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By Sandeep Gautam | February 13th 2007 11:11 PM | 9 comments | Print | E-mail | Track Comments
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More The Undercover Psychologist articles

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About Sandeep Gautam

Sandeep Gautam has a B. Tech. In Computer Science and Engineering from IIT Delhi, which gives him a foothold to opine on matters cognitive and comutational.

Cognitive Psychology is his


... Full Bio

PsyBlog has recently posted an article on Cognitive Therapy (CBT) and how it is useful in Depression treatment. this therapy has been shown to be equally effective in Depression as is medication, though this woks in a top-down fashion in the brain (revealed by brain scans), while anti-depressants work in a bottom-up fashion. PsyBlog quotes the following irrational beliefs , as outlined by Beck, that are prominent in Depression.
* Over-generalization. Drawing general conclusions from a single (usually negative) event. E.g. thinking that failing to be promoted at work means a promotion will never come.
* Minimalization and Maximization. Getting things out of perspective: e.g. either grossly underestimating own performance or overestimating the importance of a negative event.
* Dichotomous thinking - Thinking that everything is either very good or very bad so that there are no gray areas. In reality, of course, life is one big gray area.

 

To me all of these beliefs are equally relevant for Manic thinking, although in the Manic case these beliefs would be about positive events and have a different spin.

  • Over-generalization: a single instance of success at some endeavor disposing one to think that one can achieve anything in unrelated fileds. Also more co-incidence detection and more correlation-is-causation type of thinking that may ultimately lead to the Magical Thinking of full-blown Psychosis.
  • Minimalizations and Maximizations: Here, again, things go out of perspective: Overestimating one's own performance and underestimating the importance of external happenstances that might have led to success.
  • Dichotomous thinking: thinking that things are mostly good/bad and unfounded optimism/faith/trust - the opposite of the depressive feeling. Although the reverse thinking that things are mostly bad (external environment is bad, I am good) can also kick in. The point is seeing the world in Black/white but not in shades of gray.
PsyBlog also has an earlier post on depressive thinking style in which it elaborates on the internal-locus-of-control predisposition in depressive probands. Thus, the depressive style is marked by the following internal, global and stable attributions: :
* It is my fault that I didn't get the job. Here I have made an internal attribution.
* I think I am worthless: a thought that is likely to affect all areas of my life. Now I am making this attribution global.
* I see no reason for the fact that I am worthless to ever change. Now the attribution is stable

It is clear that the Manic person too makes the similar attributions: His success (maybe a single, lucky success) is due to his genius(internal attribution). His genius is not limited to one field- he is generally the most valuable, productive and creative genius and is an all-rounder(global attribution). His genius is not a short-lived entity- he will continue to remain a productive genius no matter what external circumstances / reality (stable attribution). He may thus have no drive to learn about external reality as he suspects that the external reality is not relevant and he can predict outcomes (which are bound to be good) based on his skills, expertise, grandiosity alone. An extreme form of this thinking may lead to the loss of reality characteristic of a full blown Psychotic episode.

While the minimalisations and maximizations are explained by the internal locus of control, the over-generalization is explicable by a propensity of jumping-to-conclusions sort of thinking that leads to global, stable over-regularizations. Another feature important in my view would be the mixing of contexts, where things from one context are referenced in another, dissimilar context. One could call this mixing up of metaphorical thinking where wrong analogies are applied and thus wrong (positive or negative) conclusions are arrived at. The third factor of dichotomous thinking is also very important though hard to pin down. Why should everything appear black and white in depressive or manic thinking and why in one case(depressive ), black is the color of self, while in Manic white is the color of self, remains a mystery. Answering how and when the switch from a grayish-world to a black-me-world(I'm a piece of shit) or white-me-world(I'm the next Einstein) happens would go a long way in making the bipolar patient control his moods and if he has to be sick then enable him to go for a manic episode (where the price may be insanity- a psychotic episode) instead of a depressive one (where there is a real risk of life).

Although the other wrong attributions and thinking styles also need to be addressed, the mechanism of the switching of mood/ black-white world view would help the most and should be the first one targeted in CBT/ medications.

