Cognitive Theory and CBT for Depression: Key Findings

Social Cognitive Theory and Human Behavior

Cognition is the process of acquiring knowledge, which includes aspects such as awareness, perception, reasoning, recognition, judgment, and imagination (Lexico Publishing Group, LLC 2006). The philosopher Albert Bandura led efforts in developing a social cognitive theory (SCT) for defining, predicting, and modifying human behavior individually and as a group (Brown 1999). The theory defines human behavior as a triadic, dynamic, and reciprocal interaction of personal factors, behavior, and the environment. According to the theory, these three factors uniquely determine an individual's behavior.

SCT strongly emphasizes the role and power of the mind as an active force that constructs one's reality, selectively encodes information, performs behavior on the basis of one's values and expectations, and imposes structure on its own actions. A person forms his or her own reality through the interaction of the environment and his or her own cognitions. These cognitions change over time through maturation and experience. It is through an understanding of the processes involved in the construction of reality that experts are able to understand, predict, and change human behavior.

Bandura's theory suggests that children and adults operate cognitively on their experiences and that their cognitions influence their behavior and development. A person, for example, develops self-efficacy because of a history of achievement in a particular field, by observing the successes or failures of others, from the encouragement of others, or from his or her own physiological state while performing a certain behavior. School is thus a strong source of self-efficacy in its evaluation of student performance and the encouragement or discouragement it fosters among students. Bandura also introduced other important concepts, including reciprocal determinism, self-efficacy, and the variation of time lapse between cause and effect.

Bandura's work has inspired much research on learning and behavior, especially in promoting behavior change. His Social Cognitive — or Social Learning — Theory has recently become the most commonly used framework in public health for studying various health problems, from medical therapy compliance and alcohol abuse to immunizations. It has been of particularly fruitful use in the study of moral and value internalization among children, helping researchers understand how children are socialized to accept the standards and values of their society (Brown). Bandura's cognitive behavior theory has also been used in treating behavior disorders such as depression.

Understanding Depression: Causes and Consequences

Depression is a syndrome consisting of temporary feelings of sadness, despair, and discouragement, decreased pleasure, hopelessness, guilt, and disrupted sleeping and eating patterns (Gale Encyclopedia of Psychology 2001). The American Psychiatric Association estimates that approximately one out of five Americans experiences some depression at least once in his or her lifetime. Depression develops from a combination of physical, psychological, and environmental factors involving a person's body, mood, and thoughts. It is understood through the lens of genetic inheritance, hormonal imbalance, and other physiological and psychological factors — especially life events — including developmental traumas, physical illness, intimacy problems, and losses.

Cognitive theorists believe that depressed people develop destructive ways of thinking, such as self-blame, focusing on the negative side of events, and arriving at extremely pessimistic conclusions. Depression can also develop out of learned helplessness when people lose control of their situations. It is more common in women than in men, given that women tend to dwell on negative events while men have a greater tendency to distract themselves from such events through their activities. Those who undergo major depression are often almost completely incapacitated, losing the ability to work, socialize, and even care for themselves. The most serious complication of depression is suicide. Statistics show that around 60% of those who commit suicide are depressed and that 15% of those diagnosed with depression eventually commit suicide (Gale Encyclopedia of Psychology).

Cognitive-Behavioral Therapy for Depressed Children

In cognitive-behavioral therapy (CBT), the therapist is also a diagnostician and educator who uses performance-based and cognitive interventions to effect changes in thinking, feeling, and behavior (Kendall 1995). The theory views depression as involving cognitive distortions and skill deficits. Depressed children maintain a cognitively distorted perception of themselves and arrive at universal, fixed, and cognitively distorted internal attributions of negative events. Earlier studies showed that while depressed children reported such depressive attributions, children who had overcome depression did not.

Depressed children have low levels of self-esteem and limited social and academic confidence. They evaluate their own performances severely and relate those evaluations to distorted perceptions. CBT involves behavioral training in social skills, activity scheduling, relaxation, and home assignments. In comparing the treatment outcomes of depressed children using CBT, relaxation training, and a wait list, Reynolds and Coats (1986, as cited in Kendall) discovered a significant decrease in depressive symptoms compared to the wait list at post-treatment and at a five-week follow-up. In a separate study comparing CBT and traditional counseling, CBT produced greater gains, although the reduction of symptoms and depressive cognitions was not maintained at a significant level at the seventh-month follow-up.

Furthermore, few studies have been conducted on childhood depression, and there is a strong need for randomized trials. Depressed children lack motivation and thus need cognitive restructuring to change their distorted thinking, hopelessness, assumptions, and perceptions. Affective education can facilitate this by teaching children about emotions and how they relate to thoughts and behavior (Kendall).

Conclusion

Cognitive behavior therapy, based on the five foregoing studies, has shown important gains greater than the traditional counseling approach, but needs follow-up work. It has also demonstrated efficacy in producing lower relapse rates than standard clinical treatment. The discursive approach to the negative self-perception of depressed patients has shown certain limitations as a standalone technique, but it can be useful in reducing symptoms among injection drug users. However, CBT as currently practiced fails to consider and address gender differences between depressed men and women.

On the whole, cognitive behavior therapy promises considerable help to depressed persons, as shown by the surveys and research reviewed here, but both findings and methods remain limited and require further study.