Beliefs And Depression
It is commonly thought that what people believe will influence their mood states. This meta-belief is widely accepted in the mental health sector with competing frameworks existing for how that connection between beliefs and mood states can be therapeutically exploited for good. This article describes two well-known systems and suggests an alternative.
Rational-Emotive Behavior Therapy
Rational-Emotive Behavior Therapy is a therapy developed by Albert Ellis (1913-2007) which was the earliest cognitive psychotherapy (1955). He developed his ABC model of mental disturbance which featured an Activating event, a Belief, and a Consequence.
Ellis presumed that between the activating event and the emotional consequence, illogical and irrational beliefs of a certain kind caused mental and emotional distress. In a nutshell, these major irrational beliefs were:
‘I absolutely must act in well in all situations and if I don’t I am a bad person and therefore deserving of punishment of some form’
‘Others absolutely must act well towards me and if they don’t then they are bad and therefore deserving of punishment’
‘Circumstances around me absolutely must go according to how I wish and desire and if not then it is terrible, awful, catastrophic and my life is hardly worth living’
It will be noticed that these three beliefs all incorporate ‘musts’ and ‘absolutes’ in their framework. Ellis believed that such extreme prescriptions for self, others and circumstances were irrational because they are god-like edicts and clearly humans are not gods. (Note: Ellis however was not a theist.)
His therapy method was confrontative and educative, helping clients to become their own therapists. For if they could understand that they were creating their own mental pain; if they could accept that they were repeating sentences like those above to themselves and so indoctrinating themselves to produce further upset then they would experience some relief fairly quickly.
However, Ellis emphasised that clients had to accept that they would have to continue to argue against the absolutist nature of these three types of beliefs if continued relief was to be felt.
Cognitive Therapy
Cognitive Therapy was proposed by A T Beck (b. 1921) in the early 1960s. Like Ellis, Beck also assumed that certain thoughts produced depression but unlike Ellis he developed a more collaborative method for dealing with disturbed thoughts.
Beck used a method of Socratic questioning that attempted to open up a client’s situation so that more options could be considered. For example, suppose someone was suffering depression because of failing an exam. Beck would say that it is not the exam failure that causes the depression but what the examinee is telling him/herself about it.
These thoughts could be statements such as ‘why can’t I do anything right?’, ‘I am a big failure’, ‘I am hopeless at school’, I’ve ruined my life prospects’ and a lot more besides.
Beck would tackle this situation using these three questions as set out in 1985:
What is the supporting evidence for the conclusion(s) held by the client?
What are other optional conclusions that could be reached using the same circumstances?
What will happen if the present conclusion held by the client is correct or true?
It is important to mention that Beck has developed his method extensively over decades and is open to the idea of eclectic, generic models. (Aaron T Beck is still alive and still teaching in 2012!)
Problems With Classical Cognitive Approaches
What troubles me about the advocacy of cognitive approaches for mood disorders is that people with depression are helped by other therapies that bear no relationship to cognitive ones. Doubtless, clients do feel better after cognitive-type therapies but that fact may suggest that non-specific elements of therapeutic relationships are the effective factors.
Moreover, the ‘faulty cognitions’ may not be the cause of depression but a part of the depression itself. Even that notion is questionable with some research showing that non-depressed persons have similar thoughts to depressed persons!
It should be noted that both these methods above make a common-sense distinction between the initial event and the evaluation of the event as if the ‘event’ and its perception by a person can be considered quite separately. (They also further distinguish the emotional response from the first two categories.)
Although that distinction seems valid because we know that different people can have the ’same event’ (say failing an exam) occur in their lives but not evaluate it the same way, but in that case, can we say it is actually the same event?
The abstractions of the above methods do not tally with our real experience of a failure situation. It is we who are in the situation of failure. The situation is not over there but we are in it.
An Alternative Therapeutic Approach
What if instead of trying to track down illogical or irrational beliefs therapists instead helped clients to accept the exam failure feelings as normal. So, to feel down after having failed an exam is normal because most people do.
What does cause problems and aggravates the situation is to think, imagine, act and believe that you’re unusual, stupid, deficient, imbecilic and backward to be thinking, believing and feeling the way you do about the failure. In doing that, a person judges himself to be no longer part of normal society.
Some instant relief is often felt if the counsellor talks empathically to clients and ‘normalises’ what they are experiencing.
Being told that it’s not so unusual to feel this way and to think certain things surrounding the failure could be therapeutic because it’s as if the therapist is inviting the client back into the world of normality.
Dr Ian R Ridgway is a Christian psychologist with 20 years experience in counselling and tertiary teaching. He relates the Christian faith to his vocation to assist others by developing a quality relationship built on trust and unconditional acceptance of the client (though not necessarily of all s/his behaviour). He provides an individual professional service as set out at http://psy-services.yolasite.com