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An Integrated Cognitive Theory of Depression

Lincoln Pashute

cont.

Ellis's Rational-Emotive Therapy

Ellis focuses primarily upon the benchmark state, urging that the depressive not consider goals and oughts as binding upon them. He teaches people not to "musturbate" -- that is, to get rid of unnecessary must's and ought's.

Ellis's therapy helps the person adjust the benchmark state in such fashion that the person makes fewer and less-painful negative self-comparisons. But like Beck, Ellis focuses on a single aspect of the depression structure. His doctrine therefore restricts the options available to the therapist and sufferer, omitting some other avenues which may serve a particular person's needs.

Seligman's Learned Helplessness

Seligman focuses on the helplessness that most depression sufferers report, and which combines with negative self- comparisons to produce sadness. He expresses what other writers say less explicitly about their own core ideas, that the theoretical element he concentrates on is the main issue in depression. Talking about the many kinds of depression classified by another writer, he says: "I will suggest that, at the core, there is something unitary that all these depressions share" (1975, p. 78), i. e. the sense of helplessness. And he gives the impression that helplessness is the only invariable element. This emphasis seems to point him away from therapy that intervenes at other points within the depression system. (This may follow from his experimental work with animals, which do not have the capacity to make adjustments in perceptions, judgments, goals, values, and so on, such as are central to human depression and which people can and do alter. That is, people disturb themselves, as Ellis puts it, whereas animals apparently do not.)

Self-comparisons Analysis and the procedure it implies include having the sufferer learn not to feel helpless. But this approach focuses on the helpless attitude in conjunction with the negative self-comparisons that are the direct cause of the sadness of depression, rather than only on the helpless attitude, as Seligman does. Again, Self-comparisons Analysis reconciles and integrates another important element of depression into an over-arching theory.

Interpersonal Therapy

Klerman, Weissman, and colleagues focus on the negative self-comparisons that flow from interactions between the depressive and others as a result of conflict and criticism. Bad relationships with other people surely damage a person's actual inter-personal situation and exacerbate other difficulties in the person's life. Therefore it is undeniable that teaching a person better ways of relating to others can improve a person's actual situation and therefore the person's state of mind. But the fact that people living alone often suffer depression makes clear that not all depression flows from inter-personal relationships. Therefore, to focus only on inter-personal relationships to the exclusion of other cognitive and behavioral elements is too limited.

Other Approaches

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Viktor Frankl's Logotherapy offers two modes of help to sufferers from depression. He offers philosophical argument to help find meaning in the person's life which will provide a reason to live and to accept the pain of sadness and depression; the use of values in Self-comparisons Analysis has much in common with this tactic. Another mode is the tactic Frankl calls "paradoxical intention". The therapist offers the patient a radically different perspective on the patient's situation with respect to either the numerator or the denominator of the Mood Ratio, using absurdity and humor. Again Self-comparisons Analysis encompasses this mode of intervention.

Some Other Technical Issues That Self-Comparisons Analysis Illuminates

1. It was noted earlier that the concept of negative self- comparisons pulls together into a single coherent theory not only depression but normal responses to negative self-comparisons, angry responses to negative self-comparisons, dread, anxiety, mania, phobias, apathy, and other troubling mental states. (The brief discussion here is no more than a suggestion about the direction a full-scale analysis might take, of course. And it might extend to schizophrenia and paranoia in this limited context.) Recently, perhaps partly a result of DSM-III (APA, 1980) and DSM-III-R (APA, 1987), the relationships among the various ailments -- anxiety with depression, schizophrenia with depression, and so on -- has generated considerable interest among students of the field. The ability of Self-comparisons Analysis to relate these mental states should make the theory more attractive to students of depression. And the distinction this theory makes between depression and anxiety fits with the recent findings of Steer et. al. (1986) that depression patients show more "sadness" on the Beck Depression Inventory than do anxiety patients; this characteristic, and loss of libido, are the only discriminating characteristics. (The loss of libido fits with the part of Self-Comparisons Analysis that makes the presence of helplessness -- that is, felt incapacity -- the causal difference between the two ailments.)

2. No distinctions have been made here among endogenous, reactive, neurotic, psychotic, or other types of depression. This course jibes with recent writings in the field (e. g. DSM- III, and see the review by Klerman, 1988), and also with findings that these various supposed types "are indistinguishable on the basis of cognitive symptomatology" (Eaves and Rush, 1984, cited by Beck, 1987). But the reason for the lack of distinction is more fundamentally theoretical: All varieties of depression share the common pathway of negative self-comparisons in combination with a sense of helplessness, which is the focus of Self-Comparisons Analysis. This element both distinguishes depression from other syndromes and constitutes the key choke point at which to begin helping the patient change his or her thinking so as to overcome depression.

3. The connection between cognitive therapy, with its emphasis on thought processes, and therapies of emotional release ranging from some aspects of psychoanalysis (including "transference") to such techniques as "primal scream", merits some discussion. There is no doubt that some people have obtained relief from depression from these experiences, both in and out of psychological treatment. Alcoholics Anonymous is replete with reports of such experiences. William James, in Varieties of Religious Experience (1902/1958), makes a great deal of such "second births".

The nature of this sort of process -- which evokes such terms as "release" or "letting go" or "surrender to God" -- may hinge on the sense of "permission" that Ellis makes much of. The person comes to feel free of the musts and oughts that had made the person feel enslaved. There is truly a "release" from this emotional bondage to a particular set of benchmark-state denominators that cause a constant Rotten Mood Ratio. So here, then, is a plausible connection between emotional release and cognitive therapy, though there undoubtedly are other connections as well.

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