What is the evidence that there are different levels of cognition and that the presence of the different types of cognitions is important to the experience of depression

The cognitive model makes clear that negative cognition exists at different levels or layers. Some of these layers or levels are accessible to the person and can be spontaneously described, but other levels are under less effortful control and cannot be reported by the individual directly, without training. At the most observable level, negative thinking, we have seen that there is good evidence that depressed individuals are likely to have more negative thoughts. Is there also evidence that there are other levels of cognition, and that these have a negative tone in depression? Moreover, are these other levels of cognition important in initiating or maintaining depression? These questions, though they seem simple, are complex and pose several dilemmas for researchers. First, how does one ascertain the existence of cognitive processes that cannot be described by the individual or observed directly? Second, if evidence for more implicit cognition exists, how might explanations drawing on these constructs demonstrate their incremental utility compared to accounts based on negative thoughts alone?

As in other areas of the model, one of the critical questions is whether one can measure the phenomenon of interest reliably and validly. These more implicit types of cognition are termed either "beliefs" or "schemas", and there have been attempts to measure them through self-report. The earliest and most established measure of these more deeply held beliefs is the Dysfunctional Attitudes Scale (DAS) (Weissman & Beck, 1978). The DAS has three forms, a 100-item version, and two more commonly used, 40-item versions (forms A and B). The DAS and its different forms have been found to display adequate psychometric properties (Beck et al., 1991; Oliver & Baumgart, 1985), and many of the DAS items are explicitly written as "if... then" statements to distinguish them from measures of automatic thoughts. The latter have strongly self-relevant negative content, while beliefs are expressed mainly as rules or conditional assumptions.

Clearly, implicit beliefs need to be sufficiently differentiated from automatic negative thoughts in order to be useful concepts or to have explanatory power that goes beyond negative thoughts. The conditional nature of beliefs and their content (such as "if.. .then" rules) is one factor that differentiates them. However, beliefs also need to meet additional criteria if they are to be useful in cognitive models. First, beliefs should be correlated moderately but significantly with negative thoughts; a correlation that is too high would suggest redundancy of concepts, whereas no correlation would suggest that beliefs and thoughts are independent of one another. Second, one may hypothesize that beliefs would be more stable than negative thoughts since the former are less tied to specific mood states or situations. Finally, the presence of these maladaptive beliefs should increase vulnerability to onset or relapse of depression. These hypotheses have received positive support from research to date (Clark et al., 1999). For example, the DAS has been found to correlate moderately but significantly with negative thoughts and depressive symptoms in many studies (Clark et al., 1999). Second, there is evidence that markers of these beliefs are evident even between episodes of depression (Gemar et al., 2001; Ingram et al., 1998). Finally, a large body of research supports the notion that these kinds of beliefs, especially when coupled with stressors, lead to the emergence of depressive symptoms (Hammen etal., 1985; 1995; Segal etal., 1992).

Another interesting issue in the literature on beliefs is the question of the content of these beliefs. Research has shown that the underlying factor structure of the DAS is determined by which version is at issue, and that the two forms (A and B) appear to have different factor structures. Form A factors are needed for approval, perfectionism, and avoidance of risk. Form B factors are need for success, need to impress others, need for approval, and need to control feelings (Oliver & Baumgart, 1985). The most comprehensive analysis of the DAS items, using the entire 100-item pool as a starting point, suggests that nine types of conditional assumptions are reliably measured by the DAS (Beck et al., 1991). The nine types of conditional assumptions are vulnerability, need for approval, success-perfectionism, need to please others, imperatives, need to impress, avoidance of appearing weak, control over emotions, and disapproval-dependence. Two studies have also addressed the issue of DAS and coping, that is, the connection between beliefs and behaviour. One study found no relationship between DAS scores and perceived social support (Kuiper et al., 1987). However, in a study of depressed inpatients, elevated DAS scores were associated with perceiving one's support as inadequate and having lower social adjustment (Norman et al., 1988). This research represents a promising line of inquiry, but it is too early to draw any conclusions about the link between conditional beliefs and coping strategies.

According to the cognitive model, beliefs contain meaning (or content), but are also processing constructs (Clark et al., 1999; Williams et al., 1997). There are numerous inherent difficulties in measuring the products of "implicit cognitive processing". Indeed, a self-report measure in which the respondent essentially endorses the content of an item cannot, in and of itself, support the notion of belief-based information-processing (Gotlib & McCabe, 1992; Segal & Swallow, 1994). To study the information-processing functions of beliefs, researchers have used a variety of experimental paradigms, including sentence completion, trait adjective ratings, and autobiographical memory recall. These studies suggest that depression increases accessibility to negative self-referent schema content (Clark et al., 1999). Studies in this area share an underlying conceptual and methodological framework. Researchers compare individuals at risk of depression (for example, patients who were formerly depressed, but are currently remitted or recovered) with never depressed or non-depressed psychiatric control groups. The two groups are exposed to an experimental stimulus, usually a "mood prime" designed to activate temporary negative emotions and thereby a negative set of beliefs. Comparison of the beliefs of groups before and after mood priming can demonstrate the presence of activated negative beliefs. Using this paradigm, numerous studies have demonstrated that, as a result of mood priming, remitted depressed individuals are likely to have more negative content in their thoughts and more negative recall and encoding of information than controls, and problems with focusing their attention (Ingram et al., 1998). Thus, the induced negative mood may be seen to be an analogue of negative environmental events, and the activation in cognitive structures to be a vulnerability, or risk factor for depression. More recently, one study has found a link between degree of activation of negative beliefs and vulnerability to depressive relapse, suggesting an important link between latent negative beliefs and the onset of full depression (Segal et al., 1999). These lines of research support the idea that deep cognition is a powerful explanatory construct in depression and that deep cognitive processes are distinct from negative automatic thoughts.

An elaboration of this approach to "deep" cognitive structures in depression has been provided by the interacting cognitive subsystems (ICS) approach of Teasdale and Barnard (1993). This approach suggests that depression does not increase activation of negative core beliefs, but rather results in the application of a different set of mental models. Furthermore, these mental models encode more globally negative views of self and views that are more closely allied with notions of lack of social approval and lack of success. This model, while relatively more recent, does have some empirical support (e.g., Teasdale et al., 1995). For example, Teasdale and colleagues were able to show that depressed patients completed sentence stems with positive words when doing so changed the overall meaning of the belief to be dysfunctional. For example, in the sentence, "Always seeking the approval of other people is the road to-", the depressed individuals were more likely to use the word "success", whereas non-depressed individuals were more likely to use a word such as "unhappiness". This finding suggests that depressed individuals do not process information in a monolithic or simplistic negative manner, but apply a template of beliefs that set them up to experience negative consequences (Teasdale et al., 1995).

On the whole, the investigation of beliefs has proven to be one of the most important challenges for researchers investigating the cognitive model. Thus far, the literature is sharply divided into information-processing paradigms and self-report content categories. Each has its limitations. Investigations that focus on content tell us little about the operation of these beliefs. Likewise, studies examining the processing associated with these beliefs tell us little about the content of the beliefs that have been activated. Future approaches may be helpful if they can combine these two approaches. First, for example, can situation-specific "mood prime" paradigms demonstrate the activation of specific types of beliefs? Second, do these specific beliefs then influence the subsequent processing of information? This research will require considerable rigour, and probably awaits the creation of new experimental paradigms that can test such complex questions.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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