depression

Question 1

Biological Explanations (Neurotransmitter Dysfunction)

Answer 1

Noradrenaline- Bunney et al (1965) found that low levels of noradrenaline link to depression, and that in depressed indivuals there are often low levels of by-products in urine.

Serotonin- McNeal and Cimbolic (1986) found that depressed patients had low synaptic serotonin levels and reduced amounts of serotonin by-product (signifying reduced levels of serotonin in the brain)

Question 2

What are the key components of Psychodynamic Interpersonal Therapy (PIT)?

Answer 2

Exploratory Rationale:
Interpreting relationship in the individuals life

Shared Understanding:
The therapist tries to understand what the individual is really experiencing or feeling

Staying with Feelings:
Rather than talking about feelings in an abstract way, an attempt is made to recreate feelings in a therapeutic environment

Focus on Difficult Feelings:
The individual may express anger and the therapist focuses on this

Gaining and Insight:
The therapist points out patterns in different relationships

Sequencing of Interventions:
Different aspects of the mode must be established in a coherent manner

Change:
The therapist encourages change made during the therapy

Question 3

Biological Therapies (Antidepressants)

Answer 3

SSRI’s act by preventing the re-uptake of the neurotransmitter serotonin into the pre-synaptic cell by blocking it which increases the quantity of serotonin available to excite neighbouring cells therefore reducing the symptoms of depression.
Tricyclic’s block the transporter mechanisms that re-absorb noradrenaline and serotonin into the pre-synaptic cell after it has fired.

Question 4

Psychological explanation (Psychodynamic)

Answer 4

Mourning and Melancholia - Freud explained when a loved one is lost there is a mourning period then life returns to normal. Some people continue to live in permanent state of melancholia. Mourning and Melancholia can both be reactions to the loss of loved one. Mourning is a natural process, melancholia (depression) is a pathological illness.

Question 5

psychological therapies (CBT)

Answer 5

This therapy emphasizes the role of cognition in the origins and maintenance of depression. CBT aims to identify and alter maladaptive cognitions.

there are two stages:
thought catching - the individual is taught how to see the link between their thoughts and the way they feel.
behavioural activation - based on the idea that being active leads to rewards that alter the effects of depression

CBT is a relatively short treatment (16-20 sessions) and in-between sessions homework is given to boost recovery

Question 6

psychological therapies (CBT)

Answer 6

this therapy emphasizes the role of cognition in the origins and maintenance of depression. CBT aims to identify and alter maladaptive cognitions.

there are two stages:
thought catching - the individual is taught how to see the link between their thoughts and the way they feel.
behavioural activation - based on the idea that being active leads to rewards that alter the effects of depression

CBT is a relatively short treatment (16-20 sessions) and in-between sessions homework is given to boost recovery

Question 7

Biological Explanations (genetics)

Answer 7

Family Studies - having a first degree relative (parent or sibling) with depression appears to be a risk factor for depression. Family studies select probands (people who already have depression) and examine whether other members might be diagnosed. If there is a genetic link probands’ relatives should show higher rates of depression.
Twin Studies - If we assume the environment shared by twins is the same for both types of twins (fraternal and identical), any greater similarities in identical pairs compared to fraternal, shows the action of genes.
Adoption Studies - The biological parents of the individual with depression are found and studied. This is the only type of study that ignores environmental factors.

Question 8

Evaluating CBT

Answer 8

Supporting research (Robinson et al meta-analysis, 1990) found CBT was superior to no treatment control groups

CBT in depressed adolescents, after 36 weeks of treatment 81% of adolescents responded positively and 86% responded positively when CBT was combined with antidepressant drugs

Supporting research (Bryant et al, 1999) found that homework is associated with the benefits of CBT

CBT isn’t suitable for everyone (Elkin et al, 1985) found CBT is less suitable for people who have high levels of dysfunctional beliefs

Question 9

Other issues when diagnosing and classifying depression (e.g. labelling, culture, and gender bias)

Answer 9

Cultural differences: Members of ethnic minority groups are less likely to seek professional help for depression than middles class white people. Karasz (2005)-Gave a vignette describing depressive symptoms to two different cultural groups; 36 south Asian immigrants and 37 European Americans. S.A group explained problem in social/moral terms and E.A group emphasises biological explanation, more likely to seek help.
Gender differences; Women are more likely to develop depression due to stressful social roles such as pregnancy, child rearing. Women are more likely to seek help than men.

