This is the second in a series of blog posts about Cognitive Behavioural Therapy formulations. This blog will focus on Cognitive Behavioural Therapy formulation for depression.
1. Predisposing factors
Predisposing factors consist of childhood events that may increase vulnerability to developing depression. These are stressful and/or negative early life experiences that increase the likelihood of developing negative core beliefs and maladaptive coping strategies. Predisposing factors may include insecure attachments, a lack of intellectual stimulation, experience of authoritarian, punitive or neglectful parenting, parental focus on failure, family discord, family disorganization and stresses in early life including bereavement, socioeconomic disadvantage, or parental separations.
2. Core beliefs
Core beliefs in depression are centered on beliefs of being worthless or unlovable. The core belief about others is that others are rejecting and will leave when they discover this unworthiness. Examples of these core beliefs include: “I am inadequate”, “I am a failure”, and “I am bad”. These core beliefs lead to assumptions, such as “I will be rejected” or “I will end up alone”.
3. Precipitating factors
Precipitating factors include stressful life events, such as those regarding loss, change or perceived failure.. For examples, bereavements, interpersonal conflict, loss of friendships, experience of bulling, changing home or schools or academic failure. These life events may trigger the experience of depression, as the predisposing factors have always left the individual vulnerable to depression. Conversely, the absence of predisposing factors makes the presence of the above triggers less likely to lead to experiencing depression.
4. Maintaining factors
Maintaining factors are those that prevent the cycle of depression from ending. Negative automatic thoughts stem from core beliefs. These are likely to consist of beliefs that others are rejecting them, or that there is something “wrong” with them. As the name suggests, these occur automatically and often are hard to pinpoint. Low self-esteem is also part of this maintenance cycle. Dysfunctional coping abilities in the face of negative events, such as rejections occur are a maintaining factor, as are biological factors such as disrupted sleep and drug use. These factors all increase the likelihood of the cycle continuing.
5. Protective factors
It is also important to note protective factors that are relevant to consider in CBT case formulations for depression. Protective factors are positive things in the person’s life that reduce their likelihood of experiencing depression and/or assist their recovery. Protective factors may include exercise, academic achievement, calm personality style, high self-esteem, support from family and friends, absence of current stressors and adaptive coping skills when negative automatic thoughts are triggered.
6. Case example
Here is an example of how a CBT case formulation for depression may look in brief:
Situation: Lucy’s friend cancels their plans to meet for lunch.
Core Belief: I am worthless. I am unlovable.
Assumptions/Rules: Others will reject me.
Coping Strategies: Avoidance.
Automatic thought: She doesn’t want to meet me because I’m boring. I have no friends. No one likes me.
Behaviour: Avoid making plans with this friend in the future. Avoid making plans with others due to fear of being rejected.
The cancellation was the precipitating factor, which activated negative automatic thoughts regarding her perceived inadequacy and unlikable to others.
7. How does CBT work for other mental health conditions?
To find out more about how Cognitive Behavioural Therapy work for other specific mental health conditions such as low mood & depression or anxiety disorders please read our series of blog posts on this topic:
- A Guide to Cognitive Behavioural Therapy
- Cognitive Behavioural Therapy for Anxiety Disorders
- Cognitive Behavioural Therapy for Health Anxiety
- Cognitive Behavioural Therapy for Social Anxiety
- Cognitive Behavioural Therapy for Panic Disorder
- Cognitive Behavioural Therapy for Obsessive Compulsive Disorder
- Cognitive Behavioural Therapy for Specific Phobia