Depression Flashcards
Part of Exam 2 (on Mar. 24)
How do depressive disorders rank in terms of overall global disease burden?
What are the prevalence rates of depression?
Rank first among disorders responsible for the global disease burden
Lifetime prevalence rate (for those over 13) is about 30% and the 12-month prevalence rate is about 8.6%
Prevalence rates are increasing and age of onset is decreasing
According to Figure 7.1, a person must endorse at least one of two depressive symptoms in order to qualify for a diagnosis of major depression. What are they?
Must have at least one of the following symptoms:
- Dysphoric mood (feeling sad or empty)
- Anhedonia (loss of interest or pleasure in almost all activities)
What are the remaining symptoms of major depression and how many does a patient need to exhibit (and for how long) in order to receive a diagnosis of major depression?
A patient must have at least 5/9 symptoms (one must be either anhedonia or d.m.) present most of the day, nearly everyday for at least 2 weeks PLUS significant distress or decrease in functioning as a result
- Appetite change or significant weight loss/gain
- Insomnia or hypersomnia
- Fatigue or loss of energy
- Feeling worthless or having excessive or inappropriate guilt
- Psychomotor agitation or retardation
- Decreased concentration or indecisiveness
- Suicidality
What do the following specifiers mean: Chronic MDD, Atypical MDD, & Peripartum MDD?
Chronic = continuous depression (without remission) for 2+ years
Atypical = mood reactivity, hypersomnia, fatigue, sensitivity to criticism, and increase in appetite/weight gain
Peripartum = depression during or immediately following pregnancy (previously called postpartum)
What is required for a formal diagnosis of Persistent Depressive Disorder?
Depressed mood for most of the day, for more days than not, for at least 2 years
PLUS marked distress or impairment
PLUS at least 2/6 of the following:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Fatigue
- Low self-esteem
- Poor concentration or indecisiveness
- Feelings of hopelessness
What are the four specifiers that indicate the course of chronic depression and how are they characterized?
1) Pure dysthymic syndrome: full criteria for MDD have not been met in the 2 years
2) Persistent depressive episode: full criteria for MDD were met at some point in 2 years
3) Intermittent major depressive episode, with current episode: currently in a nonchronic depressive episode
4) Intermittent major depressive episode, without current episode: previously met criteria for a nonchronic depressive episode in the past 2 years
What factors differentiate chronic depression from major depression in terms of comorbidity, personality and cognitive characteristics, and early learning/attachment history?
Chronic = greater comorbidity with anxiety, substance use, and personality disorders; more extreme personality traits (but still within the normal range); lower self-esteem with more cognitive biases, experiential avoidance, and suicidality; greater early adversity, maladaptive parenting, childhood emotional abuse, and/or family history
What data supports the notion that the prevalence of Major Depressive Disorder has increased in recent cohorts?
The prevalence of depressive symptoms has increased in younger groups (earlier age of onset), suggesting that the lifetime prevalence rate for younger generations may be higher than older ones
What was Skinner’s (1953) position on the causes of depression?
In what three ways did Ferster (1965) elaborate on this idea?
What additional notion did Ferster (1973) posit?
Skinner: depression is related to a reduction in behaviors that elicit positive reinforcement from the environment
Ferster: infrequent or absent positive reinforcement + presence of anxiety + unexpected changes in environmental stimuli = decline in specific behaviors = avoidance or escape to prevent further loss of positive reinforcement
In what three ways did Lewinsohn and colleagues expand on Ferster’s and Skinner’s model?
The rate of positive reinforcement is dependent upon:
1- the # of reinforcing activities the individual engages in
2- the amount of positive reinforcement the environment can provide
3- the skillfulness of individual in eliciting reinforcement from the environment (i.e. their social and interpersonal skills)
What “vicious web” do anhedonia, amotivation, and avoidance create with respect to the continuation and escalation of depression?
