Beck’s Cognitive Model: A Theory of Depression

Introduction

Theoretical model frameworks serve as perspectives from which to conceptualize and understand psychological underpinnings that delineate functional from dysfunctional psychological characteristics and guide the construction of psychotherapeutic approaches (Clark, 1995). The cognitive theory, developed by Aaron T. Beck, has been revolutionary for the psychotherapeutic treatment of depression (Beck 2019). The cognitive theory posits that psychopathology results from normal components of cognitive processing that have become distorted, extreme, and dysfunctional (Beck, 1967). Many symptoms of depression revolve around negative perceptions of oneself, the world, and the future. These are seen to result from cognitive distortions leading to dysfunctional cognitive reactions (Beck, 1967). Since its inception in 1967, the cognitive model has evolved including the adaptation of validated treatments for several psychopathologies and has been successfully combined with novel therapeutic approaches. This paper seeks to examine the cognitive model, its historical and evolved applications, and evaluate its strengths and weaknesses.

Beck’s Cognitive Model

Cognitive Theory

The cognitive model was developed by Aaron T. Beck as a novel way to conceptualize and treat depression and various forms of psychopathology (Beck, 1967). Up until the mid 20th century, psychoanalytic techniques that dominated psychotherapy revolved around analyzing unconscious motivations and their proposed influences. Beck believed that contrary to popular belief, the primary component of what depressed patients suffered from was not necessarily unconscious, but rather the negative outcome of cognitive processes that influence psychological, emotional, behavioural, and physiological responses (i.e., cognitive) to particular experiences (Zauszniewski & Rong, 1999). Thus, the cognitive theory asserts that cognitive processes determine how individuals interpret and respond to experiences.

Beck’s cognitive theory poses that one’s ability to navigate life is derived from the cognitive triad; how one perceives oneself, the world, and the future (Wierzbicki et al., 1994). The cognitive triad is formed by cognitive processes (e.g., perception, attention, and reasoning) that are responsible for interpreting, and integrating psychological information to create a coherent psychological image (i.e., schema; Beck, 2019). The development and function of the cognitive triad are highly influenced by the quality of development and environment during critical periods (e.g., youth and adolescence; Hankin et al., 2008). Due to its malleability, the cognitive triad is susceptible to adopting cognitive distortions (i.e., cognitive errors, dysfunctional attitudes, and automatic negative thoughts; Possel & Smith, 2020). Cognitive distortions that arise from negative experiences negatively affect the image of patients towards themselves (e.g., I’m a failure), the world (e.g., No one understands me) and the future (e.g., I’ll never be successful) and has been denoted as the Negative Cognitive Triad (Beck, 2019). 

Dysfunctional attitudes, cognitive errors, and the negative triad form the operational basis for and leave individuals highly vulnerable to states of depression (Auerbach et al., 2013; Hankin et al., 2008; Wierzbicki et al., 1994). Research shows that patients who are depressed commonly report negative early life experiences that coincide with a negative cognitive triad (Abramson et al., 1999; Beck, 2019). Negative experiences (e.g., a bad class presentation) can create potential sensitivities (e.g., fear of inability to perform) that can then be activated by stressors (e.g., future class presentations) and lead to cognitive distortions commonly seen in depressed patients (e.g., I will never feel comfortable in front of people; Hodgson & Alladin, 1988). This finding is strongly supported by repeated findings that demonstrate that children and adolescents who have negative experiences during critical periods of development are more likely to develop negative distortions in the cognitive appraisal of experiences (Beck, 2019, Hankin et al., 2008; Possel & Smith, 2020). This research demonstrates that cognitive vulnerabilities that are laid down early in life may leave unique and sensitive associations that can be activated later in life, leaving an individual susceptible to developing cognitive distortions (Abramson et al., 1999). The negative triad and cognitive distortions are central features of the cognitive model and have been used to understand and treat depression (Beck, 1967). 

The Application and Evolution of the Cognitive Model

Initial Applications of Cognitive Therapy

Amongst the traditional psychoanalytic treatments in the mid 20th century, Cognitive Therapy (CT), derived from Beck’s cognitive theory, sought to stand out as a novel, evidence-based approach to the treatment of depression (Wierzbicki et al., 1994). The conceptual framework of the cognitive model was applied directly to treat the most common symptoms of depression (i.e., the negative triad; Abramson et al., 1999; Giles & Shaw, 1987). The basis of Beck’s CT consisted of positively affecting patients schemas by asking patients to identify, focus on and analyze automatic thoughts and reactions that arise in response to particular triggering experiences (Beck, 2019). By training individuals to cognitively reappraise the validity and appropriateness of thoughts and reactions, patients are able to consciously evaluate cognitive distortions and regulate responses (Beck, 2019). Significant therapeutic effects have been found when patients are successful in reality testing, considering alternative explanations, or evaluating the logic of interpretations (Beck et al., 1992, Beck, 2019). Early evidence of success was demonstrated in patients with depression and panic disorder by targetting automatic negative thoughts and cognitive distortions (Beck, 2019). For example, research by Beck et al (1992) demonstrated that patients prescribed 12 weeks of CT showed a significant and clinically meaningful reduction in panic attacks and depressive symptoms which remained stable up to one-year post-treatment. 

