An Overview of Beck's Cognitive Theory of Depression in Contemporary Literature
Josiah P. Allen Rochester Institute of Technology
This review provides a summary of literature pertaining to Beck's Cognitive Theory of Depression, as well as a general overview of the theory. Beck believed that the cognitive symptoms of depression actually precede the affective and mood symptoms of depression, rather than vice versa. According to Beck, what is central to depression are the negative thoughts, instead of hormonal changes or low rates of reinforcement as postulated by other theorists. It shall be seen how his contributions have been used in recent studies concerning depression, whether related to his work on negative automatic thoughts, biases and distortions, or his Cognitive Model of Depression.
This article gives an overview of current research programs based around Beck's Cognitive Theory of Depression. The theory is divided into three main aspects, which concern the event preceding and during depression. As it is a cognitive theory, it strongly deals with the cognitive perceptions of the brain, which was different from the behavioral theories that were popular during Beck's time, thus making his theory a breakthrough in cognitive research. Briefly put, Beck argued that negative automatic thoughts, generated by dysfunctional beliefs, were the cause of depressive symptoms, and not vice versa.
Beck's main argument was that depression was instituted by one's view of oneself, instead of one having a negative view of oneself due to depression. This has large social implications of how we as a group perceive each other and relate our dissatisfactions with one another. Abela and D'Alessandro's (2002) study on college admissions is a good example of this phenomenon. In their study they found that the student's negative views about their future strongly controlled the interaction between dysfunctional attitudes and the increase in depressed mood. The research clearly backed up Beck's claim that those at risk for depression due to dysfunctional attitudes who did not get into their college of choice then doubted their futures, and these thoughts lead to symptoms of depression. Therefore, the students' self-perceptions became negative after failing to get into college, and many showed signs of depression due to this thinking. Other aspects of this study did not match up well with Beck. They elaborate: "As for participants' more enduring mood reactions, our findings are incongruent with Beck's...theory.... Therefore, one possible explanation of discrepancies between these studies is that immediately following the occurrence of a negative event, cognitively vulnerable individuals show marked increases in depressed mood. At the same time, the do not yet exhibit increases in other symptoms of depression.... However, in vulnerable individuals…such depressed mood may be to be accompanied by a host of other depressive symptoms.... Their level of depressed mood, however, was simply not more severe than individuals who did not possess dysfunctional attitudes" (Abela & D'Allesandro, 2002, p.122). What occurred is that the requirements, according to Beck, for depressive symptoms were there but they did not occur regardless. Findings like this show that Beck's theory may not be as complete as we would like, and there is likely to be factors which are unaccounted for in play in situations like this. Beck's Cognitive Theory of Depression Features Underlying Dysfunctional Beliefs
Another study, which was performed on Beck's Theory, was Sato and McCann's (2000) study on the Beck sociotropy-autonomy scale. The scale had originally meant to identify self-feelings that would lead to depression, mainly solitude/interpersonal insensitivity, independence, and individualistic achievement. However, the results of the study showed that the independence did not correlate with depression, and the sociotropy, not autonomy was a precursor of depression. As they described, "sociotropy can be characterized by an individual's emphasis on interpersonal interactions involving intimacy, sharing, empathy, understanding, approval, affection, protection, guidance, and help…tend to place importance on seeking approval from others and on trying to avoid disapproval from others as much as possible." (Sato, & McCann, 2000, p.66) So it is seen that a strong correlation with sociotropy and depression was found, which is a trait that is strong when relating to underlying thoughts and emotions. This support for cognitively caused depression is an interesting use of Beck's Theory.
Moilanen's (1995) study of adolescent depression also attempts to validate Beck's theory in a new way, as Beck worked mostly with adults. Indeed, she found that the student's depression was often associated with dysfunctional beliefs and negative future attitudes. She suggests that the cognitive theory has reasonable validity for describing the symptoms of depression for nonreferred adolescents, and that the subject's depression is closely correlated with his or her ability to deal with dysfunctional attitudes and beliefs, as well as doubt towards the future. Her findings may not sound truly convincing, because she did find some discrepancies: "However, the results of this study were not entirely consistent with Beck's theory, particularly the proposition that a predominantly negative self-schema underlies the information processing of depressed individuals." (Moilanen, 1995, p.440) We see how perhaps, at least in adolescents, the idea of the negative self-schema is not a clear as Beck wishes it to be.
