depression Flashcards
depression
mood disorder characterised but feelings of despondency and hopelessness
- 2 types : unipolar and bipolar
- unipolar = consistent low mood
diagnosis of depression
at least 5 symptoms must be present EVERDAY for 2 weeks
- must include sadness or loss of interte and pleasure in normal activities
- not been caused by other events (eg death of loved one)
behavioural characteristics of depression (6)
SHIFT IN ENERGY LEVELS
SOCIAL IMPAIRMENT - reduced levels of social interactions, may distance themselves
WEIGHT CHANGES - significant inc. or dec., some ppl may eat a lot, some may have reduced appetite
POOR PERSONAL HYGIENE - reduced incidence of washing, wearing clean clothes etc
SLEEP PATTERN DISTURBANCE - constant insomnia, difficulty sleeping, or they may sleep a lot, oversleep (hypersomnia)
AGGRESSION AND SELF HARM - may be irritable, physically or verbally aggressive, may self harm, suicide
shift in energy levels - behavioural characteristic of depression
reduced amount of energy, fatigue, lethargy, high levels of inactivity
may withdraw from work, education and social life
may have high amounts of nervous energy - become agitated, restless
- PSYCHOMOTOR AGITATION - ma pace around, wring their hands, tear at their skin
emotional characteristics of depression (4)
LOSS OF ENTHUSIASM - lessened concern, lack of pleasure in daily activities, hobbies person used to enjoy
CONSTANT DEPRESSED MOOD - ever present, overwhelming feelings of sadness / hopelessness, feeling empty
WORTHLESSNESS - constant feelings of reduced worth, inappropriate guilt, may also have very low self esteem
ANGER - may feel anger towards others or themselves, self harm, depression may arise from feelings of being hurt and wishing to retaliate
cognitive characteristics of depression (6)
DELUSIONS - generally concerning guilt, punishment, personal inadequacy, disease, may have hallucinations
REDUCED CONCENTRATION - difficulty paying / maintaining attention, slower thought processes, difficulty making decisions
THOUGHTS OF DEATH - constant, death / suicide, may make plans to die, world is better off without them
POOR MEMORY - trouble retrieving memories
NEGATIVE THINKING
ABSOLUTIST THINKING - see things in black or white, eg ‘it was a complete disaster’, rather than ‘it was good but…’
negative thinking - cognitive characteristics of depression
negative view of the world, expect things to turn out badly
tend to have negative EXPECTATIONS about their lives, relationships, the world
- leads to SELF FULFILLING PROPHECY - if you expect -ve things to happen, then they probs will
positives in their life = ignored
cognitive bias
what does negative schema mean?
schema = how people think / cognitive framework
- so, negative thinking
what does Beck believe about depression?
ppl become depressed because they have a NEGATIVE OUTLOOK, develop negative schemas
- -ve schemas often develop in childhood, parents and adults have been overly critical towards them
- schemas continue into adulthood, causing depressive thoughts
2 examples of negative schemas
SELF BLAME - depressed ppl feel they are responsible for all misfortunes
INEPTNESS - depressed ppl expect themselves to fail at everything
cognitive triad
negative thoughts about self
negative thoughts about the world
negative thoughts about the future
cognitive triad - stage 1
NEGATIVE THOUGHTS ABOUT SELF
- person has -ve thoughts about themselves
- might feel worthless and helpless
- criticise themselves at every opportunity
- eg i’m useless and no good at maths’
cognitive triad - stage 2
NEGATIVE THOUGHTS ABOUT THE WORLD
- -ve thoughts extend to the wider world around them
- distorted and -ve thinking continues on a larger scale
- eg ‘i’m useless at everything i do’
— the statement becomes wider / more global and negative
cognitive triad - stage 3
NEGATIVE THOUGHTS ABOUT THE FUTURE
- begins to think negatively about their future
- seems bleak and negative
- can cause low self esteem
- thinks -ve and gets depressed about the future
- eg ‘i will always be useless at everything i do, and this will never improve’
— such negative thinking can lead to suicidal thoughts, initially caused by negative thinking
— according to Beck’s cognitive triad
strength of cognitive approach by Beck
it has become very INFLUENTIAL within psychology
- during the last 30 years
- especially as the theory has been based on sound experimental research
— objective, permits testing
- seems that distorted & neg. thoughts are common amongst depression patients
— these thoughts play a key role in the development of the illness
limitation of the cognitive approach by Beck
CAUSE AND EFFECT is NOT CLEAR
- can we say neg. & irrational thoughts cause depression OR, does depression develop first and cause the neg. thinking
- cause and effect needs to be investigated further
- so psychologists can be sure that neg. thinking causes depression
evaluation of cognitive approach for depression (linked to behavioural)
cognitive approach would CRITICISE the Behavioural approach
