Cognitive explanations of depression

Depression is the most common type of affective disorder, characterised by feelings of worthlessness, loss of pleasure in normal activities, and negative thought patterns.

The cognitive approach to psychology works on the basis that it is necessary to refer to internal mental processes such as thought and perception in order to understand behaviour. Thus, in order to explain psychological disorders, it refers to internal mental processes. 

In reference to depression specifically, this approach suggests that it is caused by habitual depressive thought patterns, and often becomes more of a long-term problem when personal problems become inseparable in the mind of the individual. For example, their depression may have been reactive to dropping out of university, but then their depressive mental state and thought patterns lead them to think negatively about themselves, the world and their future and it may become a vicious cycle. Referring back to the university example, someone may begin to think they dropped out because they can't commit to anything, and that they'll never be able to, and that they don't fit in so there's something wrong with them, e.t.c. 

One study which helps to explain depression from a cognitive point of view is Beck et al (1974) which aimed to help psychologists understand the specific cognitive distortions experienced by people with depression. A sample of 50 patients undergoing therapy for depression was compared to a control group of people undergoing psychotherapy for another form of dysfunctional behaviour. Face-to-face clinical interviews were conducted, and patients were often asked to keep diaries of their thoughts and feelings about things that happened to them. The results suggested that depression is characterised by thoughts of self-blame, poor self-esteem, anxiety and inferiority, and that these and other cognitive distortions present in depressed patients were involuntary, automatic and persistent. 

Thus, the cognitive approach explains that depression is caused by distortions in thought and perception, such as catastrophic thinking, persistent pessimism and poor self-esteem. 

Treating criminals: COGNITIVE SKILLS PROGRAMMES

Offending is often attributed to dysfunctional behaviour, such as inability to control anger, poor cognitive functioning, or substance abuse. 

Treatment programmes offer offenders the opportunity to remedy these behaviours, in the hope that they will cease offending. 

Cognitive skills programmes are a form of specialised CBT. As with all forms of CBT, it aims to improve cognitive functioning. Cognitive skills programmes work on the basis that if you change the cognitive patterns of criminals, then they will change their behaviour. Two forms of CBT used specifically with offenders are:

1. Reasoning and Rehabilitation therapy targets moral development, encourages creative thinking, and teaches offenders to take a social perspective on life.

2. Enhanced Thinking Skills aims to boost pro-social behaviour by working on interpersonal skills and self-control.

Study: Friendship et al conducted a field experiment into the effectiveness of CBT in reducing recidivism. 670 male offenders took part in Reasoning and Rehabilitation therapy or ETS, and their re conviction rates were compared to 1801 offenders who'd not been part of a cognitive skills programme. Re-conviction rates were 14% lower in the therapy group, and the researchers projected that as a result of CBT, 21000 crimes were prevented. 

Turning to Crime: COGNITION

There's three sections to the Cognition explanation of turning to crime, but they can be illustrated with just two studies:

- Criminal thinking patterns (Yochelson and Samenow)
- Moral development (Palmer and Hollin)
- Social cognition: Attribution theory (Palmer and Hollin)

Criminal thinking patterns
Yochelson and Samenow propose that criminals offend because it's an attribute of their personality. They believe that they have over forty distinct and erroneous thinking errors that distinguish them from non-offenders, characterised by fear and a distorted self-image. They denied that criminals act impulsively, and proposed that they made rational decisions, but that these were biased by the criminal thinking patterns which resulted in their crimes. They also emphasized that personality develops over a lifetime, but that parent-child interaction was an important influential factor on criminality. 

Yochelson and Samenow
255 male offenders judged NGRI who were residing in a psychiatric hospital in the US were interviewed using a Freudian therapeutic style interview. Though attrition was high, Yochelson and Samenow concluded that criminals did display erroneous thought patterns which could explain their criminal behaviour. They separated the thinking errors into three categories. The first was "criminal thinking patterns" which were characterised by fear, which included errors such as a need for power and control. The second was "automatic thinking errors", which included denial of responsibility or guilt. The final error identified was "crime-related thinking errors", such as optimistic fantasies of criminal acts. It was concluded that they act rationally, but their distorted self-image and thinking errors cause distortions in judgement and criminal behaviour. 

