Depression

Question 1

What is depression?

Answer 1

Depression is a type of mood disorder

Depression can occur in cycles, with an episode of depression generally lasting 2-6 months.

Depression is divisible into two main types:
unipolar depression
bipolar depression

Question 2

What is unipolar depression (major depression)?

Answer 2

• Occurs without mania - sufferers only experience depression
  -Diagnosis of unipolar depression: at least 5 symptoms must occur every day for 2 weeks, with an impairment in general functioning, not accountable for by other medical conditions/events i.e. mourning a loved one.
• 1 of the 5 symptoms must be a constant depressed mood or lessened interest and pleasure in daily activities.

Question 3

Emotional Characteristics of depression:

Answer 3

Constant Lowered (depressed) Mood:
- Overwhelming feelings of sadness/hopelessness.
- Individuals may also feel worthless, ‘empty’ and have reduced self-esteem, with some experiencing feelings of self-loathing.

Anger:
- (Extreme) anger directed at the self or others.
- On occasion such emotions lead to aggressive or self-harming behaviour.

Question 4

Behavioural Characteristics of Depression:

Answer 4

Change in activity levels:
Increased lethargy (lack of energy)/withdrawal from activities that were once enjoyed (anhedonia);
Neglecting personal hygiene – reduced incidence of washing, wearing clean clothes, etc.

Disruption to sleep:
Sleep may reduce (insomnia) or increase (hypersomnia).

Disruption to eating behaviour:
Increased or decreased eating;
Weight gain or loss.
Aggressive acts:
Towards others or oneself (e.g. self-harm

Question 5

Cognitive Characteristics of Depression:

Answer 5

Focusing on the negative aspects of a situation:
Paying more attention to negative aspects of a situation and ignoring the positives;
Negative self concept (negative self-beliefs);
A negative view of the world;
Negative expectations i.e. expecting things to turn out badly.

Reduced concentration:
- Difficulty in paying/maintaining attention &/or slowed down thinking & indecisiveness.

Recurrent thoughts of self-harm, death or suicide.

Question 6

Unipolar Depression: Prevalence:

Answer 6

About 20% of people will experience some form of depression.
The average age of onset is the late twenties, but it can begin any time from adolescence onwards.

Women are twice as vulnerable as men:
Up to 25% of women will suffer from unipolar depression
Up to 12% of men will suffer from unipolar depression

Question 7

What did Beck (1987) discover?

Answer 7

People become depressed because the world is seen negatively through negative schemas

Negative schemas are acquired during childhood, when authority figures place unreal demands on individuals and are highly critical of them.

They are activated when a person encounters a new situation that resembles the original conditions in which these schemas were learned.

Negative schemas lead to cognitive biases, which results in distorted/faulty thought patterns.

Question 8

What are examples of cognitive biases?

Answer 8

Selective abstraction - conclusions drawn from an isolated detail of an event, without considering the larger context.

Overgeneralisation - sweeping conclusions drawn on the basis of a single event.

Question 9

What is Beck’s negative triad?

Answer 9

1. The Self - where individuals see themselves as being helpless, worthless and inadequate.
2. The World - where obstacles are perceived within one’s environment that cannot be dealt with.
3. The Future - where personal worthlessness is seen as blocking any improvements.

Question 10

What maintains the negative triad?

Answer 10

Negative schemas, together with cognitive biases/distortions, maintain the negative triad:

Question 11

What is Ellis’ ABC model?

Answer 11

Ellis believed that it is our irrational thoughts and interpretations of events that cause depression

Activating event: Something happens in the environment around you

Beliefs: You hold a belief about the event or situation
consequence: you have an emotional response to your belief

Question 12

What is Mustabatory thinking?

Answer 12

Thinking that certain ideas/assumptions must be true in order for an individual to be happy
An individual who holds such assumptions is bound to be, at the very least, disappointed; at worst, depressed

Question 13

Strengths of the cognitive approach to depression. P: Therapeutic success supports the cognitive approach to explaining depression.

Answer 13

E: Cognitive Behavioural Therapy (CBT) is found to be the most effective treatment for depression, especially when combined with drug treatments (Cuijpers et al., 2013).
(CBT identifies irrational and maladaptive thoughts/beliefs and restructures them into more adaptive and rational ones)
C: This suggests that irrational/negative thoughts have a role in causing the depression in the first place.

Question 14

strength of the cognitive approach to depression. P: There is research support for the role of irrational thinking in depression.

Answer 14

E: Hammen & Krantz (1976) found that depressed participants made more errors in logic when asked to interpret written material than non-depressed participants.
C: This suggests that …

Question 15

Limitations of the cognitive approach to depression. P: However, there is a cause-effect issue

Answer 15

E: The fact that there is a link between negative thoughts and depression does not mean that negative thoughts cause depression.
It may be that a depressed individual develops a negative way of thinking as a consequence of their depression i.e. the negative thoughts are a symptom of the depression.
C: This therefore undermines the validity of both Ellis and Beck’s cognitive explanations and suggests that there may be other causes. For example, the negative thoughts might have a biological cause e.g. low levels of serotonin.

Question 16

Limitation of the cognitive approach to depression. p:negative thoughts might be realistic.

