Cognitive and Stress Theories

A different approach to understanding depression has been put forward by
cognitive theorists. According to Aaron Beck, in Cognitive Therapy and the
Emotional Disorders (1976), cognitive distortions cause many, if not most, of a
person’s depressed states. Three of the most important cognitive distortions
are arbitrary inference, overgeneralization, and magnification and minimization.
Arbitrary inference refers to the process of drawing a conclusion
from a situation, event, or experience when there is no evidence to support
the conclusion or when the conclusion is contrary to the evidence. For example,
an individual concludes that his boss hates him because she seldom
says positive things to him. Overgeneralization refers to an individual’s pattern
of drawing conclusions about his or her ability, performance, or worth
based on a single incident. An example of overgeneralization is an individual
concluding that he is worthless because he is unable to find his way to a
particular address (even though he has numerous other exemplary skills).
Magnification and minimization refer to errors in evaluation that are so
gross as to constitute distortions. Magnification refers to the exaggeration of
negative events; minimization refers to the underemphasis of positive events.
According to Beck, there are three important aspects of these distortions
or depressive cognitions. First, they are automatic�"that is, they occur without
reflection or forethought. Second, they appear to be involuntary. Some
patients indicate that these thoughts occur even though they have resolved
not to have them. Third, the depressed person accepts these thoughts as
plausible, even though others would not view them in the same manner.
While there is ample empirical support for the association of depression
and negative cognitive factors such as cognitive distortions, irrational beliefs,
and negative statements about oneself, research that demonstrates the
ability of cognitive variables to predict subsequent depression is just beginning.
It appears that a cognitive vulnerability plays a role in symptom formation
for at least some individuals and in the maintenance of ongoing episodes
of depression for many, if not all, depressed persons.

Yet another approach to understanding depression focuses on stress and
coping. James Coyne, in a 1991 article, suggests that depression may be understood
as a failure to cope with ongoing life problems or stressors. It has
been hypothesized that coping effectively with problems and stressors can
lessen the impact of these problems and help prevent them from becoming
chronic. Depressed patients show slower recovery if they display poor coping
skills. Avoidance coping strategies appear to be particularly likely in depression
and are one example of poor coping. Depressed persons also show
elevated levels of emotion-focused coping strategies, such as wishful thinking,
distancing, self-blame, and isolation. These strategies also tend to be ineffective.
While most forms of coping are impaired during an episode of depression,
only self-isolation, an interpersonal avoidance strategy, appears to
be an enduring coping style of persons vulnerable to depression. Thus, coping
processes appear to change for the worse during an episode of depression,
and poor coping helps to maintain the episode. In particular, depressed
persons appear likely to avoid problem situations and to engage in
strategies with a low likelihood of resulting in problem resolution or an enhanced
sense of personal control.

Interpersonal approaches to understanding depression are related to
stress and coping models but highlight the interpersonal environment as
particularly important in depression. There is considerable evidence that
low levels of social support are related to depression. Perhaps the relationship
between social support and depression results from the fact that depressed
persons do not seek social support; however, there is also evidence
that poor social support leads to or maintains depressive symptomatology.
In particular, evidence links the absence of close relationships with the development
of depressive symptomatology. Accordingly, the work on general
social support and depression can be seen as pointing in the direction of
direct consideration of intimate relationships and their role in depression.
Because the strongest family ties are usually in the marital relationship, it is
natural to look to the marital relationship for particularly powerful opportunities
to provide social support. Indeed, there is considerable evidence of an
association between marital discord and depression. It had been expected
by some that the association between marital discord and depression would
be greater for women than men; however, it is generally equivalent between
sexes. Indeed, the risk of having a major depressive episode is approximately
twenty-five times higher for both men and women if they are in a discordant
marital relationship than if they are in a harmonious marital relationship.