H567/03 Section A - Alternatives to the medical model

Behaviourist learning and maintenance

Behaviourist explanations link difficulties to learning and the consequences of behaviour, rather than assuming that symptoms must originate in a bodily disease.

Classical conditioning can associate a previously neutral situation with distress; operant conditioning concerns consequences that make actions more or less likely. For depression, Lewinsohn's account emphasises a reduction in response-contingent positive reinforcement: rewarding outcomes following a person's activity become less available. Loss of work or a valued relationship may remove pleasure, achievement and social contact. Reduced activity can then further reduce opportunities for reward and help maintain low mood.

Avoidance may also be negatively reinforced. If withdrawing from a difficult conversation gives immediate relief from anxiety, withdrawal becomes more likely, even though it reduces longer-term support. Negative reinforcement means strengthening behaviour by removing something unpleasant; it is not punishment.

In an original example, Amir loses a community role that provided regular contact and a sense of achievement. He stops attending other activities, so positive experiences become rarer. Avoiding invitations briefly relieves his fear of rejection. The account explains a maintenance loop rather than proving that this sequence caused every symptom of his assessed depression.

Observable activity and consequences give testable targets and support behavioural interventions. However, concentrating only on reinforcement can overlook interpretations, biology and differences between people facing the same loss. Not everyone who loses a role develops depression, and learning may maintain a disorder without fully explaining its onset.

Cognitive schemas and the negative triad

Cognitive explanations ask how interpretations of events affect emotion and behaviour.

In Beck's model, negative schemas, or organised beliefs, bias how a person attends to and interprets experience. A stressful event can activate a vulnerable schema. Automatic thoughts may then feel immediately convincing, despite selective attention or overgeneralisation. Beck's depressive negative triad concerns the self, world and future: for example, “I am incapable”, “other people will reject me”, and “nothing will improve”. These are proposed processes, not a requirement that every person uses those exact sentences.

Amir receives no reply to one message. He interprets it as proof that nobody wants him around, rather than considering that the recipient is busy. Feeling hopeless, he avoids contact and gains less contrary evidence. His withdrawal and low mood can strengthen the original belief. The event, interpretation and consequence are connected; merely naming a “negative thought” does not explain the chain.

This account helps explain why the same event affects people differently and provides targets for CBT. Negative thoughts can be measured and followed over time. However, an association between thoughts and symptoms does not establish direction: low mood can also bias thinking. Real exclusion or hardship should not be dismissed as an imagined error. A cognitive account becomes reductionist if it treats every difficulty as only faulty thinking and ignores circumstances or biology.

Further accounts and their limits

The required further account can be humanistic, psychodynamic or cognitive neuroscience. Choose any one for the question on this part; the three accounts below remain available for comparison and wider understanding.

Humanistic incongruence and worth

Humanistic explanations emphasise lived experience, personal growth, meaning and the whole person.

In Rogers's account, conditions of worth arise when acceptance seems dependent on meeting others' expectations. A person may deny or distort experiences that conflict with an acceptable self-image. Incongruence is a mismatch between self-concept and lived experience; a large gap between how someone sees themselves and their ideal self can illustrate this tension. Anxiety and distress may follow when experience threatens the self-concept. Supportive relationships with empathy and acceptance can make experience easier to acknowledge.

Amir believes he deserves care only if he is always useful to others. Losing his role clashes with this self-image, and he cannot acknowledge needing support without feeling worthless. A humanistic interpretation considers this meaning and conditional self-worth, rather than reducing his low mood to the loss of a reward alone. It is an illustrative account of distress within his assessed disorder, not a diagnostic test.