Question 10

Psychological Explanations (Cognitive)

Answer 10

Beck- Depression is a result of a build up of negative schemas we acquire in childhood when we experience negative feelings due to rejection or criticism. the negative schema is then activated when the individual encounters a new situation which resembles the original conditions which the schema was formed.
Learned helplessness- (Seligman,1975)
Depressed people acquire a sense of being unable to control their lives. They think of situations in a pessimistic way which impairs their performance and they develop a negative attributional style.
Hopelessness- Abramson et al. (1989) developed theory and explains helplessness as pessimistic expectations of the future.

Question 11

Issues with Validity when diagnosing and classifying depression

Answer 11

Comorbidity refers to the extent that two or more conditions can co-occur. For example, research has shown that the presence of an anxiety disorder increases the risk of developing depression.
Content validity is whether the items in a test are representative of that which is being measured. The BDI has high content validity because it was constructed as a result of a consensus among mental health clinicians concerning symptoms found among psychiatric patients.
Concurrent validity is the whether a test concurs with the existing standard ways of assessing the characteristic. Research (Beck et al.) has consistently demonstrated concurrent validity between the BDI and other measures of depression, such as the Hamilton Depression Scale.

Question 12

Evaluation of validity (X4 PEE)

Answer 12

AO2 (-) McCullough et al. (2003) found considerable overlap in symptoms, making it difficult to justify different forms of depressive illness.

AO2 (-) Diagnoses made by GPs are less objective than those made by ‘specialists’.

AO2 DSM vs ICD - Andrews et al, 1999, compared the two systems and concluded no differences in validity in the diagnosis of depression.

AO2 (-) Depression is less likely to be accepted as an ‘illness’ among Asians compared to Europeans because of the stigma attached to illness (Karasz, 2005)

Question 13

Issues with reliability when diagnosing depression

Answer 13

Inter-rater reliability - low levels of this reliability related to any classification procedure suggest that it might lead to faulty diagnosis and inappropriate treatment. Lobbesteal et al (2011) showed a moderate agreement of 0.66 in inter-rater reliability.

test -retest reliability - research into the test-retest reliability of the BDI has found a significant reliability correlation on 0.93 (Beck et al 1996)

Question 14

Effectiveness of PIT

Answer 14

Research Support:
Paley et al (2008) have shown that PIT treatments are at least equivalent to the results achieved with CBT. However they do acknowledge that they did not include life events as a way of changing depressive symptoms

The Collaborative Psychology Project (CPP):
Barkham et al (1996) found that PIT and CBT were equally effective in reducing the severity of depression (measured on the BDI). However after 12 months after the course of treatment with CBT/PIT showed a recurrence of depressive symptoms, limiting it’s long term effectiveness

Question 15

Appropriateness of PIT

Answer 15

The Importance of the Relational Process:
Guthrie (1999) argues that explanations (and their related that concentrate solely on cognition and it’s role in depression, ignore the importance of interpersonal relationships. This makes PIT important in treating people whose depression stems from dysfunctional childhood relationships. As a result, the relationships between client and therapist is also key in helping to cure depression (Horvath and Bedi, 2002)

Brief Intervention:
NHS Psychotherapy patients were randomly allocated to either a 12 week waiting list (control) or to receive 12 weeks of PIT (study group). 54 patients entered the study, and 33 finished. Significant improvements were found in patients who completed therapy