Beck ascribed characteristics to psychological schemas in an attempt to codify particular tendencies for clinical approaches (Beck, 2019). The specific characteristics were denoted as having degrees of permeability/impermeability, content, charge, and magnitude (Beck, 2019). Permeability/impermeability intimated degrees of receptivity to change or the robustness of beliefs that maintain aspects of the schema (Beck, 2019). The magnitude represents the apparent weight of the schematic component such as how strongly one defines themselves in relation to the distortion (Beck, 2019). While content and charge describe the basic theme and overall sensitivity for that schema to trigger cognition distortions respectively (Beck, 2019). These characteristics can be useful in understanding psychological mechanisms that may inform treatment approaches. For example, low charge schemas can be conceptualized as associations that have gone dormant or have become more difficult to activate, however still leave a trace association that can be reactivated by a schema-congruent stimulus (Beck, 2019). This knowledge may help guide treatment approaches in for schemas that seem to be resolved, yet remain slightly active, such as continuous attempts of association extinction. 

Evolution and Recent Applications

CT has expanded to examine and treat a variety of psychopathologies in addition to depression (e.g., panic, suicide, anxiety, substance abuse, anger, relational problems, schizophrenia; Beck, Sokol, Clark, Wright and Berchick, 1992; Beck, Steer, Carbin, 1988). CT has been useful in treating the aforementioned disorders due to similar presentations of distorted cognitions that serve as maintaining factors for specific psychopathologies (e.g., cognitive distortions within schizophrenia, Beck 2019). 

In addition to the expanded clinical applications, CT has demonstrated significant clinical success when combined with other therapeutic approaches such as Lewinsohn’s behavioural therapy (1974), which is now known as Cognitive-Behavioural Therapy (CBT; Beck, 2011; Craske et al., 2014). CBT has become the gold-standard therapeutic approach for many psychopathologies and is aimed towards addressing cognitive distortions through a combination of cognitive and behavioural modifications (Craske et al., 2014). 

Mindfulness-based cognitive therapy (MBCT) is another example of the model’s adoption and evolution that has found significant clinical success through creating an attitude of curiosity surrounding one’s cognitive reactions through mindfulness (Williams, 2000). Individuals who are depressed tend to demonstrate negative memory retrieval biases (i.e., negative memories are more cognitively available and selected over positive ones) and MBCT has been shown to positively influence this tendency through teaching patients to consciously search for positive memories (i.e., top-down attentional control; Williams, 2000). 

Limitations of Cognitive Theory

Cognitive theory and its clinical applications have been adopted as one of the most common therapeutic interventions in the treatment of depression (Craske, 2014). However, despite the findings mentioned thus far, the approach is not without drawbacks that limit therapeutic potential (Clark, 1995). Researchers have recognized that one of the proposed benefits of cognitive theory is the assertion that individuals actively participate in their perception and construction of their reality. This acknowledges the value of an individual’s attempts at interfacing with depressive symptoms. However, this also leaves individuals susceptible to dominant overarching negative schemas that are impermeable and reminiscent of significant neuropsychological development that has not been met (Auerbach et al., 2013; Clark, 1995). 

Additionally, researchers have scrutinized the inadequate view of interpersonal (i.e., social and environmental) factors (Clark, 1995). This criticism is derived from the assertion that an individual is held responsible for altering cognitive reactions in situations that would otherwise be viewed as appropriate reactions in non-clinical populations (Clark, 1995). For example, if an individual with depression and an individual without depression respond similarly to a situation, the response of the individual with depression may be viewed as having been filtered through a negative bias. These neuropsychological handicaps and interpersonal criticisms identify blind spots within the cognitive theory that could help direct future model considerations.

Conclusion

Beck’s cognitive theory has been revolutionary in developing practical interventions for depression and various psychopathologies. Cognitive theory gives clinicians an ideal framework to approach depression given the tendency for depression to be maintained through dysfunctional attitudes and cognitive processing errors such as negative attentional, memory, and processing biases that feed into psychological schemas. These negative schemas give rise to and maintain the negative triad commonly identified in patients suffering from depression. Treatments oriented at ameliorating the cognitive distortions identified by cognitive theory have been shown to be the gold-standard approach in treating depression. Moreover, clinicians have found great success in treating other disorders, thus making cognitive theory widely applicable. As mental health crises arise, it is imperative that theories and interventions derived from said theories can be applicable to a range of disorders with as few limiting obstacles as possible.

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