A [Long-Winded] Exploration of CBT, the Stress Vulnerability Model, Negative Automatic Thoughts and Core Beliefs - Among Other Things...

The causes of mental disorders are complex. Genetics, formative development, current life experiences, drugs, disease and injury, core beliefs, coping mechanisms, society in general, and cultural norms can all contribute to the development or progression of different mental disorders.

During my training I was aghast by how many mental-health professionals, when working with people suffering with aspects of depression looked to explain its causes by using the 'chemical imbalance' hypothesis and furthermore continued to explain the functions of anti-depressants by using pseudo-scientific terms - all of which are simply unfounded. I am sickened by how unaware the public are of the non-science behind psychiatry and the fact that the 'chemical imbalance' theory, just does not exist AT ALL, but is in fact, a mere advertising ploy (pdf link) by the multi-billion dollar drug companies to promote the belief that mental-health issues are simply illnesses which can be remedied by swallowing a pill.

Of course, the human beings that we are, happily accept the illness paradigm, be it so to rid us of personal responsibility and the baggage that comes with it. This side-shifting-of-responsibility is increasingly apparent in my work with families, with parents who are at the end of their tether because of their unruly son. A diagnosis of ADHD and a magic pill is easier to cope with, as it shifts the responsibility of bad parenting, where boundaries are found wanting - to "Oh-he-does-that-cuz-he's-got-mental-health-issues".

There are, of course, cases where kids truly have ADHD or aspects of communicative difficulties - but such things, it seems, are far and few between.

Other than the gigantic influence that psychiatry has, there are other bio-psycho-social paradigms which exist to explain the causes of mental-illnesses. One being Zubin & Spring's Stress-Vulnerability model. This model takes into account both the result of biological and genetic factors (nature) and life experiences (nurture) to describe the pronunciation of mental disorders, where the predisposition (genetic vulnerability) interacts with the environment and life-stressors. The greater the underlying vulnerability, the less stress is needed to trigger the disorder; conversely, where there is a smaller genetic contribution (predisposition), greater life stress is required to produce a disorder. This model is most useful for people who experience psychosis and who may later develop schizophrenia.

Another excellent model, and this time to explain the cause of depression is Beck's model of cognitive and behavioural processes - CBT. Aaron T. Beck is regarded by most as one of the modern fathers of cognitive-behaviour therapy. He proposed that thoughts played a critical part in maintaining the individual's mental-health state, which differed in emphasis from earlier behavioural theories that had proposed that behaviours merely dictated outcome. Beck observed that patients with depression expressed characteristically negative views of themselves, the world and their future. He called this the 'negative cognitive triad' of depression. In an attempt to explain these characteristically negative cognitions, Beck proposed a model that separated out the thoughts of an individual into different levels.

The most superficial layer of cognitions is the 'automatic thoughts'. This is the stream of thoughts that pass into our consciousness throughout the day - the 'background hiss' of thoughts. They usually relate to mundane every-day events, but occasionally have a content that evokes a significant emotion. An example may include, "What shall I eat for breakfast" or "It's getting late, I should go home". Beck proposed that at a deeper level we all have rules and assumptions that we hold about the world. These relate to a wide variety of issues that have been forged by our life experiences. Examples may include, "If you're slim, you're more likely to meet a partner" or "If you work hard, then you will reap good rewards". The assumption then for those who are prone to depression or who are depressed have a number of 'unhelpful' rules that influence minute-to-minute thinking, producing automatic thoughts with a depressive content. Beck called these, 'dysfunctional assumptions' and the resulting automatic thought with a depressive content, 'negative automatic thoughts'. An example of this may be, 'if I don't have a job then I'm worthless' or 'if I don't get along instantly, I'll be rejected'. These thoughts may also relate to others, 'if you give others the chance, they will use you'. The assumptions usually take on an 'IF, THEN' rule.

The resulting negative automatic thought from the rule, 'if I don't have a job then I'm worthless' may result in thinking, "I should not be off work; John's a better bloke than I am - he's got a job; my family think I'm a right waste of space". It can be seen how such thoughts could cause the depressed person's mood to stay depressed! It is then important to note that because automatic thoughts are ALWAYS with us, we do not generally question whether they are biased or problematic - we all have automatic thoughts, but we rarely question their validity and accuracy.


Finally, Beck proposed that at the deepest layer of cognition we hold quite rigid unconditional beliefs about ourselves, the world and others. These are termed, 'schemas' or 'core beliefs'. Core beliefs can be positive but those that have a negative theme were proposed by Beck to be 'activated' in depression. Such beliefs are expressed in short, unconditional terms such as 'I'm defective' or 'I'm unlovable'. Some may hold to the belief that 'the world is a dangerous place', or 'people are selfish' or even 'people are kind'. Beck hypothesised that we all hold core beliefs, that they have their origins in our early life experiences - although can be altered to some extent by later experiences, and that their content shapes the development of our assumptions, and through them our automatic thoughts.

As my interests are both in mental-health and 'grace', I am constantly intrigued by the interaction between Biblical principles with its take on the depravity of the human mind and the many secular theories explaining human cognition and behaviour. While I find CBT a most useful tool in helping others, I do wonder about its diametrical opposition to 'grace'. A cognitive-behaviour therapist merely acts as a facilitator in helping the other person to take control of the way they think, and the way that they feel to then make small changes in the way they behave in relation to the internal cognitive processes and then to steer their lives in order to have a positive influence over their environment. The emphasis in CBT, over every other therapy (in my opinion) is SELF-DETERMINATION; when the message given by God through His word stands as a firm opposition to self-help: "Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength" and "Trust in the LORD with all your heart and lean not on your own understanding; in all your ways acknowledge him, and he will make your paths straight"

Where both candidates start from a foundation of utter despair, the journey to freedom for the one who finds success in CBT is through gutsy self-determination; repentant, that is, a turning away from living a life of failure to a life full of self-indulged positivity and self-made success. But the point of freedom, and where the journey begins for the other – the one who has encountered 'grace' is through a humiliating understanding that it is Jesus alone who saves; also repentant, though not necessarily a turning away from life’s despair, but instead an embracing of the despair (because this is the realising of one's sinful nature) whilst clinging (otherwise known as faith) to Him who has already accomplished the work. The repentance here involves a turning away from self-help to His-help.

The gospel message will continue to be nothing but foolishness, because the human instinct is to help one's self...