The cognitive model of depression and case conceptualization Enduring cognitive vulnerability to depression

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Cognitive therapy of depression is defined as: 'an active, directive, time-limited, structured approach...based on an underlying theoretical rationale that an individual's affect and behaviour are largely determined by the way in which he structures the world'.(1) The cognitive model of depression proposes that enduring cognitive structures and processes shape how everyday experience is interpreted, and are in turn reinforced by these interpretations. This model (illustrated in Fig 1) forms the basis for an individualized conceptualization, developed and shared with the patient, which informs and guides therapy. It suggests that, on the basis of experience (loss, events with lasting implications for self-worth), people arrive at fundamental conclusions about themselves, others, and the world ('basic' or 'core' beliefs, or schemas). They also devise rules or guidelines for living ('conditional assumptions'), which allow them to operate in the world, given the truth of those conclusions. Using general concepts and rules to organize experience and guide behaviour is a normal part of human functioning. However, where conclusions are globally negative (e.g. 'I am inferior') and assumptions extreme and resistant to change (e.g. stringent perfectionism), they become counterproductive. Evidence for cognitive vulnerability to depression has been inconsistent, perhaps because it is difficult to access relevant cognitions in normal mood. However, attributional style when not depressed may predict later depression, and negative biases in information processing (especially about the self) may occur in people at risk of depression, at least when experiencing mild depressed moodA8,,.19)

Cognitive Model Perfectionism
Fig. 1 Cognitive model of depression.

The relationship between thinking and other aspects of depression

Dysfunctional beliefs and assumptions are activated by events that match the person's particular sensitivities. So a person with negative beliefs about the self whose psychological well being depends on love and approval might become depressed after experiencing rejection. Activation of the system results in an upsurge of 'negative automatic thoughts'—'negative' in that they are associated with painful emotions, and 'automatic' in that they pop into the person's mind rather than being a product of reasoned reflection. Such thoughts are also 'distorted'; that is to say, they reflect processing biases such as arbitrary inference (jumping to conclusions) and overgeneralization. Depression is characterized by distorted negative thoughts about the self (e.g. 'I'm useless'), the world (e.g. 'My situation is intolerable') and the future (e.g. 'Nothing will ever work out for me'). The latter (hopelessness) is central to suicidality. (2°)

The more depressed people become, the more negative thoughts they think, and the more they believe them. Equally, the more negative thoughts they think and the more they believe them, the more depressed they become. Thus a vicious circle is formed in which negative thinking and other symptoms of depression reinforce one another. Experimental and clinical research support this idea. That is, increasing or decreasing depressive thinking produces corresponding increases or decreases in depressed mood.(2 22 and 23> Equally, variations in depressed mood are attended by corresponding variations in the frequency and intensity of depressive thinking.'2425» These observations support a reciprocal interaction between mood and cognition. (26>

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Exploring EFT

Exploring EFT

EFT stands for Emotional Freedom Technique. It works to free the user of both physical and emotional pain and relieve chronic conditions by healing the physical responses our bodies make after we've been hurt or experienced pain. While some people do not carry the effects of these experiences, others have bodies that hold onto these memories, which affect the way the body works. Because it is a free and fast technique, even if you are not one hundred percent committed to whether it works or not, it is still worth giving it a shot and seeing if there is any improvement.

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