Question 16

Clinical Characteristics of Depression

Answer 16

Sad, Depressed Mood:
Indicated with subjective report or observations made by therapists

Loss of Interest and Pleasure in usual Activities:
Indicated by subjective report or by other people

Difficulties in Sleeping:
Insomnia or Hypersomnia

Shift in Activity level:
Observable by others (Lethargy or Agitation)

Poor Appetite or Weight Loss:
Fluctuations in weight and appetite

Loss of Energy or Great Fatigue

Negative Self-Concept:
Feelings of worthlessness or guilt

Difficulty Concentrating:
Slowed thinking and indecisevness

Recurrent Thought of Death or Suicide:
MDD accounts for 20%-30% (Angs et al 1995)

Question 17

Psychological Explanations (Cognitive)

Answer 17

Beck- Depression is a result of a build up of negative schemas we acquire in childhood when we experience negative feelings due to rejection or criticism. the negative schema is then activated when the individual encounters a new situation which resembles the original conditions which the schema was formed.
Learned helplessness- (Seligman,1975)

Question 18

Psychological explanation (Psychodynamic)

Answer 18

Pathology of depression - Freud believed we unconsciously harbour negative feelings towards loved ones. When we lose them those feelings are turned upon ourselves. We may also resent being deserted by them. This period is followed by period of mourning (recalling memories and gradually separate ourselves from them). In some cases we continue on a path of self-blame/abuse because anger towards lost person is turned inward. Depression is ‘anger turned against oneself’.

Question 19

Evaluating Psychological Explanations (Psychodynamic)

Answer 19

AO2 (+) Role of early loss in depression: Shah and Waller 2000 found that many people who have suffered depression describe parents as “affectionless”, supporting freud’s concept of loss through withdrawal of affection.
A02 (+) Barnes and Prosen 1985 found that men who’s fathers died during childhood scored higher on a depression scale.
A02 (-) Loss only explains a small percentage of cases of depression. Only 10% of those who experienced early loss became depressed.
A02 (-) Psychoanalysis has not proved very effective with cases of depression.

Question 20

Biological Explanations (genetics)

Answer 20

Family Studies - having a first degree relative (parent or sibling) with depression appears to be a risk factor

Question 21

Evaluating Biological Explanations (Genetics) x3 PEE

Answer 21

(-) The concordance rates of twin studies are never 100%. McGuffin et al (1996) found it was only 46% for MZ twins and 20% for DZ twins. If depression was caused purely because of genetics, the results should be 100% for MZ and 50% for DZ.

(+) Low concordance may be because of comorbidity. Kendler et al (1992) found higher incidence of a range of disorders in twins than with just depression alone. Suggests that some disorders are a product of genes that underlie a different number of disorders. The actual disorder that developed could be related to environmental triggers.

(-) Genetics don’t consider the effect of the environment. Identical twins share the same environment because they are treated the same because they look the same, this could explain the high concordance rates.

Question 22

Evaluating psychological explanations (Cognitive)

Answer 22

1. Hammen and Krantz (1976)- depressed women made more mistakes in logic when asked to interpret written material than non-depressed patients.
2. Hiroto and Seligman (1975)- College students who were exposed to aversive life events were more likely to fail on cognitive tasks.
3. We cannot say that negative schemas cause depression, it could be that depression causes negative thoughts.

Question 23

Evaluating Biological Explanations (Neurotransmitter Dysfunction) x3 PEE

Answer 23

(+) Increased noradrenaline show antidepressant states. Kraft et al (2005) studied 96 patients with depression who were treated for 6 weeks with SNRIs. They showed a significantly more positive response than placebos, strengthening the link between neurotransmitters and depression.

(-) This research is a correlational study. Means that there can only be a relationship shown but not direct cause and effect.

(+) Ruhe et al (2007) found that when patients were given a trypophan-deficient amino acid mixture that temporarily decreases serotonin levels in the brain. They experienced a brief relapse of symptoms which suggests that lowering serotonin results in depression.