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Unmasking Depression: Exploring the Three Levels of Cognitive Distortion in Depression



Depression is something that very many people face. It often starts with negative thinking. In this blog post, we will talk about the three levels of negative thinking that can make depression worse. These are automatic thoughts, wrong assumptions, and core beliefs. By learning about these, we can understand how depression works and how to feel better. Let's explore how changing the way we think can help us feel happier and healthier.


 

Cognitive Factors: The Three Levels of Cognitive Distortions


Cognitive models of depression suggest that negative thinking patterns cause, increase, or keep depression going. According to Aaron T. Beck and his colleagues, people with depression have negative thoughts about themselves, their experiences, and their future. They might think, “I am a failure,” “Nothing good ever happens to me,” and “The future will be full of failure.” 


These negative thoughts are supported by thinking mistakes, called “automatic thoughts.” These include:


  • Labelling: Calling oneself names, like “I am a failure.”

  • Fortunetelling: Predicting bad things will happen in the future.

  • Personalizing: Blaming oneself for everything.

  • All-or-Nothing Thinking: Seeing things in black and white, with no middle ground. 

  • Discounting the Positive: Ignoring good things that happen.

  • Catastrophizing: Thinking the worst will happen. 

  • Mind Reading: Believing you know what others think about you, usually something negative. 


For example, if something bad happens at work, a person might think, “I am a failure” (labelling) or “This is terrible” (catastrophizing). These thoughts make them feel even more depressed, less motivated, and more negative. 


Certain negative beliefs, called “maladaptive assumptions,” can make people more vulnerable to depression. These assumptions are rigid and hard to live up to, like “I should succeed at everything” or “I must be liked by everyone.” For example, if someone thinks that they must do well on everything to be worthwhile, they will feel very depressed if they do poorly on an exam. 


When people with depression face loss or failure, deep negative beliefs about themselves and others get activated. These core beliefs might be that they are unlovable, helpless, or incompetent, and that others are judgmental or unreliable. For example, someone might predict that they will fail because they believe that they are basically incompetent. 


 

Cognitive Therapy


Cognitive therapy helps by changing these negative thoughts and beliefs. It starts with assessing the patient’s automatic thoughts, assumptions, and core beliefs. Therapists then work with patients to change these thoughts and adopt new, healthier thinking patterns. 


Here are some techniques used in cognitive therapy for depression: 


  • Listing examples of depressive behaviours: Identifying behaviours like isolation, passivity, and rumination.

  • Examining triggers for depressed mood or behaviour: Finding out what events lead to depressive responses.

  • Identifying goals: Setting short-term and long-term goals. 

  • Reward planning: Listing enjoyable activities.

  • Activity scheduling: Planning and rating rewarding activities.

  • Graded task assignment: Gradually taking on more challenging positive behaviours.

  • Self-reward: Using positive self-statements and tangible rewards for positive behaviour. 

  • Decreasing rumination: Developing distracting and active behaviours to replace passivity and rumination. 

  • Social skills training: Increasing positive behaviours toward others and improving personal hygiene, appearance, and approach behaviour.

  • Assertiveness training: Increasing positive assertions, like giving compliments and making requests.

  • Problem-solving training: Learning to recognize problems, define them, identify resources, generate solutions, develop plans, and carry out solutions.


Research shows that cognitive therapy can be effective as medication in treating depression. Changing the way you think can change the way you feel, and some patients may start feeling better after just one or two therapy sessions.


 

Behavioural Deficits and Excesses in, and Precursors of, Depression

Deficits

Excesses

Precursors

Social Skills

Complaining

Marital/relationship conflicts

Assertiveness

Negative/punitive behaviour toward others

Arguments 

Self-reward

Self-criticism

Relationship exits

Rewards from others

Punishments from others

Daily hassles

Sleep deprivation

Hypersomnia 

Negative life events (e.g., loss of job, divorce, death of close relative)

Problem-solving skills


Early loss of parent

Rewarding and pleasurable experiences


Parents with negative attributional style

Self-control and self-direction


Lack of nurturance from parents

Ability to reward others


Noncontingency of behaviour and rewards

* Table 2.1. from Treatment Plans and Interventions for Depression and Anxiety Disorders


 

Summary of Behavioural Techniques for Depression

Technique

Description

Listing examples of depressive behaviours

Typical examples: isolation, passivity, complaining, rumination, avoidance

Examining triggers for depressed mood or behaviour

Help the patient to determine what stimuli precede depressive responses

Examining consequences of depressive behaviour

Typical example: avoidance leads to reduction of anxiety

Identifying goals

Help the patient to develop short-term and long-term behavioral goals that he or she wishes to accomplish

Reward planning

Have the patient list positive behaviors enjoyed in the past or anticipated in the future

Activity scheduling

Have the patient schedule rewarding activities, rating each activity for pleasure and mastery, and then self-monitor actual activities

Graded task assignment

Have the patient schedule rewarding activities, rating each activity for pleasure and mastery, and then self-monitor actual activities

Self-reward

Help the patient to increase use of positive self-statements and identify tangible reinforcers that may be associated with positive behavior

Decreasing rumination and excessive self-focus

Encourage the patient to develop distracting and active behaviors to replace passivity and rumination; to set aside rumination time; and to delay rumination

Social skills training

 Help the patient to increase positive and rewarding behaviors toward others, such as complimenting and reinforcing other people; to become more reliable with others; to improve personal hygiene, appearance, approach behavior, etc.; and to decrease complaining and negative social behavior

Assertiveness training

Help the patient to increase responsible positive assertion (reinforcing others, giving compliments, making requests, and knowing when to escalate assertion

Problem-solving training

Train the patient in problem recognition, definition, identifying resources, generating possible solutions, developing plans, and carrying out solutions

* Table 2.2. from Treatment Plans and Interventions for Depression and Anxiety Disorders


 

In conclusion, understanding the three levels of negative thinking—automatic thoughts, wrong assumptions, and core beliefs—helps us learn a lot about how depression works. By finding and fixing these negative thoughts, people can start to challenge their bad ideas and feel better. Cognitive therapy gives useful ways to change these harmful thoughts, helping people think more positively. Remember, changing how you think can really change how you feel, making it possible to overcome depression and live a happier, healthier life.


 

References:

Leahy, R. L., & Holland, S. J. (2000). Treatment plans and interventions for depression and anxiety disorders (pp. 23-26). New York: The Guilford Press.

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