Underlying Mechanisms

At the presumed root of a patient's overt difficulties lie the underlying psychological mechanisms, which represent the second level ofPersons's (1989) case formulation model. Indeed, an underlying psychological mechanism represents a problem or deficit that causes or contributes to an individual's overt difficulties. According to the cognitive theory of depression (Clark et al., 1999), maladaptive schemas are the underlying psychological mechanisms for depression and associated difficulties. The specific content of these schemas represents one's core beliefs: one's most central ideas about the self, others, and the world (J. S. Beck, 1995). These schemas may be represented as conditional beliefs, such as "If I put others' needs before my own, they will love me," or unconditional beliefs, such as "I am a worthless person." Furthermore, the underlying psychological mechanisms may represent other deficits, such as a lack of problem-solving skills (Nezu, Wilkins, & Nezu, 2004).

In considering potential underlying mechanisms of depression, Beck (1983) identified two cognitive-personality styles that are hypothesized to reflect distinct underlying themes associated with major depression— "sociotropy," or excessive need for approval from others, and "autonomy," or excessive concern about independent achievement. Sociotropy and autonomy correspond to the core beliefs of unlovability and worthlessness, respectively, which are the two broad categories of core beliefs associated with psychopathology (J. S. Beck, 1995). Cognitive theory proposes that individuals whose underlying schemas reflect themes of sociotropy develop symptoms of depression in response to rejection or other interpersonal difficulties, whereas individuals whose underlying schemas reflect themes of autonomy may develop depressive symptoms in response to failure events or exposure to obstacles that prevent goal achievement. Research to date has yielded partial and inconsistent support for the congruency hypothesis; there is also some evidence that sociotropy represents a general vulnerability to depressive symptoms in the face of both interpersonal and achievement stressors (Clark et al., 1999). Conceptual and methodological shortcomings in existing research make it difficult to draw firm conclusions regarding these cognitive-personality styles and depression onset. However, the two broad dimensions of sociotropy/unlovability and autonomy/worthlessness may provide a useful conceptual model for understanding a patient's underlying belief systems.

Belief Change 101

Belief Change 101

Do you suffer from a habit or a behavior or a repetitive thought pattern that keeps you from being who you want to be? Do you try to change this or that aspect of your life, but wind up right back where you started? You're not alone! Millions of Americans try to make changes, but the whopping majority fail exceptionally.

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