Revisiting the Cognitive Model of Depression: The Role of Expectations

Abstract

The cognitive model of depression was highly stimulating for a better understanding and development of treatment for depression. However, the concept of “cognition” is rather broad and unspecific, and we suggest to focus on the cognitive subset of expectation. We conducted a narrative review on the role of expectations, and present an expectation-focused model of explaining why depression tends to persist despite the occurrence of positive events. Several results from basic neuroscience to effects in clinical interventions indicate that expectations play a special role not only for the understanding of the development of mental disorders and the effects of treatment approaches, but especially for an improved understanding of the persistence of mental disorders. If expectations are a major mechanism of depression, the treatment of depression must maximize the violation of dysfunctional expectations. We also introduce the concept of immunization that describes any cognitive or behavioral strategies to reduce the effect of expectation violation experiences, and hereby contributing to expectation maintenance despite expectation contradicting events. We postulate that the development of immunization strategies could help to better understand the transition from episodic to chronic depression. While in early periods of depression development, a focus on expectation change might be sufficient in treatment, the treatment of patients with chronic depression requires addressing these cognitive and behavioral immunization strategies more intensively. Further implications for treatment and research are outlined that are derived from this balance between expectation violation and cognitive immunization in depression. A focus on “expectations” helps to better understand the maintenance of depression We offer a model that explains why depression persists even in the presence of positive experiences. Many psychological treatments focus on the violation of negative expectations, but cognitive immunization can hinder treatment success. We suggest strategies on how to improve psychological treatments for depression by maximizing expectation violation, and minimizing cognitive immunization. A focus on “expectations” helps to better understand the maintenance of depression We offer a model that explains why depression persists even in the presence of positive experiences. Many psychological treatments focus on the violation of negative expectations, but cognitive immunization can hinder treatment success. We suggest strategies on how to improve psychological treatments for depression by maximizing expectation violation, and minimizing cognitive immunization.

How Depressive Symptoms Hinder Positive Information Processing: An Experimental Study on the Interplay of Cognitive Immunisation and Negative Mood in the Context of Expectation Adjustment

“…This is where the idea of cognitive immunisation comes into play: According to Rief et al (2015), cognitive immunisation refers to the very process of reappraising new information in such a way that the discrepancy between the prior belief and new information is reduced. It has been suggested that this cognitive reappraisal leads to sustained negative expectations that become immune to belief updating and learning from new experience (Kube et al, 2020;Rief & Joormann, 2019). In a series of experimental studies, we confirmed this hypothesis by first demonstrating that people with depression maintained negative expectations for their performance despite positive performance feedback, whereas healthy people adjusted their expectation in accordance with the positive feedback (Kube, Rief, Gollwitzer, Gärtner, et al, 2019a, b, c;Kube, Rief, Gollwitzer, et al, 2018).…”

Motivation and cognitive control in depression

“…Several recent theoretical models have emphasized the role of prior expectations in depression. For example, it has been proposed that the cognitive theories of depression should focus more on the role of negative expectations and the reasons why such expectations are not being efficiently updated in light of disconfirming evidence (Rief & Joormann, 2019). A recent account of cognitive process in depression has proposed that depression is related to increased prior beliefs that negative events will happen which are not optimally updated thus creating a negative feedback loop (Kube, Schwarting, Rozenkrantz, Glombiewski, & Rief, 2019).…”

When Beliefs Face Reality: An Integrative Review of Belief Updating in Mental Health and Illness

“…Cognitive reappraisal of disconfirmatory evidence is an additional factor that has been discussed as a contributor to the maintenance of dysfunctional beliefs (Rief & Glombiewski, 2016; Rief et al, 2015; Rief & Joormann, 2019). In particular, it has been suggested that people with mental disorders are prone to devaluing positive information that disconfirms disorder-specific negative beliefs by post hoc questioning of its credibility or considering it to be an exception rather than the rule.…”