Depression Flashcards
What is depression? Theories of depression. Interventions and real-world examples.
What is depression?
-Depressive disorder, or depression, is a common mental health condition that can happen to anyone.
-It is characterised by a low mood or loss of pleasure or interest in activities for long periods of time.
-It is Different from regular mood changes and feelings about everyday life.
-Depressive episodes last most of the day, nearly every day, for at least two weeks.
What are the two symptoms of depression that at least one has to be present for a diagnosis to be made?
Depression must include at least one of either dysophia (depressed mood) or anhedonia (deminished interest).
What things (not including symptoms) must ALL be apparent for a diagnosis of depression to be made?
-symptoms persist for at least 2 weeks.
-significant distress or impairment in daily functioning?
-not attributional to a substance or medical condition.
-no history of manic or hypomanic episode.
What characterises depression (further to anhedonia and dysophia) ?
-weight changes
-sleep disturbances
-psychomotor changes
-fatigue
-feelings of worthlessness or excessive guilt
-diminished concentration
-suicidal thoughts
What are 4 theories of depression?
1.) Ancient world theory of “Melancholia”.
2.) Freud’s theory of “Psychoanalysis”.
3.) 1st Wave CBT: “Behaviourism”.
4.) Cognitive (2nd and 3rd wave CBT).
Summarise the ancient world theory of depression, i.e. ‘Melancholia’.
According to generations of humoral practitioners, beginning with the Greek physician Hippocrates around 400 BCE, an excess of black bile was implicated in the melancholic temperament and related to depressive symptoms. An imbalance of these humors (e.g. black bile, phlegm etc). was thought to lead to disorders of the mind and body.
Summarise Freud’s “psychoanalysis” theory of depression.
Freud believed that depression was caused by ‘anger turned inwards’, i.e. we have desires, impulses, or experiences that feel unacceptable, and we therefore push them away.
In doing so, we create problems for ourselves resulting in depression - Freud’s idea of ‘anger turned inwards’ refers to the idea of these repressed feelings that become energy consuming and manifest as depression.
Summarise “behaviourism” (1st wave CBT) as a theory of depression.
In essence, the behaviourism theory of depression is that depression is caused by a lack of positive reinforcement (Ferster, 1971)which causes people to lose contact with these positive reinforcements (i.e. decreased environmental rewards), and therefore their behaviour becomes maladaptive.
Behavioural theories of depression emphasise the role maladaptive actions play in the onset and maintenance of depression.
These theories stem from work concerning the principles of learning and conditioning from the early to mid-1900s (e.g. Skinners box). This was an example of operant conditioning : the idea that people learn to behave in certain ways because if they do that it makes them feel less bad.
Operant conditioning is the basis of ‘behavioural activation’
Describe 1st wave CBT (based on behaviourist principles) as an intervention for depression.
- The intervention is based on classic conditioning (e.g. Skinner)
-The idea is that depression is based on a lack of positive reinforcement (Ferster, 1971).
-This forms the basis of behavioural activation: activity monitoring, activity scheduling, and graded task assignment.
What is ‘activity monitoring’?
-Relating to the 1st wave CBT intervention for depression (based on behaviourist principles) activity monitoring is a step towards behavioural activation.
-During activity monitoring, individuals track their daily activities and and see how this corresponds to their moods.
-While we can’t fix the depression
just by noticing this, we can take a
step toward feeling better by
understanding which behaviors
help us feel better, which continue
to maintain the depression as it is,
and which make us feel worse.
What is ‘activity scheduling’?
What is ‘graded task assignment’?
What is ‘behavioural activation’?
https://medicine.umich.edu/sites/default/files/content/downloads/Behavioral-Activation-for-Depression.pdf
-behavioural activation is one of the most important CBT skills used in
treating depression. It has to do with the way that behaviours and
feelings influence each other.
-behavioural activation helps us understand how
behaviours influence emotions, just like cognitive work
helps us understand the connection between thoughts
and emotions.
