Depression

Question 1

Understand What is meant by Normal Moods?

Answer 1

Normal moods are emotional states that everyone experiences as part of their daily lives. They are responses to events around us and are usually proportionate to those events. For example, feeling happy after receiving good news or feeling sad after a disappointment are considered normal mood responses.

Normal moods are transient, not excessively intense and do not typically interfere with a person’s ability to function

Normal moods are influenced by both external (e.g. weather, life events) and internal factors (e.g. hormones, physiology).

Question 1

Differentiate normal from abnormal moods

Answer 1

Abnormal moods differ from normal moods in duration, intensity and impact on daily functioning

Duration: These moods last significantly longer than would be expected given the situation

Intensity: The emotional response is disproportionate to the situation

Impact: They significantly impair the individual’s ability to function in daily life. Social and occupational.

Often seen in mood disorders such as depression, where the individual might feel persistently sad, empty or hopeless for most of the day, nearly every day

Might sometimes be considered normal, reflecting the complexity of mood disorders

Question 2

Understand the aetiology of moods and mood disorders

Answer 2

multifactorial, involving a combination of genetic, biological, environmental, and psychological factors:

Genetic Factors: Family studies have shown a genetic predisposition to mood disorders. “The genetics of mood disorders” (Lau and Eley, 2010)

Biological Factors: Neurotransmitter imbalances, hormonal changes, neurophysiological abnormalities (serotonin uptake receptors), physiology (vitamin deficiency or lack of sleep), diet can contribute to mood disorders. “Development and natural history of mood disorders” (Costello et al., 2002)

Environmental Factors: Stressful life events, trauma and chronic stress can trigger mood disorders. “Development and natural history of mood disorders” (Costello et al., 2002)

Psychological Factors: Personality traits (neuroticism and extraversion), coping mechanisms, and past psychological trauma are also important. “Adult mood disorders and childhood psychological trauma.” (Zavaschi et al., 2006)

Question 3

Know the main aspects of talking therapies and underlying ethos of CBT and Psychodynamic therapy

Answer 3

Talking therapies are based on the understanding that we can control our thoughts and behaviours to influence our moods.

CBT

Ethos: based on the idea that our thoughts, feelings and behaviour are interconnected, and that changing negative thought patterns can change feelings and behaviour

Approach: involves identifying and challenging cognitive distortions and developing more balanced and constructive ways to respond to stressors

Techniques: include cognitive restructuring, behavioural activation and mindfulness practices

“Cognitive behavioural therapy for mood disorders: efficacy, moderators and mediators” (Driessen and Hollon, 2010)

Psychodynamic Therapy

Ethos: Stems from psychoanalytic theories, primarily focusing on unconscious processes as they are manifested in a person’s present behaviour. Understanding of the influence of past on present behaviour

Approach: Explores unresolved issues and unconscious conflicts from the past that are affecting the individual’s current behaviour and emotions.

Techniques: Free association, exploration of transference and countertransference and interpretation.

“Comparison of clinical significance of cognitive-behavioral therapy and psychodynamic therapy for major depressive disorder: A randomized clinical trial.” (Soares et al., 2018)

Question 4

Pros and cons of CBT based approach to mood disorders

Answer 4

Introduction:

Cognitive Behavioural Therapy (CBT) is a psychotherapeutic treatment that has gained widespread acceptance and use for mood disorders such as depression and anxiety. Developed on the premise that maladaptive cognitive processes significantly influence emotional and behavioural responses, CBT aims to identify, challenge and modify detrimental thoughts and beliefs to alleviate psychological distress

Pros

1) Evidence-Based Effectiveness. CBT is one of the most studied forms of therapy and is considered highly effective for treating mood disorders. Research shows it to be particularly effective in managing symptoms of depression and anxiety, reducing the severity of symptoms and preventing relapse (Butler et al., 2006)

2) Structured and short-term. Unlike some psychotherapies, CBT is typically time-limited and structured. Patients often complete treatment in 12-20 sessions, making it a cost-effective method of treatment. This structure allows for measurable goals and outcomes, which can be motivating for patients (Soares et al., 2018)

3) Skills and Strategies. CBT equips individuals with practical and transferable skills, such as cognitive restructuring and stress reduction techniques, that patient can use beyond the therapy sessions to manage their conditions and prevent future episodes. (Driessen and Hollon, 2010)

4) Focus on the Present. CBT focuses on current thoughts and behaviour, this present-oriented approach helps patients modify their behaviour and thought patterns in ways that directly influence their current emotional state and functioning. (Soares et al., 2018)

5) Empowerment and Autonomy. By emphasising self-help and problem-solving skills, CBT fosters a sense of personal agency and control over one’s mood, which can be empowering for individuals suffering from mood disorders.

