Depression

Question 1

Examples of Behavioural Characteristics of Depression

Answer 1

• Low levels of activity- lethargic: tend to withdraw from work, education, and social life (Avolition).
• Change in sleep patterns (particularly premature waking, insomnia, hypersomnia).
• Change in appetite leading to weight gain or loss.
• Aggression to others, self-harm, suicide attempts.

Question 2

Examples of Cognitive Characteristics of Depression

Answer 2

• Negative thinking.
• More black-and-white absolutist thinking- narrow perspectives
• Poor concentration- hard to make decisions and stick to a task, may affect individuals work.
• Bias towards recalling unhappy events than happy ones. Focus on the negatives.

Question 3

Examples of Emotional Characterstics of Depression

Answer 3

• Lowered mood- feeling a daily kind of sad and lethargic (‘empty’, ‘worthless’)
• Not getting enjoyment from activities you usually do.
• Anger- what can lead to aggression or self-harm
• Lowered self-esteem- reduced self-esteem and sometimes feeling of self-loathing.

Question 4

What are the three main aspects of Beck’s (1967) cognitive explanation for depression?

Answer 4

• Negative self-schemas
• The Negative Triad
• Faulty Information Processing

Question 5

What are negative self-schemas?

Answer 5

A self-schema is the package of knowledge we have about ourselves.

Negative self-schemas are negative mental framework from our interpretation of all information about ourselves as negative.

This leads to cognitive biases in thinking. Individuals over-generalise, drawing sweeping negative conclusion regarding self-worth on the basis of a small piece of negative feedback

Question 6

What is The Negative Triad?

Answer 6

Negative schemas and cognitive biases maintain a negative triad.

This is a pessimistic and irrational view of three main elements in a person’s belief system:
•About self ‘(No one likes me’).
•The world (‘everything is beyond my control’).
•The future (personal worthlessness blocks any improvements; ‘I will always be useless’).

Question 7

What is Faulty Information Processing?

Answer 7

Faulty Information Processing is when the negative aspects of situations are focused on and the positives are ignored.

As a result, small problems tend to be blown out of proportion and there may be a tendency towards black-and-white thinking.

Question 8

What does ABC from Ellis’ ABC Model stand for?

Answer 8

A- Activating event - something occurs in your environment.

B- Beliefs - a belief is held about the situation/event.

C- Consequences - an emotional responses occurs that led to characteristics of depression.

Question 9

What does Ellis’ ABC Model believe about depression?

Answer 9

Ellis believed that depressive mistakenly blames external events when its the interpretation of the events that causes the distress.

The activating event triggers an emotion that triggers depression because there is a negative view about themselves and a lack of confidence in their ability.

People without depression may interpret a situation differently and get a different conclusion from the event.

Question 10

Advantages of cognitive explanations of depression

Answer 10

• Practical applications- These theories have been applied to create treatments for depression. For example, Cognitive Behavioral Therapy, which is a successful therapy for many.
• All cognitive aspects of depression can be identified and challenged in CBT. This translates more into successful therapies.

Question 11

What are the two cognitive explanations for depression?

Answer 11

• Beck’s (1967) cognitive explanation
• Ellis’ ABC Model

Question 12

Disadvantages for the cognitive explanations of depression

Answer 12

• Only provides a partial explanation for the disorder, e.g. does not consider biological factors.
•They don’t account for symptoms such as hallucination and delusions.
• The concept of depression developing after an activating event is true for reactive depression but many cases for depression do not appear to be caused by an activating event.

Question 13

Outline Beck’s cognitive behavioural therapy (CBT) for treating depression

Answer 13

• Automatic thoughts from the negative triad (self, world and future) are identified.
• The central aspect is that these thoughts are challenged directly in order to refram them into more postive ones.
• The reality of the negative perceptions are tested.
• They may be asked to keep a record of the postive aspects of their days as they go, which can be used as evidence for disproving negative beliefs.
• Sometimes referred to ‘patients as scientists’ investigate the reality of their negative beliefs.

Question 14

Outline Ellis’ rational emotive behaviour therapy (REBT)

Answer 14

Extends the ABC model to ABCDE model. D stands for dispute and E for effect:
* The central technique of REBT is to identify and dispute (challenge) irrational thoughts.
* Challenging irrational beliefs in REBT usually involves conflict :
Empirical argument- disputing whether there is evidence to support the rational belief.
Logical argument- disputing whether the negative thought actually follows from the facts.

The goal of CBT is behavioral activation- gradually decreasing avoidance and isolation of the client to increase their engagement in activities that have been shown to improve mood.

Question 15

Strengths of the cognitive treatments for depression

Answer 15

• It is effective- there is a large body of evidence to support the effectiveness of CBT for depression.
• A study by March (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents with a main diagnosis of depression. After 36 weeks 81% of the CBT group, 81% of the
  drug group and 86% of the combination group were significantly improved- CBT emerged as just as effective as drugs and useful to use alongside drugs.
• This suggests that there is a good case for making CBT the first choice of treatment on the NHS.

Question 16

Weaknesses of the cognitive treatments for depression

Answer 16

• Individual differences- CBT appears to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change (Elkin 1985).
• Individual differences- CBT also appears to be less suitable in situations where high stress in the individual reflect realistic stressors in the person’s life that therapy cannot resolve (Simons 1995).
• Ellis also explained a possible lack of success in terms of suitability- some people simply do not want the direct sort of advice that CBT practitioners tend to dispense. They tend to prefer to share their worries with a therapist without getting
  involved in the cognitive effort that is associated with recovery.- However medication can be helpful in these situations because it can give them the motivation to participant in the therapy or leave stressful situations.
• CBT may not work for the most severe cases- in some cases depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive
  work of CBT. They may not even be able to concentrate in a session. Where this is the case it is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated. This still means CBT cannot be used as the sole treatment for all cases of depression.
• This would suggest that early intervention for depression would be effective for many people. If those with mild to medium symptoms of depression can access CBT, then they will have the opportunity to develop copying stratergy to prevent the depression from getting worse and reaching a point where they motivation is so low that they cannot get out of bed. This would be useful as it would ensure that many people with depression can continue to function adequately. E.g. go to college and work, thus improving quality of life.
• Some patients really want to explore their past- one of the basic principles of CBT is that the focus in therapy is on the present and the future, not the patients past.
  This is in contrast to some other forms of psychological therapy. Some patients are aware of the link between their childhood experiences and current depression and want to talk about their experiences.They can find this ‘present-focus’ very frustrating.