Cognitive Theorists’ Approach to Depression and Suicidal Ideation

Question
Discuss how cognitive theorists (Kelly, Beck, and Ellis) might address a client with depression and suicidal ideation. After reviewing cognitive therapies in your textbook, what interventions might you suggest. Explain and justify your response.
2. In what ways can spirituality or religious beliefs, or lack of, influence an individual’s personal decision-making process, and how might this impact the choices they make in various areas of their life, such as relationships, career, and personal goals?

Answer
1. Introduction
The introduction provided by David Lester is brief but straight to the point and covers all necessary areas. Lester starts by discussing the severity of the healthcare issue that is depression and quotes a Spanish saying “There is no greater pain than being blind in Granada” which he changes to “There is no greater pain than depression.” A short account of the symptoms and severity of depression is discussed, and then Lester moves onto the topic of suicide. Suicide is a sensitive topic but a necessary one in the field of psychology and healthcare. People relate great sadness and negativity to suicide as something people feel is “the easy way out,” but as Lester points out, “The act of suicide is one of shooting oneself in the head while one in dead aim at one’s foot,” essentially stating that people are self-destructive rather than simply destructive of life, and suicide is the ultimate reflection of this. This puts the severity of depression into an easily understandable perspective. Lester concludes his introduction with an outline of the theoretical development of cognitive theory and finishes with a statement of what he will discuss in this book. This introduction is suitable with no major flaws.
Cognitive Theory of Depression and Suicidal Behaviour by David Lester opens up with a clear and to the point introduction that states the implications of cognitive theories and their strategic development. Tony Beck’s Cognitive Theory and Therapy of Anxiety and Depression also opens with an explicit introduction about the extent of the problem of depression and its link with suicide. In this essay, I will give an overview of these introductions and compare them to my own introduction to the topic of cognitive theories and depression, specifically outlining what I have done differently and the reasons for this.
1.1. Overview of cognitive theorists
As cognitive theory offers an explanation of the onset and maintenance of depression, theories are best researched using causally related treatment studies. i.e. the most convincing tests of a theory come from studies where the cause of a particular disorder or disorder symptoms is manipulated and a change in the dependent variable is observed. Beck has described depression as a disorder of negative thinking, and there is much empirical evidence showing that when depressed people make inferences about self, world, and future they characteristically do so in a negative way, and the same is true for their interpretations of ongoing experience. Following on from this, there is now a large body of research showing that depression is associated with memory biases for mood congruent material and the use of cognitive avoidance strategies. This is only a very general overview of the research within depression, suffice to say Beck’s model has enjoyed a great deal of empirical support and as such it has been adapted and extended so that it can offer a cognitive theory of depression in all its richness and diversity. This is important as according to Beck, a good theory of depression should be able to explain how a single etiological mechanism can cause a disorder with such a wide range of different symptoms.
Research within the field of cognitive psychopathology has now been extended to the field of clinical psychology and there have been a large number of studies of depression and more recently studies of other psychological disorders. Major Depressive Disorder, hereafter referred to as depression, is diagnosed according to the standards provided in the Diagnostic and Statistical Manual of Mental Disorders edited by the American Psychiatric Association. Symptoms of depression include loss of interest or pleasure, significant change in weight or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, and impaired concentration or indecisiveness. In its severe form, depression is a highly debilitating, long-lasting, and pervasive condition.
Cognitive theory is a theoretical model of mental disorder that postulates that a relatively small number of recurrent cognitive processes are implicated in the various forms of psychopathology. Of these, cognitions that negatively bias the interpretation of ongoing experience or otherwise inferred meaning of an event or stimulus are seen as particularly important. Beck’s (1967) influential model is exemplary. This model holds that depressive symptoms are caused by the latent cognitive structures within the mind. When these cognitive structures take on a negative schema, they can activate a negative self-referent cognitive process when the person is faced with a situation that resembles a particular schema. This can lead to the production of a series of negatively biased automatic thoughts. It is these thoughts that cause the overt psychological and behavioral symptoms of depression. Following on from this, negative automatic thoughts are thought to arise from underlying cognitive errors.
1.2. Importance of addressing depression and suicidal ideation
Depression is a serious and debilitating illness, which affects mental, emotional, and physical health of an individual. It is often reflected in low mood, feeling of sadness, and aversion to activity. Depression increases cognitive vulnerability to negative schema about self, world, and future. A recent research (NIMH, 1999) shows that depression is the top contributor for the suicide and suicide rate is higher in the elderly person, who have medical illnesses, college educated and who live alone, suicide risk is always higher in presence of the symptoms of hopelessness. About 60-70% of people who committed suicide suffer with major depression or bipolar (manic-depressive) disorder and people in this group are the most treatable great proportion of suicide can be averted by the effective treatment of depression and other psychiatric illnesses. Suicidal persons directly express their negative self-schema and hopelessness in a way they talk about their selves and future, and their feeling towards leaving and escaping from an intolerable situation reflect the state of cognitive deconstruction which increasingly becomes activated when hopelessness and negative schema intensifies and diversifies. As Brown and others have suggested, suicidal act is the final common pathway of a broad range of biological and psychiatric states said to increase the risk of such behavior, it can be the consequence of impulsive, aggressive act or carefully planned and executed by the individual who would otherwise make considered rational decision. Cognitive theory of suicide states that suicidal intent is correlated with strong feelings of hopelessness and helplessness, and absence of alternative way of solving the problems, when the hopelessness and helplessness is too severe then the individual will become focused on taking his own life.
2. Cognitive Theories and Depression
2.1. Albert Ellis’ Rational Emotive Behavior Therapy (REBT)
2.1.1. Challenging irrational beliefs
2.1.2. Identifying and disputing negative thoughts
2.1.3. Developing rational alternatives
2.2. Aaron Beck’s Cognitive Therapy (CT)
2.2.1. Recognizing and restructuring negative automatic thoughts
2.2.2. Examining cognitive distortions
2.2.3. Behavioral activation techniques
2.3. George Kelly’s Personal Construct Theory
2.3.1. Identifying and modifying negative constructs
2.3.2. Constructive alternativism
2.3.3. Role of core beliefs in depression
3. Interventions for Depression and Suicidal Ideation
3.1. Psychoeducation on cognitive distortions
3.1.1. Teaching clients about common cognitive distortions
3.1.2. Providing examples and exercises for recognition
3.2. Cognitive restructuring techniques
3.2.1. Guided thought records
3.2.2. Socratic questioning
3.2.3. Cognitive reframing
3.3. Behavioral activation strategies
3.3.1. Setting achievable goals
3.3.2. Encouraging pleasurable activities
3.3.3. Monitoring and challenging negative behaviors
4. Conclusion
4.1. Summary of cognitive theorists’ approach
4.2. Importance of addressing depression and suicidal ideation
5. References