Depression Flashcards
The diagnosis of depression:
• At least 5 symptoms must be present every day for two weeks.
• The five symptoms must include sadness or loss of interest and pleasure in normal activities
• The person will show impairment in general functioning that has not been caused by other events (death of loved one).
What are the behavioural characteristics of depression (action)
1) Shift in energy levels:
Depressed people might have reduced amounts of energy resulting in fatigue, lethargy and high levels of inactivity. This might lead them to withdraw from work, education and their social life. Some depressed people might have high amounts of nervous energy whereby they become agitated and restless, this is called psychomotor agitation. They may pace around, wring their hands and tear at their skin.
2) Social impairment:
There are reduced levels of social interactions with friends and relations. The person may distance themselves from friends and family.
3) Weight changes:
Significant increase or decrease in weight is associated with depression. Some people might eat a great deal when they are depressed and therefore put on a great deal of weight. Other people have a reduced appetite and eat very little, and therefore lose a great deal of weight
4) Poor personal hygiene:
Depressed people often have reduced incidence of washing and wearing clean clothes etc.
5) Sleep pattern disturbance:
Depression is often characterised by constant insomnia whereby they have difficulty falling asleep, staying asleep and they might wake up very early. Alternatively they might require large amounts of sleep and they might oversleep (hypersomnia)
6) Aggression and self harm:
Sufferers of depression are often irritable and they can become physically or verbally aggressive, for instance quitting their job impulsively. They might also be physically aggressive in the form of self harming.
What are the emotional characteristics of depression?
1) Loss of enthusiasm:
Depression is often characterised by a lessened concern with and/or lack of pleasure in daily activities such as hobbies or things that the person used to enjoy.
2) Constant depressed mood:
A key characteristic is the ever present and overwhelming feelings of sadness/hopelessness and feeling empty.
3) Worthlessness:
Sufferers of depression often have constant feelings of reduced worth and/or inappropriate feelings of guilt. They might also experience very low levels of self esteem.
4) Anger:
The person might feel anger which might be directed towards others or turned inwards towards the self, which could result in self harm. Depression may arise from feelings of being hurt and wishing to retaliate
What are the cognitive characteristics of depression (thinking)
1) Delusions:
Some depressive patients will experience delusions, generally concerning guilt, punishment, personal inadequacy or disease. Some will also experience hallucinations, which can be auditory, visual, olfactory (smell), and haptic (touch)
2) Reduced concentration:
There can be difficulty in paying/maintaining attention, and the person might feel that they cannot stay on task for long periods of time. They might have slower thought processes than normal and difficulty making decisions (even if the decision seems very simple). This can interfere with the person’s ability to do their job.
3) Thoughts of death:
Depressed people will have constant thoughts of death. They might believe that the world would be a better place without them.
4) Poor memory:
Depressed people will have trouble retrieving memories and their memory might be very poor in general.
5) Negative thinking:
Depressed people often have a negative view of the world and they expect things to turn out badly rather than well. They tend to have negative expectations about their lives and relationships, and the world in general. This leads to the self fulfilling prophecy whereby if you expect negative things to happen, then they probably will. Positive factors in their life will be ignored and they have a cognitive bias.
6) Absolutist thinking:
Most situations are not all bad or all good. Sufferers of depression tend to think in this format, and they usually think about events in absolutist terms, “it was a complete disaster” rather than, “that was good, but there are a few things that could have been better.”
What is the cognitive approach to explaining depression
The cognitive model proposes that individuals who are suffering from depression often have distorted and negative thinking.
People who think in a very negative or irrational way might be more prone to developing depression.
The Cognitive Triad by Beck - Introduction (1960)
The Cognitive Triad explains the thought processes that a depressed person might develop.
Beck believes that people become depressed because they have a negative outlook and develop negative schemas which dominate their thinking.
These negative schemas often develop in childhood whereby parents or adults have been overly critical towards them. The negative schemas continue into adulthood and provide a negative framework, whereby life is viewed in a negative way, which could cause depressive thoughts.
Examples of negative schemas:
• Self blame – depressed people feel that they are responsible for all misfortunes
• Ineptness – depressed people expect themselves to fail at everything
What are the stages of the cognitive triad
Stage one - Negative thoughts about self:
- The person has negative thoughts about themselves and might feel worthless and helpless.
