Cognitive Theory by Aaron Beck: Distortions & Depression

• The basics of this theory discuss cognitive distortions that occur, and these distortions are corrected in CBT (Cognitive Behavior Therapy).
• This theory hypothesizes that thinking along negative lines is the hallmark of clinical depression or that the patient has automatic negative thinking.
• The central idea of this theory is that the hallmark of depression is negative thoughts or thinking.
• Depression results from specific cognitive distortions, also known as depressogenic schema.
• These distortions are cognitive templates that perceive internal and external data in ways that are altered by early experiences.
• This subsequently leads to a biased interpretation of life events. Or there is a negative or inaccurate way of thinking that occurs.

Types of Cognitive Distortions

A. Arbitrary Inference

• The person here is inferring something arbitrarily or drawing a specific conclusion without sufficient evidence. This is another way of negative thinking. For example, a person may state:

“Everyone can tell that I'm a loser.”

• He or she has just drawn this conclusion without any evidence. How can the individual know what everyone else thinks about them? This is a negative conclusion towards oneself.
• In CBT, this sort of thinking is corrected, and the individual is shown the error in having such negative thoughts and tries to correct this distortion.

B. Specific Abstraction

• There is a focus on a single detail, ignoring others, which are more important parts of the experience. For example, an individual is applauded for a lecture, but there was one feedback that gave a poor rating. Based on this single detail and ignoring the other important aspects of the lecture. The person begins to think, "I am a bad speaker.”
• This is a specific abstraction, as the individual is focused on one single negative detail and ignores the other experiences of the event.

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C. Overgeneralization

• Here, the individual forms conclusions based on a single event. The person will overgeneralize. He or she will believe that since it is true in one case, it will be true in all the other cases, even if slightly similar. For example, if a student does badly on one test, they form the conclusion that:

                     “I am going to fail in all exams.”

• The individual is trying to generalize that one fact into other situations.

D. Magnification and Minimization

• Here, there is an error in the evaluation of an event/oneself/others. The person either unreasonably magnifies the negative or minimizes the positive.
• In magnification, the person tries to overvalue or focus on the worst possible outcome. If the person has got two marks less in a viva, he or she will magnify it to:

“This is my worst result error.”

• In minimization, a person will minimize or undervalue the importance of an event. The positive is being minimized. An example is:

“Getting average marks proves how inadequate I am.”

• Average marks are not bad, but in minimization, the person starts to undervalue it. A person with depression starts to have these negative cognitive distortions.

E. Personalization

• This is a self-reference to external events, which have no basis for such a connection. The person believes that others are behaving negatively because of them without considering a more plausible reason for their behavior. This is personalization, as the person thinks the events are occurring due to them.

“My friend failed the exams because I didn't give him my notes a day before the exams.”

• In this example, the individual is personalizing this. There could be many other reasons why their friend failed, but the individual believes it is because they did not give him the notes one day prior.

F. Absolutist or Dichotomous Thinking

• This is all-or-nothing thinking. It is seeing things only in black or white. There are only two extreme ways of thinking. For example, a person may think of their friend:

      “You did not pick up my phone. You are worse than an enemy.”

 Or

 “You helped me with my notes. You are an angel.”

• So, there are two extremes of thought.

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Cognitive Triad of Depression Given by Aaron Beck

Negative Views About Self

The patient may think he or he is a very bad person, a good for nothing, a bad parent,

worthless, etc. These are negative thoughts about oneself. This is also known as worthlessness.

Negative Views About the Environment

The person may have negative views about the environment. It is very harsh; nobody can help me; there is hostility, etc. This is known as helplessness.

Negative Views About the Future

The person may feel the future is weak, nothing good will happen, it is all dark, there is no hope in the future for me, etc. This is known as hopelessness.

Cognitive Disturbances

• About 50 to 70% of all depressed patients have some form of cognitive impairment.
• Patients may have the symptoms of the cognitive triad: worthlessness, helplessness, and hopelessness (already discussed).
• The patterns that may occur are:
• Negative self-evaluation: The patients will evaluate the situations in a very negative way. There is a faulty thinking pattern, which is seen in depression patients. These include:
  • Loss of ideas of deprivation
  • Low self-esteem and self-confidence
  • Self-reproach, pathological guilt: Excessive guilt is characteristically seen in depression
  • Helplessness, hopelessness, pessimism: This is mostly due to their negative thinking
  • Recurrent thoughts of death, suicide
• In cognitive disturbances, about 10% of patients have marked symptoms of thought disorder, which usually include:
  • Thought blocking: The patient may be talking, and suddenly, there is a block in the train of thought and may suddenly pause. After some time, they may start a new topic and are unable to explain why this block happened.
  • Profound poverty of content: Patients have very little content to talk about. May use very few words and may not be able to explain clearly or in detail.

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Mood-Congruent Psychotic Features

• Patients with depression may have hallucinations and delusions. These psychotic features may be mood-congruent.
• This means that these psychotic features are phenomenologically understandable considering the prevailing pathological mood. There may be a lot of psychotic features in sync or congruent with the depressed mood.
• According to Kurt Schneider, delusional thinking in depression, when in congruence, may arise or be related to four basic human insecurities:
  • Moral worth: Patients may have delusions related to their worth. They may consider themselves worthless, sinners, good for nothing, etc., up to a level of delusion.
  • Health: Patients may have delusions of ill health and believe they have some serious illness despite there being no evidence for the same. The patient may exhibit nihilistic delusions where they believe their body parts are missing, or their brain is empty, etc. May even deny the existence of people around them or the world itself.
  • Financial status: The patient may have delusions of poverty or mismanagement of their own finances due to family living in poverty.
  • Relationships to others: Here, the patient may have delusions of persecution, where the patient feels that people are going to kill him or her and that this punishment is deserved. In reference, the patient believes that people are talking about them in a negative way, which they deserve.
  • Patients with depression feel incompetent in various phases of life, including sexual activity. They may feel inadequate and may start to believe that because of this, their spouse is having an affair, and they are to blame.
  • All these delusions are in sync with the mood of the patient, which is why they are called mood-congruent psychotic symptoms.
  • At times, patients may have fleeting hallucinations, auditory or visual. Patients might visualize that someone has come to kill them. These are in sync with the mood or are mood congruent.

Hope you found this blog helpful for your Psychiatry Residency Clinical Psychiatry preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.