Moral development
One theory of why some people turn to crime emphasizes the role of moral development. Kohlberg devised a stage theory of moral development, based on the Piaget's work. It outlined that there are three levels to moral development, each containing two stages. The first level is pre-conventional morality, which is where children tend to be at. Their morality is driven by reward, punishment and self-interest. "Conventional" level is where most people fall into; their morals are driven by society, law and conformity. Post-conventional level is seen as potentially an ideal that many do not reach, consisting of universal laws which supersede actual laws. Some have argued that criminals offend due to only being in stage 1 or 2 and thus driven by self-interest, and avoiding being punished.

Social cognition: Attribution theory
Social cognition refers to how we think about others around us, and a key part of this is attribution theory. Cognitive psychologists believe that we attribute our own behaviour to the situation, but others' behaviour to their disposition, particularly when they are negative or undesirable. For example, if we are in a bad mood, we may blame someone else, or the weather, but if someone else is in a bad mood, we assume they are being hostile or are generally grouchy. Attribution theory might explain criminal behaviour in terms of criminals incorrectly attributing more hostile behaviours to disposition, and thus they feel like they can justify being anti-social and committing offences because they feel victimized or an outcast anyway.

Both of these theories could be used with:

Palmer and Hollin
Palmer and Hollin aimed to investigate the relationships between moral reasoning, attribution theory and other cognitive processes amongst young male offenders and non-offenders. Their sample consisted of 97 convicted male offenders aged between 13 and 21 and 77 non-offenders aged between 12 and 24; all were from the Midlands area. Data was collected psychometric tests. The sociomoral reflection measure tested moral reasoning by asking questions such as to the importance of promises, which gave the participants a level and stage of moral reasoning according to Kohlberg’s theory. Participants were also given scenarios where they were to attribute intent to others' behaviour. The other psychometric tests assessed perceptions of parenting including rejection and an SRD checklist of 46 offences. One of the key findings was that offenders were more likely to have less mature moral reasoning, whilst there was also a common theme of perceiving parental, particularly paternal, rejection, as well as criminals making more incorrect attributions of hostility. The researchers argued the latter two to be significant predictors for SRD scores.

Depression - Comparing treatments [Biological, behavioural and cognitive]

Depression is an affective (mood) disorder which affects approximately one in 5 older people, and thus being able to treat depression is obviously very important. 

The biological approach to treating depression

The biological approach assumes that all behaviour has a biological cause, and thus it targets biology when attempting to treat depression. As many biological psychologists believe that depression is caused by neurotransmitter dysfunction, the treatment for depression aims to target this through a form of therapy called drug therapy. 

Drug therapy is specific to the type of disorder that is being treated; anti-psychotics for psychotic disorders, anti-anxiety medication for anxiety disorders, and anti-depressants for affective disorders. 

Anti-depressants aim to treat depression by raising levels of certain neurotransmitters such as serotonin, as low levels of serotonin have been associated with depressed mental states. 

Study: Karp and Frank (1995) carried out a review article on the effectiveness of drug therapy in treating depressed women. Meta-analysis  (combined analysis) of nine pieces of research featuring a total of 520 women with depression showed that adding cognitive therapy to drug therapy was no more effective than merely prescribing anti-depressants. This suggests that drug therapy for depression is sufficient treatment for depression without other components. 

The behavioural approach to treating depression

The behaviourist approach works on the basis that if behaviour is learned, it can also be unlearned, often through the use of Cognitive Behavioural Therapy (or CBT).

The cognitive element of CBT essentially asks the client undergoing therapy to keep a diary of thoughts and beliefs, and then the therapist will work through them in order to challenge negative thought patterns. The behavioural element, focussed on behavioural activation, features the client and therapist planning pleasurable activities (working on the basis of classical conditioning) and providing rewards for non-depressed activities such as being sociable and active (working on the basis of operant conditioning). Thus, the client learns to associate "non-depressed" activities with pleasure and will therefore be more likely to continue in order to get the positive reinforcement of pleasurable activities and feelings. 