Comments

Cash's picture
Great article.

So is that the route the neuroscience community is taking? Finding a physical mechanism ( or perhaps the term mechanism confuses me - is it physical? ) and controlling it chemically?

If people have these two extremes and the three sub-systems, can they ever be controlled, or just mollified?

sandygautam's picture

Thanks cash for reading!


The cognitive neursocince community tries to find psychological as well as neural mechanims involved and tries to counter the abnormal behavior/thinking by analyzing the underlying mechanisms. A cognitive explanation of depression/mania can offer new therapies like CBT; while a biological explanation can lead to better medications.


People can (and should) neither be controlled nor mollified. If anything the culture should be modified to include these outliers. After that it is the choice of those affected to either use medication/ therapy to remain normal; or to enjoy their 'abnomral' states of moods, thinking and behaviour. It is very much plausible that they chose 'abnormality' over normality as that may lead them to be more creative/ better introspectors.


regards,


Sandeep Gautam


Hey, I read your article and I am bipolar, I'm wondering where you got your information about bipolar, and I'd just like to say that bipolar has affected my whole outlook, when I'm manic (stressors still win out over medication) I hate myself and don't do anything in case I do something wrong.

when I'm depressed I hate myself and want to die.

So that beats your theory a little, wouldn't you say?

sandygautam's picture

Hi Trudy, As per some of the relevant literature on bipolar people's cognitive style, it is indeed the case that in both manic and depressive phase they suffer from low self-esteem. This could explain why you hate yourslef in both the situations. And yes, the hesitation that you do not act erraneously when having a a manic episode is also real, but perhaps gets triggered only forsubsequent episods and not the first few episodes.

What I was suggesting is that apart from these well documented cognitive distortions in mania, there is a possibility of a cognitive style driven by a magical feeling of the self/SOs as a special person. Here one considers oneself special and whatever good things happen are due to one's own efforts/luck and not due to external factors/ happenstance.

As for the other cogniive biases regarding overgenralizations etc, I believe it shold not be hard to prove that experimentally.

regards,

Sandeep Gautam


Wow what an excellent article. You combine all the precision, detail-orientation and logic of a programmer with the ability to bring a sense of "this is an accurate depiction" to your descriptions. Its not a dead technical piece. You make it real enough that it reflects life, like an artist.

In spite of clear research evidence and clinical guidelines regarding therapy, depression is often undertreated. Hopefully, this situation can change for the better.

Although I have never been diagnosed as manic depressive, my doctor did once tell me that I was possibly borderline. I did try anti depressants and nerve pills like xanax off and on for a while, but eventually I discovered that a lot of my problems was the way I dealt with things like certain situations, family,etc. Over the years I have learned on my own and through reading a lot of material such as this, that there is hope for some without having to take all kinds of medication. I still have a problem with negativity that seems to be my first response to things sometimes, but when I just slow down and do a little self analyzing, I can usually figure out if it is the situation or circumstance that really is negative or is it just me. Depression is such a complicated thing and visiting a good doctor that you trust is a good idea because sometimes you can not handle things on your own. You could be like me and not require medication except when extreme things happen like when my late husband died. I did need some help then, but the good thing was that I recognized I did need help at that time and so many depressed people do not seek the help they need.

I am not certain that you are correct about depression being the dangerous aspect and mania merely leading to psychosis, but I guess psychosis is better than death. My daughter (age 21) is very bipolar and she is most dangerous when she is manic and almost all her suicide attempts occur when she is manic and activated. Of course, maybe it is different with the rapid cyclers and mixed states. It has been fascinating watching her behavior evolve from what we thought was just really bad ADHD when she was a baby to now when she is functional but nuts most of the time.

I am bipolar and I am a danger to myself either depressed or manic. Either way, this illness is not something that can be wished away and despite being highly functional and very educated I have not been able to escape it's grasp as one early comment suggests could happen by "learning some coping strategies". Once we figure out the exact wiring that causes each brains function and malfunction it will spell some major relief for those of us who SUFFER with this horrible illness that up until present is merely treated and controlled with medications and therapy. I pray more funding is given to research!!!

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