- BA would state depression is caused by LEARNING and the environment
- whereas cognitive approach would disagree and state neg. thinking causes depression
there have been attempts to COMBINE the cognitive and behavioural approaches
- to form the ‘cognitive and behavioural approach’
- the CB approach would aim to look at both the cog. and behavioural elements to look at causes of depression
strength of cognitive triad
great deal of SUPPORTING EVIDENCE
- to suggest that depression is caused by neg. & irrational thinking
- Terry (2000) assessed 65 pregnant women for cognitive vulnerability & depression before + after birth
— found that women who had high cog. vuln. (to think neg.) we’re more likely to suffer post natal depression
- SUPPORTS the cognitive approach
- (that neg. thinking can cause depression)
criticism of Beck’s theory
does not explain how some symptoms of depression might develop
- some depressed patients show symptoms of anger, hallucinations, bizarre beliefs
— eg Cotard syndrome : believes they’re a zombie
- Beck’s theory fails to account for how these symptoms occur
Ellis proposed that depression is caused by …
IRRATIONAL BELIEFS
- devised ABC model to explain how irrational & neg. beliefs are formed
Ellis’s ABC model
ACTIVATING EVENT
- patients record events leading to neg. thinking
- triggered by event in the environ.
- eg exam failure, or getting fired
- this has a neg. effect on their mood and outlook
BELIEFS
- patients record their thoughts associated w the event
- (rational or irrational)
- eg they think they’re useless and stupid for failing an exam
- might record thoughts in a diary or journal so they can keep track of thinking
CONSEQUENCES
- patients record emotional response to their beliefs
- irrational beliefs can lead to neg. emotions like feeling upset
- consequences could be debated w many diff. options
- eg ‘if i fail maths and feel like i’m not good at it, i could feel upset, useless and demotivated, and i might drop out of the course or school’
mustabatory thinking (Ellis)
this can cause irrational and neg. thinking that can be emotionally draining + lead to depression
- eg ‘i must be loved by everyone ‘ and ‘i must excel in all areas … otherwise i’m worthless’
- individual who holds these beliefs is bound to be disappointed or depressed
— these thoughts are too idealistic and expectations are too high
strength of Ellis’s ABC model (evidence)
RESEARCH to SUPPORT the model as a cause of depression
- Bates (1999) found that depressed ops who were given neg. thought statements became more and more depressed
— supporting view that neg. thinking helps cause depression
- if psychologists know what causes depression the this can help provide effective treatments for curing it
- (eg cognitive therapy via changing neg. thoughts into positive ones)
disadvantage of Ellis’s model➡️
CAUSE AND EFFECT
- not clear whether neg. thinking acc causes depression
- or if depression occurs first and this causes neg. and irrational thinking
- cause and effect needs to be established when looking at causes of depression
disadvantage of ABC model (ignores…)
it BLAMES the client when looking at depression causes
- gives client some power to change the situation and improve their symptoms
- however, it could mean that situational factors that may have helped to cause depression are overlooked
- instead, psychologist examines thoughts alone as a cause
criticism of the cognitive approach - ABC model
biological approach to understanding depression would criticise cog. approach
- bio approach suggests genes and neurotransmitters may cause depression
— low levels of serotonin
- Zhang (2005) found that there is a gene related to depression
— makes it 10x more likely for someone to develop illness
- bio approach would state that bio factors are more likely to cause depression than cog factors
strength of ABC model (based on …)
based on sound scientific evidence that permits objective testing
- allows improvement of the model
- and greater understanding for the causes of depression as a whole
strength of cognitive approach - ABC model 👩🍼
supporting evidence that ppl who develop depression in adulthood tended to experience INSECURE ATTACHMENTS in CHILDHOOD
- therefore seems to be a link between insecure childhood attachments contributing to neg. thinking, which can cause depression in adulthood
CBT by Beck
cognitive behavioural therapy
- central idea is to CHALLENGE and RESTRUCTURE negative ways of thinking
- so they become position and rational
- has a positive influence on patients’ behaviour
- Beck would use the cognitive triad as the basis for his CBT (neg. thoughts abt self, world, future would be addressed)
- focuses on present experiences
- therapist needs to be highly trained
CBT - patients
- can be used in individual patients & small groups
- allows patient to have some control over thinking
- encouraged to identify their neg. thoughts
— THOUGHT CATCHING - challenge their neg. thoughts and test them out