An earlier study by Molianen (1993) showed even stronger results when evaluating college students. This study showed much more clearer results: "In support of Beck's cognitive theory of depression, the student's current depressive states were consistently found to be related to their negative processing of personal information" (Moilanen, 1993, p.345). The students' cognitive thoughts were shown to be affecting them, and as a result they developed symptoms of depression. Molianen, impressed by the findings, seems to suggest that Beck's theory should be used in further research in the college student population and how depressed students are treated, as counselors and therapists would do well to closely look at a student's cognitive thoughts as a way of assisting the student in recovery. These results are positive, because there is enough evidence for Molianen to suggest a cognitive treatment for depression via Beck's Theory. Molianen's work with Beck's Theory is no doubt a welcome look at cognitive thinking.
Beck's Negative Cognitive Triad
Another way to look at these cognitive thoughts is through Beck's Negative Cognitive Triad, which explains that negative thoughts are about the self, the world, and the future. For example, in a study done by Brown et al (1995) they centered their focus on college students receiving poor exam scores. Brown reported, "The results suggested that a specific construct measured by the DAS…interacted with a congruent stressor (poorer than expected performance on a college exam) to predict increases in depressive symptoms." (Brown et al., 1995, p.434) In this study we would say that the students are having negative thoughts about their future, because they may not pass the class. Negative thoughts about the world, meaning they may come to believe they do not enjoy the class. And finally negative thoughts about themselves, as in they do not deserve to be in college.
The Beck Depression Inventory
A study done by Boury et al. (2001) studied Beck's theory by monitoring student's negative thoughts with the Beck Depression Inventory (BDI). They gave an overview of Beck's ideas: "Individuals who are depressed misinterpret facts and experiences in a negative fashion, limiting their focus to the negative aspects of situations, thus feeling hopeless about the future. A direct relationship is postulated between negative thoughts and severity of depressive symptoms." (Boury et al., 2001, p.14). They later found this idea to be true, despite their predictions that as time passes negative feelings would on average improve. "The result--that BDI-II scores significantly correlated with the number of automatic thoughts, number of core beliefs, and different types of core beliefs in both time periods--supports Beck's assumptions that negative thought content characterizes depression." (Boury et al., 2001, p.34) The effects of the negative cognitive thinking again proved to prolong depression and it's symptoms in a group, and we see more examples of Beck's theory in use.Beck's Theory has formed into what is called Beck's Depression Inventory, which is used to measure depression in many studies. One such study done by Saisto et al (2001), attempted to show how different approaches to becoming a mother could stave off depression common with such a major life event. They hypothesized that if the individual set self-focused goals they would be able to think rationally about their situation. "As expected, the results showed that women who adjusted their personal goals to match the particular stage-specific demands of the transition to motherhood showed a decrease in depressive symptoms, whereas those who disengaged from the goals that focused on dealing with such demands showed an increase in depressive symptoms" (Saisto et al., 2001, p.1154). As they used Beck's Theory as a background for their study, we can extrapolate that the subject's who had a goal were able to avoid negative thinking patterns more often then the subjects whom did not have focused goals, so we see that many modern theories of depression are actually based off of Beck's Cognitive Theory.
