Depression: Causes and Treatment by Aaron T. Beck M.D. & Alford Ph.D. Brad A

Author:Aaron T. Beck M.D. & Alford, Ph.D., Brad A. [Beck M.D., Aaron T.]
Language: eng
Format: azw3
Publisher: University of Pennsylvania Press
Published: 2014-04-03T16:00:00+00:00

Thematic Content of Cognitions

The types of cognitions outlined below were reported by the depressed patients to occur under two general conditions. First, the typical depressive cognitions were observed in response to particular kinds of external stimulus situations. These were situations that contained an ingredient, or combination of ingredients, whose content had some relevance to the content of the idiosyncratic response. This stereotyped response was frequently irrelevant and inappropriate to the situation as a whole. For instance, any experience that touched in any way on the subject of the patient’s personal attributes might immediately make him think he was inadequate.

A young man responded with self-derogatory thoughts to any interpersonal situation in which another person seemed indifferent to him. If a passerby on the street did not smile at him, he was prone to think he was inferior. Similarly, a woman consistently had the thought she was a bad mother whenever she saw another woman with a child.

Second, the typical depressive thoughts were observed in the patients’ ruminations or free associations, that is, when they were not reacting to an immediate external stimulus and were not attempting to direct their thoughts. The severely depressed patients often experienced long, uninterrupted sequences of depressive associations, completely independent of the external situation.

Low self-regard. Low self-evaluation formed a prominent part of the depressed patients’ ideation. This generally consisted of an unrealistic downgrading of themselves in areas that were of particular importance to them. A brilliant academician questioned her basic intelligence, an attractive society leader insisted she had become repulsive looking, and a successful business executive believed he had no real business acumen and was headed for bankruptcy.

The low self-appraisal was applied to personal attributes such as ability, virtue, attractiveness, and health; to acquisitions of tangibles or intangibles (such as love or friendship); or to past performance in one’s career or in one’s role as a spouse or parent. In making these self-appraisals, the depressed patient was prone to magnify any failures or defects and minimize or ignore any favorable characteristics.

A common feature of many of the self-evaluations was the patients’ unfavorable comparisons with other people, particularly in their own social or occupational group. Almost uniformly, in making comparisons, depressed patients rated themselves as inferior: less intelligent, less productive, less attractive, less financially secure, or less successful as a spouse or parent than those in their comparison groups. These types of self-ratings comprise the feeling of inferiority, which has been noted in the literature on depressives.

Ideas of deprivation. Allied to the low self-appraisals are the ideas of destitution seen in certain depressed patients. These ideas were noted in the patient’s verbalized thoughts that he or she is alone, unwanted, and unlovable, often in the face of overt demonstrations of friendship and affection. The sense of deprivation was also applied to material possessions, despite obvious contrary evidence.

Self-criticisms and self-blame. Another prominent theme in the reported thoughts of the depressed patients was concerned with self-criticism and self-condemnation. These themes should be differentiated from the low self-evaluation already described. The

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