- They criticise themselves at every opportunity, e.g. “I am useless and I am no good at Mathematics”
Stage two - Negative thoughts about the world:
- The negative and distorted thinking continues on a larger scale, “I am useless at everything I do.” The statement becomes more global and negative.
Stage three - Negative thoughts about the future:
- The person begins to think negatively about their future which might seem bleak and negative; this can cause low self esteem. e.g. “I will always be useless at everything I do, and this will never improve.”
Such negative thinking according to Beck’s cognitive triad can lead to suicidal thoughts that have initially been caused by negative thinking.
Evaluation of the Cognitive approach by Beck: AO3
Advantages
1) A strength of the cognitive approach is that it has become very influential during the last 30 years, especially as the theory has been based on sound experimental research that is objective and permits testing. Distorted and negative thoughts are very common amongst patients who have depression, and these negative thoughts play a key role in the development of the illness.
2) There have been attempts to combine the cognitive and behavioural approaches together to form the “Cognitive Behavioural approach.” The CB approach would aim to look at both the cognitive (negative and irrational thinking) and behavioural (classical and operant conditioning and social learning) elements in order to look at causes of depression. (+)
3) There is a great deal of supporting evidence to suggest that depression is caused by negative and irrational thinking, as well as the cognitive triad. Terry assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. It was found that women who had a high cognitive vulnerability (to think negatively) were more likely to suffer post natal depression. This supports the cognitive approach that negative thinking can cause depression
Disadvantages:
1) A limitation of the cognitive approach is that cause and effect is not clear. Cause and effect needs to be investigated further so that psychologists can be sure that negative thinking causes depression to occur
2) The cognitive approach would criticise the Behavioural approach when examining causes of depression. The behavioural approach would state that depression is caused by learning and the environment, whereas the cognitive approach would disagree and state that negative thinking causes depression to occur
3) Beck’s theory can be criticised, because it does not explain how some symptoms of depression might develop. Some depressed patients show symptoms of anger, hallucinations and bizarre beliefs. Beck’s theory fails to account for how these symptoms of depression occur.
Ellis’s ABC Model (AO1)
Ellis proposed that depression is caused by irrational beliefs. He devised the ABC model to explain how irrational and negative beliefs are formed:
A = Activating Event:
Patients record events leading to negative thinking and this is triggered by an event in the environment around them. This activating event has a negative effect on their mood and outlook
B = Beliefs:
Patients record their thoughts associated with the event (rational or irrational). E.g recording thoughts in a diary or journal so they can keep track of their thinking
C = Consequences:
Patients record the emotional response to their beliefs. Irrational beliefs can lead to negative emotions such as feeling upset. The consequences could be debated with many different options
What is Mustabatory thinking (Ellis)
mustabatory thinking can cause irrational and negative thinking that can be emotionally damaging and can lead to depression.
E.g ‘I must be loved by everyone’ and ‘I must excel in all areas….otherwise I am worthless’. An individual who holds these beliefs is bound to be disappointed or depressed, because these thoughts are too idealistic and the expectations are too high
Evaluation of Ellis’s ABC Model
Advantages
1) There is research to support the idea of Ellis’s ABC model as a cause of depression. Bates found that depressed participants who were given negative thought statements became more and more depressed supporting the view that negative thinking helps to cause depression. If psychologists know what causes depression (negative thinking), then this can help provide effective treatments for curing depression (cognitive therapy via changing negative thoughts into positive ones).
2) The ABC model of depression is based on sound scientific evidence that permits objective testing. This allows improvement of the model and a greater understanding for the causes of depression as a whole.
3) There is supporting evidence that people who develop depression in adulthood, tended to experience insecure attachments in childhood. Therefore there seems to be a link with insecure childhood attachments contributing to negative thinking which can cause depression in adulthood
Disadvantages:
2) A disadvantage of Ellis’s model is that it is not clear whether negative thinking actually causes depression. It could be that depression occurs first (maybe through biology or genetics) and then this causes the person to think in a negative and irrational way. Cause and effect needs to be established when looking at causes of depression
3) A disadvantage of the ABC model is that it blames the client when looking at the causes of depression. It gives the client some power to change the situation and improve their symptoms of depression, however it could mean that situational factors that have helped to cause the depression are overlooked e.Instead the psychologist would examine negative and irrational thoughts alone as a cause for depression
3) The biological approach to understanding depression would criticise the cognitive approach. The biological approach suggests that genes and neurotransmitters may cause depression. Zhang found that there is a gene related to depression that makes it ten times more likely for someone to develop the illness. The biological approach would state that biological factors are more likely to cause depression than cognitive factors.