Study: Lewinson (1990) refers to the CBT programme of "coping with depression", a skills based programme where people with depression work together in small-groups to relieve their depression through learning skills such as assertiveness, mood monitoring, relaxation and conflict resolution. It used a sample of 69 depressed self-selected adolescents from Oregon, US, who were split into 3 conditions: only adolescent received training, both adolescent and parents received training, and a control group who were put onto a waiting list for therapy. Note that whilst the adolescents received the "coping with depression" course, parents were taught about positive reinforcement for non-depressed activities and positive changes in their children. By the end of the treatment, group 1 had a 43% reduction in depression, group 2 showed a 47% reduction, whilst the control group showed only 5%. All follow up interviews showed depression rates continued to drop over time, suggesting that CBT is valuable in reducing depression in the short and long term, and that positive reinforcement training for parents is also significant.

The cognitive approach to treating depression

The cognitive approach assumes that it is necessary to recognise the importance of internal mental processes such as thought and perception in determining behaviour. In terms of depression, this approach attempts to identify cognitive distortions through therapy, and to challenge them.

One common type of cognitive therapy used to treat depression is Rational Emotive therapy (RET). It was devised by Albert Ellis and aims to target the irrational beliefs that cause depression. It focuses on depressed people's tendency to think catastrophically (worst case scenario) and then challenging the irrational assumptions underlying this tendency. His model is often referred to as the ABC model:

A: Activation (event which triggers depressive thought/depression)

B: belief (main target of therapy; irrational thought/assumption)

C: consequence (what happens as a result; depression)

Study: Beck et al (1978) is one study which looked at cognitive therapies such as RET, comparing their effectiveness to drug therapy. 44 patients diagnosed with depression undergoing therapy (either drug or cognitive) for 12 weeks were monitored. Whilst both groups showed marked improvements, self-report measures and observations made by psychologists suggested that cognitive therapy was substantially more effective in reducing depression and also seemed to be linked to greater adherence (shown by less attrition in the cognitive group).

Similarities:

Both the behavioural and cognitive approaches use face-to-face therapy and recognise the importance of interaction and cognitive elements in treating depression.

None of the approaches are instantaneous; they require a course across several weeks to be effective. 

Differences:

Drug therapy doesn't require much patient-client interaction, nor does it require much effort on the part of the client - this might be more appropriate as lack of energy or concentration is often part of depression. The other two require more effort.

The behavioural approach is the most holistic as it includes both a cognitive and behavioural element, and aims to treat both the depressed person and change their social environment by changing their parents' behaviour. The other two are quite reductionist as they believe depression is simply dispositional in terms of cognition or biology. 

What is Reliability?

Reliability is probably one of the most difficult concepts to get a handle on that you have to understand at A-level psychology. So I'll ease you in gently.

Reliability refers to the extent to which something is consistent. It does not imply validity, as something may consistently give incorrect measures, though both can be affected by factors such as participant variables, observer bias, subjectivity and standardisation. 

You can be asked to assess reliability of a number of things, most commonly:

- reliability of a measure
- reliability of research
- reliability of a method

There are two main types of reliability: external reliability and internal reliability. Internal reliability refers to the extent to which a measure is consistent within itself whilst external reliability is consistency over time (i.e. it is externally reliable if the measure taken in similar circumstances would produce similar results).

Generally, the factors that affect reliability are:
- the level of control over confounding variables. The higher the control, the less chance there is of inconsistencies over time and thus the more externally reliable it is likely to be
- standardisation. If research into an area tends to use experiments with standardised procedures, or a manual is used, it's more likely that reliability will be high.
- population and ecological validity (research). If a study has poor generalisability due to an ethnocentric or biased sample, or poor mundane realism (as in the case of many lab experiments) findings when applied to real life cannot be expected to be consistent with that of the research.
-subjectivity. If a measure or study relies on subjectivity to give results, as with all qualitative data, self-reports or observations and much research done in cognitive/psychodynamic psychology, it's unlikely to produce consistent results and will probably lack in internal reliability because interpretation becomes a confounding variable and thus may change from measure to measure.

