2015 May 11.

Vos T1, Haby MM, Barendregt JJ, Kruijshaar M, Corry J, Andrews G. (2004). The burden of major depression avoidable by longer-term treatment strategies. Arch Gen Psychiatry. 2004 Nov;61(11):1097-103.