The Beck Cognitive Triad Inventory
An interesting study is McIntosh and Fischer's scrutinized look at Beck's Cognitive Triad. They decided to put the triad up to the test to see if there were actually three distinct visible negative thoughts using the Cognitive Triad Inventory (CTI). They found that there was no clear separation of negative thoughts, and that there was actually a singular one-dimensional negative view of the self. They explain in detail their findings: "The present data for the CTI suggest that the components of the triad are not discrete factors but are rather commonly saturated by a single dominant factor, which we have named ‘Self-Relevant Negative Attitude.' Therefore, it would appear that retaining all three areas of the triad as separate dimensions is not necessary for representing the latent structure of depressive cognition within Beck's framework" (McIntosh & Fischer, 2000, p.156). Not only is Beck's theory being built on, but also studies are ongoing to flesh out Beck's basic assumptions about cognitive thinking. It is important to note that this does not take anything away from Beck's work, but actually strengthens it through empirical research which clarifies Beck's ideas, which can then be used with even more confidence in later studies. So as we have seen, Beck's Theory conjectures that underlying dysfunctional beliefs can serve as a diathesis for the occurrence of depression. These thoughts Beck believed centered on a negative cognitive triad, which is made up of thoughts about the self, one's surroundings, and about one's future.
A key part of Beck's Theory is not only that the subject will feel negative underlying beliefs, but also that these beliefs fall into a certain field which separates them from other disorders such as panic and anxiety disorders. For example, these include polar reasoning, selective abstraction, and overgeneralization. Such feelings promote failure in the first and last and loss in the second. Polar(dichotomous or all-or-none) reasoning is extreme, so even a slight waiver from perfection is considered failure. Abstraction means that successes are ignored, and lost to the subject, who is left only with sadness. Overgeneralization implies one will do poor at one thing, and assume failure in all related things. Thus, the main feelings of depression according to Beck are failure and loss. In a study done by Beck himself with Clark and Brown (1989) he looks to confirm this by studying psychiatric outpatients. He found that "the cognitive content-specificity hypothesis was strongly supported by the present study. Thoughts of loss and failure were uniquely predictive of depression, whereas cognitions of harm and danger were specifically associated with anxiety." (Clark, Beck, & Brown, 1989, p.963) Here we see the even Beck himself was working on fleshing out aspects of his theory. Beck is careful to caution us however that his findings are not only from the subjects cognitive thoughts, but that the ‘temporal orientation' of the cognitive thoughts must be examined as well in order to confidently specify a cognitive-affective relationship. While anxiety patients may feel failure, it is not related to depression but due to those feelings' prominence during and after an anxiety attack. Beck's Cognitive Theory of Depression Features Cognitive Biases and Distortions
In another study, Hewitt et al (2003) attempts to improve on Beck's inclusion of dichotomous reasoning as a fuel for the negative cognitive triad. They explain that in "Beck's…model the self-related and socially based features of perfectionism are combined and regarded as similarly influencing the development and maintenance of depression…In Hewitt and Flett's model, perfectionistic self-expectations and perfectionistic interpersonal dynamics are conceptualized as three distinct personality traits." (Hewitt et al., 2003, p.373) Their results were interesting, and showed to clarify the current understanding of how perfectionism relates to depression in terms of Beck's Theory. "Contrary to the widespread understanding of perfectionistic attitudes as a clear-cut representation of the self-related features of perfectionism, socially prescribed perfectionism--not self-oriented perfectionism--was most strongly related to perfectionistic attitudes." (Hewitt et al., 2003, p.383) In this case Beck's theory has been expanded with another theory in the field of cognitive psychology. Beck's Theory also includes the fact that these negative cognitions are fueled by distortions of rationale, such as all-or-none reasoning, selective abstraction, and overgeneralization.
