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An Integrated Cognitive Theory of Depression

Lincoln Pashute

cont.

Differences From Previous Theories

Before discussing differences, the fundamental similarity must be stressed. From Beck and Ellis comes the central insight that particular modes of "cognitive" thinking cause people to be depressed. This implies the cardinal therapeutic principle that people can change their modes of thinking by a combination of learning and will-power in such fashion as to overcome depression.

This section barely dips into the vast literature on depression theory; a thorough review would not be appropriate here, and several recent works contain comprehensive reviews and bibliographies (e. g. Alloy, 1988; Dobson, 1988). I shall focus only on some major themes for comparison.

The key point is this: Beck focuses on distortion of the actual-state numerator; loss is his central analytical concept. Ellis focuses on absolutising the bench-mark-state denominator, using ought's and must's as his central analytical concept. Seligman argues that removing the sense of helplessness will alleviate the depression. Self-comparisons Analysis embraces Beck's and Ellis's approaches by pointing out that either the numerator or the denominator can be the root of a Rotten Mood Ratio, and the comparison of the two. And it integrates Seligman's principle by noting that the pain of negative self- comparison becomes sadness and eventually depression in the context of belief that one is helpless to make changes. Hence, Self-comparisons Analysis reconciles and integrates Beck's and Ellis's and Seligman's approaches. At the same time the self- comparisons construct points to many additional points of therapeutic intervention in the depression system.

Beck's Cognitive Therapy

Beck's original version of Cognitive Therapy has the sufferer "Start by Building Self-Esteem" (title of Chapter 4 of Burns, 1980). This is certainly excellent advice, but it lacks system and is vague. In contrast, focusing on your negative self-comparisons is a clear-cut and systematic method of achieving this aim.

Beck and his followers focus on the depressive's actual state of affairs, and her distorted perceptions of that actual state. Self-comparisons Analysis agrees that such distortions-- which lead to negative self-comparisons and a rotten Mood Ratio-- are (together with a sense of helplessness) a frequent cause of sadness and depression. But an exclusive focus on distortion obscures the deductively-consistent inner logic of many depressives, and denies validity to such issues as which life goals should be chosen by the sufferer.7 The emphasis on distortion also has pointed away from the role of helplessness in hindering the purposive activities which sufferers might otherwise undertake to change the actual state and thereby avoid the negative self-comparisons.

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Beck's view of depression as "paradoxical" (1967, p. 3; 1987, p. 28) is not helpful, I believe. Underlying that view is a comparison of the depressed person to a perfectly-logical individual with full information about the present and future of the person's external and mental situation. A better model for therapeutic purposes is an individual with limited analytic capacity, partial information, and conflicting desires. Given these inescapable constraints, it is inevitable that the person's thinking will not take full advantage of all opportunities for personal welfare, and will proceed in a manner which is quite dysfunctional with respect to some goals. Following on this view, we may try to help the individual reach a higher level of satisficing (Herbert Simon's concept) as judged by the individual, but recognizing that this is done by means of trade- offs as well as improvements in thinking processes. Seen this way, there are no paradoxes.8

Another difference between Beck's and the present point of view is that Beck makes the concept of loss central to his theory of depression. It is true, as he says, that "many life situations can be interpreted as a loss" (1976, p. 58), and that loss and negative self-comparisons often can be logically translated one into the other without too much conceptual strain. But many sadness-causing situations must be greatly twisted in order to be interpreted as losses; consider, for example, the tennis player who again and again seeks matches with better players and then is pained at the outcome, a process that can be interpreted as loss only with great contortions. It seems to me that most situations can be interpreted more naturally and more fruitfully as negative self-comparisons. Furthermore, this concept points more clearly than does the more limited concept of loss to a variety of ways that one's thinking can change to overcome depression.

It also is relevant that the concept of comparison is fundamental in perception and in the production of new thoughts. It therefore is more likely to link up logically with other branches of theory (such as decision-making theory) than is a less basic concept. Hence this more basic concept would seem preferable on the grounds of potential theoretical fruitfulness.

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