-Behavioural Activation is based on the well-researched understanding that depression often keeps us from doing the things that bring enjoyment and meaning to our lives. This “downward spiral” causes us to feel even worse. In BA we work to
reverse this cycle using our actions and choices.
What is involved in behavioural activation?
Behavioral Activation involves:
* Understanding the “vicious cycles” of
depression
* Monitoring our daily activities
* Identification of goals and values
* Building an upward spiral of motivation and
energy through pleasure and mastery
* Activity Scheduling: purposefully scheduling
in enjoyable and meaningful activities
* Problem solving around potential barriers to
activation
* Reducing avoidance
* Working as a team to make gradual,
systematic, sustained progress. Change
doesn’t happen over night!
* Using between-session assignments. Practice
changes the brain, little by little!
What is the basic idea of 2nd wave CBT?
2nd wave CBT focused on the content of the persons thoughts, the idea being that thoughts might affect how we feel.
What is the basic idea of 3rd wave CBT?
3rd wave CBT was still focused on thoughts, but less on what the thoughts were and more so on how the person relates and responds to their thoughts. I.e. thoughts are not facts, and therefore do not have to affect behaviour.
What is the ABC model?
The ABC model is:
A - activating event
B - beliefs
C - consequences
e.g.: activating event - I got a poor mark on my essay. Belief - this means I am stupid and doomed to fail my degree. Consequence - what’s the point of trying? study less, give up, possibly fail.
what is a ‘maintenance cycle’ in CBT?
a maintenance cycle is the cycle which maintains the ongoing issue.
Explain Beck’s cognitive triad for depression.
The three elements of Beck’s cognitive triad refer to 1.) the self, 2.) the world and 3.) the future.
Core beliefs (schemas) are no longer conditional, and become all encompassing. They then filter out everything that does not fit with said belief, biasing the persons information processing. This has a biological impact on the brain, and can even bias memory.
and example of how this might work as a thought process using the triad, would be as follows:
1.)self: “I am worthless/ugly/a failure”.
2.)world: “no one loves me”.
3.)future: “It’s hopeless because things will always be this way.”
In essence:
-depressogenic schemas (i.e.: rigid, extreme and counterproductive ways of thinking)
-select, code, and evaluate stimuli.
-accompanied by memory biases.
-formed by experience.
What is Beck’s cognitive theory?
-Beck’s cognitive theory states that emotional disturbances, such as anxiety and depression, emerge from dysfunctional information processing.
-Through interaction between their individual vulnerabilities and stressors in the environment, children may develop negative cognitive structures or ‘schemata’.
-this is illustrated in Beck’s cognitive triad.
What does Beck’s cognitive triad look like?
A triangle. 1) thoughts about the self. 2.) thoughts about the world. 3.) thoughts about the future.
What the ‘hot cross bun’ model
the ‘hot cross bun model’ is a cross sectional formulation.
four circles: 1.) thoughts, 2.) physical response 3.) emotions, 4.) behaviours.
Summarise the process of CBT for depression.
-brief treatment (nhs, usually 16 sessions)
-focus is on the ‘here and now’.
-collaborative approach
-requires good therapeutic rapport (like all CBT).
-its an empirical approach, i.e.: patient and therapists are as scientists/detectives, testing cognitions through rational discussion and by gathering evidence.
Often CBT for depression takes the following form:
1.) Behavioural activation
2.) Identifying and challenging negative automatic thoughts.
3.) Restructuring core beliefs about the self/world/future.
Summarise mindfulness-based cognitive therapy (MBCT).
-derived from Buddhist principles.
-started as mindfulness-based stress reduction for chronic pain
-goal of treatment is to accept thoughts and feelings without judgement.
-it involves meditation as a core component of treatment.
-facets include living in the present moment, engaging fully in current actions, and letting feelings and thoughts ‘come and go’ without acting upon them.