Beck's Cognitive Model of Depression shows how early experiences can lead to the formation of dysfunctional beliefs, which in turn lead to negative self views, which in turn lead to depression. One interesting study on this aspect is Reed's (1994) study on reducing depression in adolescents. Many studies have ascertained that depression is more common in women in western society. Reed's study amazingly shows a large number of female whose cognitive thinking prevented them from recovering from depression, while the males adjusted much better. He comments that this is from the difference between common early experiences between males and females. Males, he believes "run a fairly structured and consistent developmental course… Depressed males often appear either physically awkward or lacking in social/interpersonal skills. Responses to this awkwardness by adults and peers usually consist of strong sanctions, punishment, and negative reinforcement. Moderate improvement in male functioning will usually receive positive responses from both peers and adults. Additionally, male social networks tend to be flexible, and based primarily on current functioning. Therefore, male adolescents can improve their social status as their interpersonal functioning improves." (Reed, 1994) His conclusion is that because males are developing healthy beliefs, they are able to cope with depressing feelings. They do not generally develop depression due to lack of negative thoughts about the self, because the social structure correctly rewards them for having positive thoughts, which prevents depression. On the other hand, the female adolescent social structure is much different, and they are more prone to develop irrational and dysfunctional beliefs. Reed explains, "Female adolescents run a less structured and more inconsistent developmental course. Responses from peers and adults to the female's incompetence is variable…Improved behavior of female adolescents also receives inconsistent feedback…. Adolescent females in general are expected to be competent interpersonally. Therefore, a female adolescent who had been depressed, upon achieving appropriate functioning, would receive only minimal attention for her accomplishment…Consequently, improved functioning will often not facilitate immediate social acceptance by females" (Reed, 1994). He explains how females are more likely to form dysfunctional beliefs due to mixed signals from society. This coincides strongly with Beck's Model of Depression and the large problem of female depression in western society. Beck's Cognitive Theory of Depression Features a Cognitive Model of Depression Showing the Formation of Dysfunctional Beliefs
Comparison to the Hopelessness Theory of Depression
Another interesting study compared Beck's Cognitive Theory against the hopelessness theory of depression in predicting depression in adolescents, done by Lewinsohn et al (2001). He reported "A main finding of this study was support for dysfunctional attitudes as a risk factor, under conditions of stress, for adolescent major depressive disorder. This finding provided evidence for the Beckian version of the diathesis-stress hypothesis…." (Lewinsohn et al., 2001, p.210) An interesting thing to note is that their positive findings for risk factor support Beck's idea that early experience leads to the formation of dysfunctional beliefs, which other studies have not been able to show. He explains more on why his study is profound, because there has simply not been enough research on Beck's theory, so these findings have great heuristic value as well. Because he was not able to find similar correlations with the hopelessness model, he concludes that it is not supported in an adolescent population (Lewinsohn et al., 2001). This adds weight to Beck's Theory, especially in regards to his beliefs on the creation of negative thoughts and vulnerability to depression.
Clinic-Referred Children
A study done by Epkins (2000) looked at clinic-referred children. Two main groups were children whose personality tended to be internalized, and those who were externalized. Epkins' was looking for evidence of Beckian thinking in young children. She explains, "Based on the theory, it was predicted that specificity would emerge on all cognitive measures, with internalizing children reporting more negative cognitions than externalizing children." (Epkins, 2000, p.201) This makes sense, because focusing on yourself would logically lead to a greater increase of negative automatic thoughts on average. Her findings were positive in this matter: "Consistent with Beck's Theory, the findings suggest that the negative cognitive triad, cognitive processing distortions, and depressive and anxious thought content, may be specifically related to internalizing versus externalizing problems" (Epkins, 2000, p.205-206). Therefore, we see how dysfunctional beliefs tie in at an early age with internalized cognitive thinking, which gives us better insight into how our childhood has a strong correlation to whether or not we will be vulnerable to depression.