Cognitive Behavioural Therapy by Beck: AO1:
The central idea of Beck’s is to challenge and restructure negative ways of thinking so that they become more positive and rational.
It allows the patient to have some control over their thinking
It focuses on present experiences
The therapist needs to be highly trained
This can help the depressed patient to think in a more positive way, which can positively influence their behaviour.
The negative thoughts associated with the depression are challenged.
Beck would use the cognitive triad as the basis for his cognitive behavioural therapy (negative thoughts about self, world and future would be addressed).
Patients are encouraged to identify their negative thoughts “thought catching”. The patient would be encouraged to challenge their negative thoughts and test them out.. The patient must test out their negative thinking/hypotheses and act as a scientist
Patients would be encouraged to keep a record of events in their life that can be used to help challenge their negative thinking to try to prove the existence of positive events. Reinforcement of positive thoughts is encouraged
Patients would attend weekly sessions either independently on their own or with a group (known as group therapy) in order to overcome their negative thinking
Evaluation of Cognitive Behavioural therapy by Beck (AO3):
Advantages:
1) An advantage of CBT is that it is widely respected and supported by vast amounts of research as a therapy for depression. It is offered as a cost effective treatment for many disorders by the NHS in Britain, especially for depression. The treatment is quite economical compared to other treatments such as the psychodynamic approach
2) CBT has been praised because it tends to get to the root cause of the depressive problem. This is a very good point because other treatments for depression such as medication and drugs tend not to get to the root cause of the problem of depression, but merely act as a, “plaster” that cover up and mask the symptoms of depression. Therefore CBT actually works as a cure for depression.
3) An advantage of CBT is that it can be used as a long term cure for depression. Once a patient has undergone CBT, it has lasting positive outcomes and there is a high chance that the patient has actually been cured and they are less likely to suffer a relapse compared to other treatments (such as medication or placebos). Therefore CBT might be cost effective for the NHS. When a depressed patient has successfully completed CBT treatment they are very unlikely to return to hospital needing further treatment in the future (relapse rates are low)
Disadvantages:
1) The most popular treatment for depression is anti-depressant drugs. Drugs require less effort than CBT in general. However, Cujipers (2013) found that CBT can be very effective if is combined with drug therapy. Therefore maybe CBT used on its own to treat depression is not very effective, and drugs should be used alongside it. (-)
Both:
1) A strength of CBT is that it is very effective to use when a client has mild depression, as CBT stops the mild depression from getting much worse. Therefore CBT is more applicable to clients who had mild depressive symptoms rather than severe symptoms. If the depression is very severe then drugs/medication might be more appropriate than CBT (+) (-)
Rational Emotive Behavioural Therapy by Ellis: (AO1)
Irrational thoughts cause negative self-statements and so the therapy involves making depressed clients think in a more rational and positive manner.
The therapist aims to challenge depressed patients’ thinking and show them how irrational their thoughts are.
Depressed patients are told to practise positive and optimistic thinking, which can then have a positive impact on their behaviour.
REBT involves challenging negative thoughts by reinterpreting the ABC model in a more positive and logical way. For
Homework
- Depressed clients are asked to complete homework assignments between therapy sessions which is vital for testing irrational beliefs out in the real world, and replacing them with more rational and positive beliefs.
Behavioural Activation
- CBT encourages depressed clients to become more active and engage in pleasurable activities. Many depressed clients often do not engage in activities that they used to enjoy, so the therapist would encourage active participation.
Outline the (DEF) model by Ellis
1) Disputing irrational thoughts and behaviour:
- Logical disputing occurs when self defeating beliefs do not follow logically from the information available, the therapist can ask the depressed client, “Does thinking in this way make sense?”
Thoughts can also be disputed by empirical disputing, whereby self defeating beliefs may not be consistent with reality e.g. “You believe that everyone hates you, but there is little proof of this.”
2) Effects of disputing and effective attitude to life:
Effective disputing can change self defeating beliefs into more rational beliefs. The depressed client can move away from negative and irrational thinking, e.g. “No one likes me” to more rational interpretations of events, e.g. “My friend has not replied to my text message because she is busy, not because she hates me.”
3) Feelings/emotions:
The depressed patient will begin to think in a more positive and rational way and they will begin to feel better. This can have a positive impact on their behaviour.