Loss of interest in activities that previously brought pleasure (anhedonia) = loss of desire to continue to attempt those activities (amotivation) = find greater satisfaction in doing nothing b/c activity requires too much energy and is no longer rewarding (avoidance)
What is the function of avoidance behavior in depression?
What are two of its negative consequences?
Meant to minimize distress BUT:
1- short-term avoidance can lead to the build-up of worse, longer-term problems
2- reduces the opportunity for individuals to encounter positive reinforcement or interactions
According to Beck, what are automatic thoughts and how do they contribute to depression?
Words that go through one’s mind frequently and without effort in response to an event
- People with depression often have negative automatic thoughts that maintain negative moods
What is a cognitive distortion and what are some examples?
A cognitive error created by continuous negative self-statements or core beliefs about oneself
Ex: all-or-nothing (black+white) thinking and overgeneralization
According to Sacco and Beck (1995), depression is predicated on a diathesis-stress model. In this context, what aspect of this model relates to depressogenic schemas (i.e., cognitive frameworks from where depression can originate) and where do these schemas come from?
Depressogenic schemas serve as a filter for incoming information and increase the likelihood of cognitive errors and negative self-statements
They originate:
1- early in life (diathesis)
2- remain dormant until activated by a negative life event (stress)
What is the benefit of schemas in general versus how might they cause problems?
Schemas help organize information and enhance/streamline everyday cognitive processing (to reduce mental effort)
- When our basic beliefs or schemas are not accurate reflections of reality, it can cause problems
According to the learned helplessness model, what are the three essential belief dimensions related to depressive symptoms?
3 belief or attribution dimensions:
- internal vs external
- global vs specific
- stable vs unstable
Those with depression tend to have internal (their fault), stable (permanent/unable to change), and global (universal) attributions for negative events
What is hopelessness depression and what does hopelessness theory suggest in terms of when depression is most likely to occur?
Hopelessness depression: expect that desired outcomes will not occur (i.e. aversive outcomes will occur) and there is nothing the individual can do to change that outcome
Depression is most likely to occur when:
- important negative events are attributed to global and stable causes and predicted to have further negative consequences
- the individual assumes the negative event was somehow caused by their deficiencies
What three clinical points are highlighted by research on information processing, learning, and memory in depression?
1- information presented in therapy may be misinterpreted by the individual due to attentional and memory distortions/biases
2- the therapist will likely need to inquire directly about positive experiences that have occurred
3- the proportion of negative and positive events reported in therapy should be tracked and monitored for shifts, which may indicate clinical progress
What factors differentiate ruminative thoughts from automatic thoughts?
Rumination is a repetitive focus on the individual’s negative emotional symptoms, including the potential causes and consequences of them, that the patient has difficulty disengaging from
Differences:
- Unlike automatic thoughts, which often include cognitive distortions, ruminative thoughts are usually accurate reflections of reality
- Automatic thoughts are also usually time-limited while ruminative thoughts are recurrent
What is meant by “response contingent reinforcement”? What does a low rate of it lead to?
R.C.R. is when reward is given as a direct result of the individual’s behavior
When this reinforcement is not given (either by removing aversive stimuli or rewarding appetitive stimuli), the behavior is extinguished
What does Lewinsohn’s Integrative Model suggest about response contingent reinforcement and depression?
Response-contingent reinforcement may NOT be given due to: environmental changes, skill deficits (or overall inability to access rewards), lack of environmental opportunities for rewards, and/or individual disengagement from activities that may provide reward
This low rate of return on behavior (due to a decrease in rewards or increase in costs) will increase depressive symptoms
What types of behaviors are a depressed person likely to engage in?
Avoidance behaviors such as social withdrawal, substance use, and excessive eating/sleeping
This represents a narrowing of the person’s behavioral repertoire
What is the role of avoidance behavior in depression?
Avoidance behaviors provide immediate relief by alleviating negative affect, but this relief is only temporary and makes depression worse in the long run
Some avoidance behaviors can also cause additional impairments that yield further aversive experiences, making depression worse (this creates a self-perpetuating feedback loop)
