The Cognitive Model Of Acute Depression

Nama               : Ratna Sari Fauzia

Npm                : 10509841

Kelas               : 3PA03

Tugas Psikoterapi

Automatic Thoughts

the standard cognitive model of beck and colleagues (1979) describes negative thinking in depression at three levels : negative automatic thoughts, thinking errors or biases and underlying beliefs or assumptions. firstly, many of the spontaneous or automatic thoughts of people with depression are manifestly negative. such negativity focuses on the self, the world and the future: the negative cognitive triad. people suffering from acute depression tend to see themselves as defective or inadequate, and see the world as presenting them only with insuperable obstacles and difficulties. they see such problems persisting indefinitely into the future and are pessimistic to the point of hopelessness and perhaps suicidal wishes. when these negative automatic thoughts come to mind, they tringger feelings of misery and despair or  exacerbate an existing low mood state. negative emotions or low mood can prime these negative thoughts, making them more likely to come to mind and more believable when they do. as low mood primes the negative thoughts, which then further exacerbate low mood, a vicious circle is set up whereby the person's mood can spiral downwards. this can also lead to procrastination and inacitivity, which further feed into the vicious circle, as illustrated in figure.

Cognitive Biases

The negative content of thinking manifest in these negative automatic thoughts results in part from certain biases or distortions in the processing of informations. These biases include all-or-nothing or ‘black and white’ thinking, personalization and jumping to conclusion. Dichotomous or ‘black and white’ thinking is central, whereby the person sets unrealistically high standards for their own performance. If these standards are not met, negative judgements ensue. negative biases may also be in the form of arbitrary inferences, where the depressed person jumps to the most negative conclusion about a situation in the absence of any evidence. patients often predict quite catastrophic outcomes are never conceived or are dismissed as highly unlikely. this way of thinking is particularly characteristic of depressed patients who present with significants anxiety symptoms. For example, this processing bias could readily be identified with one patiens, Elizabeth, from the early strages of therapy and was a target for intervention. if something did not meet elizabeth's exacting high standards it was dismissed as substandard and of no value. elizabeth saw no shades of grey, so that even an adequate outcome was seen as not making the grade. black and white thinking can lead to a mental filter, such that positive or neutral aspects of a situation are ignored, whereas negative aspects are selectively focused on and dwelt on at length. having such high standards served to focus elizabeth continually on her shortcomings. her expectation of failing to meet her standards accounted in large part for the avoidance and procrastination that had pervaded her life since the onset of her depression. elizabeth's thinking biases are evident in the following discussion that took place while reviewing one of her homework assignments

Dysfunctional assumptions

the third level of negative thinking is that of longstanding cognitive structures that predate the onset of the episode of depression and whose activation results in cognitive biases and automatic thoughts. in cases od acute depression, conditional beliefs or assumptions are thought to confer the cognitive aspect of vulnerability. these conditional beliefs typically set out the conditions that must be satisfied for the person to adopt a sense of worth, fulfilment or happiness.

in the cognitive model of depression, these conditional beliefs are thought to develop in many cases through early life experiences. where parents have been excessively critical, the child may internalise the implicit rule that being valued only comes from perfect performance, as was the case for elizabeth. this assumption may become latent or silent during parts of adults life where any endeavours are met with a reasonable degree of success. thus, prior to becoming depressed, elizabeth had, by unrelenting hard work, managed to live up to the excesses of her conditional belief. however, any notable failures activate the latent assumption and the person becomes sensitised to any signs of falling short of their perfectionistic standard.

Sumber : cognitive therapy for chronic and persistent depression karangan Richard G. Moore dan Anne Garland tahun 2003 penerbit West Sussey,England.