Since Beck formed his theory, it has catalyzed a lot of work involving cognitive theory and depression, which during the time was rare. Like all great theories, the initial version was no doubt the most accurate, but his theory does lend itself to research, and a large portion of depression related research in one way or another relies on the theory. Beck's Cognitive model will no doubt continue to be scrutinized as we look closer at how negative automatic thoughts are formed and who is vulnerable for future depression. Finally, we have looked at Beck's Cognitive Model of Depression, which conjectures that dysfunctional beliefs are created by early experience. Beck believes that critical events would activate these beliefs, which would then create negative automatic thoughts about oneself. These cognitive thoughts then lead to symptoms of depression, which then reinforce more negative automatic thoughts. The studies shown here are but a small part of the ongoing research on and using Beck's Cognitive Theory of Depression, but it certainly has had a large impact on the way we look at depression in terms of clinical psychology. This paper does side strongly with Beck's Theory, and this is due to most of the literature surrounding the theory being positive. Conclusion
Peer Commentary
This peer commentary summarizes limitations of "An Overview of Beck's Cognitive Theory of Depression in Contemporary Literature," by Josiah P. Allen. The last segment of the paper is where I felt flaws were present in the argument. Beck's cognitive theory of depression features a cognitive model of depression showing the formation of dysfunctional beliefs in adolescence. Allen stated that females were more likely than males to be depressed due to "mixed signals from society." Although this is probably true, it is well documented that females have other underlying causes for the susceptibility to depression, including biological differences, age prevalence of depression differences, sex/gender-role identity differences, depression rate and recurrence differences, and comorbidity differences in males and females. Beck's Cognitive Theory Based on Negative Self Schemas
Christina M. Mulé
Rochester Institute of TechnologyIt is also important to note that the cited research determined that Beck's cognitive theory of depression is central to negative thoughts only. It did not take any other factors into account, such as biological factors (e.g., hormones or genetics) or rates of reinforcement.
Certain points throughout the paper provided factual evidence that depression can be attributed to negative thoughts. I think, however, that it is important to inform readers that, although the author presented one probable cause of depression, it is not the only probable cause of depression. Several factors that may cause of depression were never mentioned in this paper. Consequently, I feel that the paper may be a bit misleading. Readers should not finish this paper with the impression that negative thoughts are the only cause of depression.
Peer Commentary
This is a commentary on the paper titled "An Overview of Beck's Cognitive Theory of Depression in Contemporary Literature," by Josiah P. Allen. In this paper, he explored the topic of cognitive theory introduced by Beck and analyzed in the contemporary literature. He gave an overview of current research programs based on Beck's theory. Beck's cognitive theory is based on cognitive perceptions and is considered a breakthrough in cognitive research. Beck's cognitive theory basically states that depression-prone individuals possess negative self-beliefs. They have a negative view of themselves, seeing themselves as worthless, unlovable, and deficient; they have a negative view of their environment, seeing it as overwhelming, filled with obstacles and failure; and they have a negative view of their future, seeing it as hopeless and believing that no effort will change their lives (Gonca & Savasir, 2001). These three factors were called the cognitive triad. The negative way of thinking guides one's perceptions, interpretations, and memory for personally relevant experiences, thereby resulting in a negatively based worldview and leading to depression (Gonca & Savasir 2001). Negative Self-Schemas and Cognitive Theory
Irina V. Sokolova
Rochester Institute of TechnologyAn interpersonal schema is conceptualized as a generalized representation of self-other relationships (Gonca & Savasir, 2001). The interpersonal schema is initially based on interactions with attachment figures such as parents, permitting the individual to predict interactions in a way that increases the probability of maintaining relatedness with these figures. In theory, an interpersonal schema contains information of the form: "If I do X, others do Y." Thus, interpersonal schemas maintain themselves using the principle of complementary, which states that specific interpersonal behaviors tend, predictably, to pull for other specific, interpersonal behaviors (Gonca & Savasir, 2001).
Different from an exclusively cognitive focus that emphasizes the way in which people actively construe their environment, the cognitive-interpersonal approach puts forth the view that people both construe and construct their environments (Gonca & Savasir, 2001). This approach formulates the occurrence or maintenance of psychopathology in terms of a dysfunctional cognitive-interpersonal cycle (Gonca & Savasir, 2001). Accordingly, people develop interpersonal schemas that are adaptive in a developmental context, because the schemas permit the prediction of interactions with attachment figures. Unfortunately, these interpersonal schemas often fail to adapt to new circumstances, because they continue to shape interactions. For example, people who expect hostile behavior from others selectively interpret neutral behavior as hostile and thus elicit hostility from others. This interpretations evokes anger and, in turn, confirms the interpersonal expectations of hostility, thus maintaining the interpersonal expectations and perpetuating the cognitive-interpersonal cycle.