— ‘is this really true? it can’t be because …’ - patient must test out their neg. thinking / hypothesis and act as a scientist
- encouraged to keep a record of events eg diary entries
- reinforcement of positive thoughts is encouraged
- weekly sessions
strength of CBT (effective when …)
EFFECTIVE when a client has MILD depression
- CBT stops it from getting worse
- so it’s more applicable to clients who have mild symptoms rather than severe symptoms
- if symptoms are very severe, then drugs might be more appropriate than CBT
weakness of CBT
most popular treatment for depression is anti depressant DRUGS
- require less effort than CBT
- Cujipers (2013) found that CBT can be very effective if it’s combined w drug therapy
- therefore, CBT by itself is not a very effective treatment, and drugs should be used alongside it
advantage of CBT (widely respected and …)
WIDELY RESPECTED and SUPPORTED by vast amounts of RESEARCH as a therapy
- offered as a cost effective treatment for many disorders by the NHS
- (especially depression)
- quite economical treatment compared to other treatments such as the psychodynamic approach
strength of CBT (tends to …)
tends to get to the ROOT CAUSE of the depressive problem
- usually cbt can uncover than real underlying issues that caused depression
- good bcs other treatments, like medication, tend NOT to get to root cause
— merely act as a ‘plaster’ that cover up and mask the symptoms
- therefore, CBT actually works as a cure for depression
strength of CBT (tends to …)
tends to get to the ROOT CAUSE of the depressive problem
- usually cbt can uncover than real underlying issues that caused depression
- good bcs other treatments, like medication, tend NOT to get to root cause
— merely act as a ‘plaster’ that cover up and mask the symptoms
- therefore, CBT actually works as a cure for depression
advantage of CBT (less likely to…)
can be used as a LONG TERM CURE
- once patient has undergone CBT, it has lasting positive outcomes
- high chance that they’ve acc been cured
- less likely to RELAPSE (compared to other treatments like medication)
- so, cost effective for the NHS
- patient is unlikely to return to hospital needed further treatment in the future
- (relapse rates are low)
REBT by Ellis (1975)
- rational emotive behavioural therapy
- involves making clients think in a more rational ans positive way
- challenge their thinking and show them how irrational their thoughts are
- patients told to practise +ve & optimistic thinking, which can have a +ve impact on behaviour
REBT: main differences to CBT by Beck
- involves reinterpreting the ABC model to challenge -ve thoughts
— eg the exam was hard, or not enough revision, instead of patient thinking they are useless and stupid - HOMEWORK - patients complete hw between sessions = vital for testing irrational beliefs in the real world and replacing them w more rational ones
- BEHAVIOURAL ACTIVATION - encourages patients to become more active and engage in pleasurable activites
REBT: DEF model
DISPUTING irrational thoughts & behaviour
- logical disputing occurs when self defeating beliefs don’t follow logically from the info
- eg ‘does thinking in this way make sense?’
- empirical disputing = when beliefs may not be consistent w reality
EFFECTS of disputing & effective attitude to life
- can change self defeating beliefs into more rational ones
- patient moves away from -ve & irrational thinking
- eg ‘she hasn’t replied bcs she’s busy not bcs she hates me’
FEELINGS / emotions
- patient begins to think in a more positive and rational way
- begin to feel better
- +ve impact on behaviour
strength of REBT
Flannaghan et al (1997) supports it
- effective way to treat depressive stroke victims
- suggests that it’s a suitable treatment for specific groups of ppl w depression
- help them become more positive over time (thoughts and behaviour)
strength of REBT
research support
- David (2008) compared 170 depressive patients who had 14 weeks of REBT w patients who were treated w medication (fluoxetine)
- outcomes were compared 6 months after treatment
- found that REBT was a better LONG TERM treatment compared to drug therapy
disadvantage of REBT
unclear if the distorted thinking is the CAUSE of depression or only a symptom
- if symptoms, then REBT is not tackling the root cause of the depression
- might return in the future
- means that it hasn’t been cured properly
disadvantage of REBT
it’s dependant on the patient being articulate and able to talk about their thought processes coherently
- wouldn’t work for ppl w severe depression if they were unable to talk or communicate properly
- or those uncomfortable talking abt their feelings
- other treatments would have to be considered (eg medication)
disadvantage of REBT
success of treatment depends upon the SKILL & expertise of the THERAPIST
- the more skilled, the better the therapeutic outcomes will be
- essential for treatment’s effectiveness
- so, psychologists need to be highly skilled
— + develop a good rapport w client for it to be successful