(Hofmann et al., 2012) - “The Efficacy of Cognitive Behavioural Therapy: A review of Meta-analyses”

• meta-analyses to affirm the effectiveness of CBT across different disorders, emphasizing its status as an evidence-based therapeutic approach

Tolin, 2010 - “Is cognitive-behavioural therapy more effective than other therapies? A meta-analytic review”

• Highlight its relative strengths and weaknesses

Cons

1) Reliance on Client Engagement. The effectiveness heavily relies on the patient’s active participation and commitment, including doing homework outside of sessions. For individuals struggling with severe mood disorders, this requirement can be challenging and potentially discouraging if they are not fully engaged or motivated

2) Cognitive Focus May Overshadow Emotional Depth. May not adequately address the emotional or historical underpinnings of a mood disorder. This can be a limitation for patients who need to explore deeper emotional roots of their mental health issues which could be better addressed by approaches like psychodynamic therapy (Soares et al., 2018)

3) Not Suitable for All Patients. Particularly those with complex co-morbidities or more severe psychiatric disorders such as bipolar disorder or schizophrenia

4) Overemphasis on Rationality. May invalidate patient’s feelings and lead to resistance against therapy as CBT’s focus on rational thinking and reframing of thoughts can sometimes lead to the minimisation of genuine emotional experiences. Minami and Wampold (2013)

5) Therapist Skill and Fidelity to the Model. Success depends on the therapist’s competence and their adherence to the CBT model. Poorly implemented CBT can result in reduced effectiveness and patient dissatisfaction.

Johnsen and Friborg (2015)

• Effectiveness of CBT decline over time particularly in treating depression

Conclusion

acknowledging the strong evidence supporting the effectiveness of CBT in treating mood disorders while also recognizing its limitations. Suggest that for some patients, a combination of CBT with other therapeutic approaches might be necessary to address all aspects of their mood disorder comprehensively.

Question 5

How might moods be influenced

Answer 5

Introduction:

Mood is an overarching psychological state which influence how individuals perceive and interact with the world. Unlike stable personality traits, moods are transient emotional states that can fluctuate dramatically based on a myriad of internal and external factors. From the biochemical processes without our brains to the social environments we navigate, numerous elements can sway our emotional equilibrium.

Biological/Physiological

1) Neurotransmitters.

• Serotonin is critically involved in preventing depression and regulating anxiety, happiness and mood. Low levels of serotonin are associated with depression, anxiety and other mood disorders (Young, 2007).
• Dopamine is linked to the brain’s reward system and is associated with feelings of pleasure and satisfaction. Dysregulation in dopamine levels is often found in individuals with depression and bipolar disorder, affecting their motivation and pleasure-seeking behaviours (Nestler & Carlezon 2006)
• Norepinephrine, affects how the brain responds to events, particularly how it handles stress. An imbalance in norepinephrine levels can lead to mood disorders, including depression and anxiety (Delgado & Moreno, 2000)

2) Hormonal Influences.

• Cortisol can affect all aspects of emotional regulation and mood. Chronic stress leading to elevated cortisol levels can result in prolonged bad mood, anxiety and depression (Herbert, 2013)
• Thyroid hormones are also vital in mood regulation. Both hyperthyroidism and hypothyroidism can lead to mood disturbances such as irritability, depression and anxiety (Bauer and Whybrow, 2021)
• Oestrogen and Testosterone fluctuations can result in mood swings, irritability and anxiety as seen during different phases of the menstrual cycle or in andropause in men (Fink et al., 1996)

3) Genetic Factors:

• Studies conducted by Caspi et al (2003) revealed that individuals with one or two copies of the short allele of the 5-HTTLPR polymorphism exhibited more depressive symptoms, diagnosable depression, and suicidality in response to stressful life events than individuals homozygous for the long allele

4) Environmental

• Seasonal Affective Disorder (SAD) is an example of how changes in light exposure and circadian rhythms can affect mood. Individuals with SAD experience mood deterioration during the shorter, darker days of winter, often improving naturally in the spring and summer when daylight increases (Rosenthal et al., 1984)
• Physical Activity: Improve mood and reduce symptoms of depression (Blumenthal et al., 2007)

Psychological

5) Cognitive Appraisals:

• Perception of Control: Positive mood when people perceive they have control over their environment and outcomes, the opposite can lead to feelings of helplessness and depression
• Optimism vs Pessimism: An optimistic outlook encourages a positive mood and resilience against stress, whereas a pessimistic outlook can predispose individuals to negative moods and depression (Seligman, 1991)

6) Emotional Regulation:

• Reappraisal Techniques: Individuals who employ adaptive emotional regulation strategies, such as cognitive reappraisal, tend to experience better mood stability. Reappraisal involves reinterpreting a situation to alter its emotional impact (Gross, 2002).
• Suppression and Avoidance: can lead to increased anxiety and depressive symptoms, negatively influencing mood (Gross & John, 2003)

7) Social Interactions:

• Hill et al. (2010) found that social activities and relationships can provide emotional support, enhance mood and mitigate the effects of stress.

8) Resilience: Associated with recovery from negative moods and is protective against the development of mood disorders following stressful life events (Bonanno, 2004)