Even though Allen attempted to show that negative thought processes sometimes form during childhood, and, therefore, we can see how some people become more prone to depression than others, it is somewhat unclear how those negative self-schemas are formed, what factors affect the formation of negativity in children to make them grow into depression-prone adults.
Allen explained that dysfunctional beliefs control dysfunctional moods, analyzing several studies the results of which corroborate that hypothesis. In these studies, students' depression was associated with negative future attitudes and increases in depressed mood. Depression-prone students were found to have a negative processing of personal information, resulting in the development of symptoms of depression.
Weinstein (1983) proposed the theory that perceived vulnerability to harm or negative experiences is related to a person's history of similar experiences. He suggested that persons without aversive background events tend toward an optimistic approach to evaluating their vulnerability to negative life events. On the other hand, persons who have already been exposed to negative events, according to Weinstein, tend to react the same way they reacted before. Weinstein's theory contradicts the negative self-schemas theory proposed by Beck, because it introduces the factor of an individual's previous experience with the negative event.
Allen compared Beck's cognitive theory to the hopelessness theory, which was based on Seligman's work on learned helplessness and attribution styles. The hopelessness theory reflects on Weinstein's theory, because it states that when confronted with a negative event, individuals with a negative thinking process are vulnerable to depression, because they will infer that negative consequences will follow from this negative event and that occurrence of that event means that the individuals themselves are worthless or flawed (McGinn, 2000).
Several studies corroborate Beck's cognitive thoery. These studies indicate that the theory has shown its usefulness in explaining and treating depression. Cognitive-behavioral techniques have proved extremely effective in treating depression. Undoubtably Beck's theory was a powerful work that guided a lot of research on depression and provided a reliable explanation for some causes of depression. Even though there are other very interesting and accurate theories of depression, altogether they provide a great source of information about depression, its causes and treatments.
Author Response
I thank those who commented on my paper, and I feel I must address the issues put forth both in relation to my work and in relation to the understanding of the public. Both commentators critiqued the section involving depression in adolescence, so I will address this issue first. Negative Thoughts Are a Safe Bet, Even If Obscured
Josiah P. Allen
Rochester Institute of TechnologyIn the last section of my paper, based on the work by Epkins (2000), I attempted to show how cognitive theory and depression relate to adolescents. I alluded earlier in the paper to the fact that Beck's cognitive theory was less reliable in dealing with adolescents, based on Moilanen's (1993, 1995) work with adolescents and college students. The pattern that formed was that the more refined the cognitive process and mature the mind, the more relevant was Beck's theory.
In response to Mulé, although I agree that studies have shown many causes of depression in females, Beck might reply to this notion by stating that all these causes are actually many causes of negative thoughts. Perhaps the core dysfunction in the brain is caused by genetics or experiences beyond Beck's cognitive theory, but he never attempted to explain the exact occurrences at a young age that lead to the formation of negative thoughts. I still believe it can be argued, however, that negative thoughts are a necessary ingredient for depressive symptoms to occur, regardless of whether they can be explained rationally. It is true, however, that depression is not always caused only by negative thoughts.
In response to Sokolova, I agree that it is unclear how negative self-schemas are created, and this fact often undermines opinions of Beck's cognitive theory. Consequently, researchers have difficulty finding answers for prevention, and followers of Beck tend to concentrate on cognitive therapy as the fruits of the theory. The topic of Weinstein's (1983) theory is interesting, as it adds the notion of behavioral conditioning, but although it conflicts with Beck's grander view of depression and its formation, it still cannot challenge the fact that given an individual with depression, one can conjecture safely that his or her symptoms were preceded by negative thoughts. If researchers can learn to avoid this pattern, then I do not feel that this takes anything away from the core hypothesis of Beck's theory but perhaps opens up a different field relating to prevention.
Abela, J. R. Z., & D'Allesandro, D. U. (2002). Beck's cognitive theory of depression: The diathesis-stress and causal mediation components. British Journal of Clinical Psychology, 41, 111-128. References
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