Answer 16

E: Alloy & Abrahmson (1979): Depressive realists tend to see things for what they are
(with normal people tending to view the world through ‘rose-coloured spectacles’).
They found that depressed people gave more accurate estimates of the likelihood of a disaster than ‘normal’ controls – the ‘sadder, but wiser’ effect
C: This therefore implies that not all beliefs are ‘irrational’, although they may simply seem irrational.

Question 17

What is cognitive behavioural therapy?

Answer 17

Thoughts are perceived as affecting emotions and behaviour

CBT assists patients to identify irrational/maladaptive thoughts and alter them.

As behaviour is seen as being generated by thinking, the most logical and effective way of changing maladaptive behaviour is to change the maladaptive thinking underlying it.

Question 18

What is the cognitive element of CBT?

Answer 18

The therapist encourages the client to become aware of faulty beliefs that contribute to their depression. This can involve direct questioning e.g. ‘Tell me what you think about…’

Question 19

What is the behavioural element in CBT?

Answer 19

The therapist and client decide how the client’s beliefs can be reality tested through experimentation e.g. role play, homework assignments, encouraging the client to recognise the consequences of their faulty cognitions on their behaviour.

Question 20

What is homework in CBT?

Answer 20

Clients are asked to complete assignments between therapy sessions e.g. asking a person out on a date when they had been afraid to do so for fear of rejection – encouraging clients to make positive changes to their behaviour.
Homework is vital in testing irrational beliefs against reality and putting new rational beliefs into practice.

Question 21

What is Rational emotional behaviour therapy?

Answer 21

Due to irrational thinking, individuals develop self-defeating habits because of faulty beliefs about themselves and the world around them.

The aim of therapy is reframing these irrational and negative thoughts into rational and positive ones

Question 22

How did Ellis extend his ABC model in REBT?

Answer 22

He extended it to ABCDEF:
- Disputing irrational thoughts and beliefs
- Effects of disputing
- Feelings (new emotions) that are produced

Question 23

What does REBT involve?

Answer 23

-Logical disputing
-Empirical disputing
-Pragmatic disputing

Question 24

What is research support for CBT?

Answer 24

Embling (2002)

Question 25

What was Emblings aim of the study?

Answer 25

Aim: To assess which types of patients benefit least and most from CBT.

Question 26

What was Embling (2002) procedure?

Answer 26

Procedure:
An opportunity sample of 38 patients (19-65 years) diagnosed with depression.
Two groups were compared:
Control group: 19 patients receiving antidepressant medication (they were seen once a week for 10-20 minutes by a clinician who reviewed symptoms, side effects and provided advice).
Treatment group: 19 patients who received antidepressant medication in addition to 12 sessions of CBT over an 8 week period.
Patients completed dysfunctional thought records (DTRs) to monitor and record mood changes.
The Beck Depression Inventory (BDI) was used to assess the level of depression in all patients, both before and at one-week intervals throughout the study.

Question 27

What was Embling (2002) findings?

Answer 27

The treatment group’s mean BDI scores decreased over the course of the treatment, suggesting an improvement in symptoms, whereas the control group’s mean scores remained the same.
The treatment group expressed more negative emotions at the end of the study than the beginning , which is part of CBT’s success. Expressing negative emotions is necessary for recovery to occur.
Those who did not improve with CBT had high levels of sociotropy and perfectionism, low levels of autonomy and a high external locus of control.

Question 28

What was Embling (2002) conclusions?

Answer 28

CBT combined with drug therapy is more effective than drug therapy alone.
Personality characteristics affect CBT outcomes. People with high levels of autonomy, an internal locus of control and low levels of sociotropy benefit most from CBT.

Question 29

Strength of CBT: P:Research has shown the long-term benefits of REBT.

Answer 29

David et al. (2008) 170 patients suffering from major depressive disorder were randomly assigned to one of the following: 14 weeks of REBT, 14 weeks of CT (Cognitive Therapy), or 14 weeks of pharmacotherapy (fluoxetine).
It was found that patients treated with 14 weeks of REBT had better treatment outcomes than those treated with the drug fluoxetine six months after treatment.

This suggests that REBT is a better long-term treatment than drug therapy.

Question 30

What is a limitation of CBT: P:CBT is not an effective treatment for everyone.

Answer 30

CBT appears to be less suitable for:
People who lack the commitment and motivation to engage fully with the therapy.
People who have high levels of irrational beliefs that are both rigid and resistant to change.
Realistic stressors (i.e. irrational environments) in the person’s life that therapy cannot resolve.
People who have difficulty concentrating.
People who have difficulties talking about their inner feelings, or who don’t have the verbal skills to do so.

There are individual differences in the receptivity towards CBT.

Question 31

Strength of CBT: CBT is considered to be cost-effective

Answer 31

CBT empowers patients, providing them with self-sufficient and life-long coping strategies that they can continue to use long after the completing a course of CBT.
This is more cost-effective than drug treatment, where medication must continue even after improvements in mood have been achieved otherwise relapse may occur.

Question 32

Limtation of cognitive behavioural therapy: The effectiveness of CBT also very much depends on the therapist

Answer 32

For example:
The better trained the therapist, the better the therapeutic outcomes.
However, CBT can be too therapist centred, in that therapists may abuse their power of control over patients, forcing them into certain ways of thinking and patients can become too dependent on therapists.

Therefore, the success of CBT isn’t just dependent on the commitment and motivation of the client.