AN INTEGRATED COGNITIVE THEORY OF DEPRESSION

Lincoln Pashute

Rehm recently summarized the state of depression studies as follows: "The important question to be asked here is, Can the various factors that have been postulated [with respect to the causation of depression] be reduced to some single factor characteristic of depressive inference? The likely candidate appears to be simply negativity about oneself." (1988, p. 168). Alloy and Abramson begin another recent article in similar fashion: "It is common knowledge that depressed people view themselves and their experiences negatively" (1988, p. 223).

The present article argues that, typically, Rehm's summary1 is correct but insufficient. It is incomplete in omitting the role of a sense of helplessness, which I shall argue is a vital auxiliary to the central mechanism. Even more fundamental, the summary's term and concept "negativity" are crucially imprecise; they do not specify what this paper argues is the key intellectual mechanism responsible for the pain in depression. A theory will be offered which substitutes the concept of negative self-comparisons for negativity, a substitution for which major theoretical and therapeutic benefits are claimed.

Beck has properly claimed as an advantage of his Cognitive Therapy over previous work that "the therapy is largely dictated by the theory" rather than being simply ad hoc (1976, p. 312). Beck also notes that "Currently, there is no generally accepted theory within the cognitive-clinical perspective." This article offers a more comprehensive theory of depression which includes the theories of Beck, Ellis, and Seligman as elements within it. The theory focuses on the key cognitive channel -- self- comparisons -- through which all the other influences flow. Specific therapeutic devices are clearly dictated by this theory, many more devices than are suggested by any of the previous approaches alone.

Philosophers have understood for centuries that the comparisons one makes affect one's feelings. But this element has not previously been explored or integrated into scientific understanding of the thinking of depressives, or exploited as the central pressure-point for therapy, and instead, the concept "negative thoughts" has been used. That is, negative thoughts have not been discussed in a systematic fashion as comprising comparisons. Nor have theorists specified the interaction between negative self-comparisons and the sense of helplessness, which converts negative self-comparisons into sadness and depression.

An expanded theoretical view of depression which encompasses and integrates the key insights of previous theories makes possible that instead of the field being seen as a conflict of "schools," each of the "schools" may be seen as having a distinctive therapeutic method that fits the needs of different sorts of sufferers from depression. The framework of Self- Comparisons Analysis helps weigh the values of each of these methods for a particular sufferer. Though the various methods may sometimes be serviceable substitutes for each other, usually they are not simply viable alternatives for the given situation, and Self-Comparisons Analysis helps one choose among them. This should be of particular benefit to the helping professional who is responsible for referring a patient to one or another specialist for depression treatment. In practice the choice probably is usually made mainly on the basis of which "school" the referring professional is most familiar with, a practice severely criticized by recent writers (e. g. Papalos and Papalos, 1987).

For ease of exposition I shall frequently use the word "you" in referring to the subject of the theoretical analysis and therapy.

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