MANAGING STRESS: Behaviourist Approach and biofeedback [Budzynski et al]

The behaviourist approach to psychology assumes that we are all born as a blank slate, and we learn all of our behaviour. It's a very reductionist approach as it is purely on the nurture side of the nature-nurture debate, the situational side of the situational-dispositional debate, and deterministic on the freewill-determinism debate. 

It essentially works on the basis of three concepts: classical conditioning (learning via association), operant conditioning (learning via punishment and reinforcement) and social learning theory (learning via imitation and interaction with others).

In terms of stress management, the behaviourist approach takes the view that as behaviour is learned, you can be taught to manage stress through the same processes. Stress is often dealt with in behavioural therapies through the use of CBT (mentioned in this post on cognitive therapies) or through the use of positive reinforcements. This often involves direct positive reinforcement in terms of improved relaxation and reduced stress combined with feedback from a biodot (which shows you reducing your stress) or a monitor such as a heart rate monitor.

Study: Budzynski et al 

Budzynski et al conducted a study on the role of biofeedback in reducing stress management. It was a field experiment using 18 volunteers who had responded to an advert asking for people with tension headaches. They were split into 3 conditions. Group 1 were taught relaxation techniques during two weekly sessions for eight weeks, during which they had their muscle tension measured by an EMG machine. They were informed about the biofeedback in terms of clicks, (more clicks = more tension) and encouraged to relax. Group 2 had the same relaxation training but didn't know about the biofeedback and were given a false soundtrack of clicks, whilst Group 3 were not trained in the relaxation techniques nor taught about the biofeedback and so acted as a control group. The study showed that Group 1 had the lowest muscle tension, lowest levels of hysteria and depression and the fewest tension headaches by the end of the study, concluding that biofeedback combined with relaxation techniques help to significantly reduce stress-related illness. 

MANAGING STRESS: Cognitive Approach and SIT [Meichenbaum]

The cognitive approach works on the assumption that it is necessary to refer to internal mental processes such as thought, perception and language in order to understand and explain behaviour. 

It would thus view stress as the result of faulty thinking and poor perceptions, and as a form of dysfunctional and maladaptive behaviour which can be improved or cured via cognitive restructuring. This is the fundamental concept behind all forms of cognitive behavioural therapy (CBT).

One form of CBT specifically targeted at coping with stress is Stress Inoculation Therapy (or SIT). It was developed in the 1970s by Meichenbaum, and has three stages which aim to help clients to replace "self-defeating thoughts" which cause stress with more positive ones, which can help to reduce the effect of potential stressors, and thus reduce the overall stress response.

The three stages of SIT are:

1. Conceptualisation - the client and therapist work together to identify the nature of stress, and the therapist educates the client on the general effects of stress to help them understand what stress is and thus how it can be overcome

2. Skills acquisition - the therapist helps to train the client in relevant skills which will aid them to cope with and reduce their stress. This often includes monitoring their own internal dialogue and reassuring themselves that things are okay if not everything goes to plan.

3. Follow through/application - the patient has to apply their skills to real-life situations, and the therapist helps them with this. 

Study: Meichenbaum: comparing SIT to systematic desensitisation and a control group in reducing test anxiety (a major cause of stress)

The study consisted of 21 students aged 17 to 25, who had responded to an advert asking for participants in a study on test anxiety. It was a field experiment, where the IV was the type of therapy (if any) the participant received, and the DV was reduction in test anxiety, which was measured through the use of grade averages and self-reported measures. It was a matched pairs design with three conditions. Group 1 received eight therapy sessions where they were taught to identify stress, learn how to reduce thoughts which increased their stress, monitoring their internal dialogue, etc. Group 2 received the same number of sessions but were given the behavioural therapy of systematic desensitisation, whilst Group 3 were put on a waiting list. Both therapy groups had improved results, but Group 1 (SIT group) performed better in test conditions and had reduced anxiety levels than both other groups, and thus it was concluded that SIT helped to reduce the test-associated stress people felt and enabled them to perform better.