Depression and its disorders

Question 1

What are the critisisms of Beck’s model of depression?

Answer 1

Even with support for the model, it could be that the model is a descriptor of the symptoms and does not describe the cause of the symptoms

Question 2

What are the diagnostic criteria for depression?

Answer 2

Must have 5 of the following present including depressed mood & loss of interest

1. Depressed mood most of the time
2. Less interest/enjoyment from activities
3. Significant weight change
4. Insomnia or excessive sleep
5. Excessive increase or reduction in physical movement
6. Substantial fatigue
7. Feelings of worthlessness or excess/inappropriate guilt.
8. Lack of concentration / ability to decide
9. Recurrent thoughts of death/suicide.

In order to be diagnosed with major depressive disorder ….

• Present of single major depressive episode (not attributable to normal reactions to loss) without previous manic or hypomanic episodes and where symptoms are not better accounted for by other disorders
• Symptoms must cause clinically significant distress or impairment in social/occupational or other forms of functioning.

Question 3

What biological factors are associated with depression?

Answer 3

• genetics
• neurochemicals
• brain abnormalities
• neuroendocrine factors

Question 4

What social and contextual factors were identified by Harris and Brown (1978)

Answer 4

Brown and harris, 1978 identified the social protective and vulnerability of depression.

Protective factors (found to protect against development of depression in spite of stressors)

• Extended education
• Being employed
• Having a close intimate relationship -as only 10% of women with a close friend became depressed compared to 37% of those without an intimate friend (Brown & Harris, 1978).

Vulnerability factors (found to increase risk of depression in combination with particularly stressful life events):

• Loss of one’s mother before the age of 11
• lack of a confiding relationship
• more than three children under the age of 14 at home
• Unemployment
• Being female
• Divorced/separated
• Major adverse life advent

The vulnerability factors seem to interact with provoking agents to increase the risk of depression. Provoking agents (found to contribute to acute and ongoing stress). These stressors could result in grief and hopelessness in vulnerable women with no social support.

• 61% of the depressed women had experienced at least one very stressful life event compared to only 19% of the non-depressed women

Question 5

What do the interpersonal theories claim to be the etiology for depression?

Answer 5

The frequent failure of depressed individuals to elicit reinforcing reactions from individuals with whom they are communicating has led to these theories.

They argue that depression is maintained by a cycle of excessive reassurance seeking that is subsequently rejected by family and friends because of the negative and repetitive way in which the depressed individuals talks about their problem.

Excessive reassurance seeking is also associated with motivation to obtain self-confirming negative feedback – which is another risk factor for depressive symptoms.

Question 6

Why is it difficult to gauge the prevalence of depression?

Answer 6

1. rates differ across cultures – why?Because some countries stigmatise psychopathology
2. incidence of diagnosis has increased over the past 90 years
3. studies use different diagnostic tools- depression can’t be measured or observed directly – it is subjective recall problems may occur for the elderly.

Question 7

What supports are there for the interpersonal theories of depression?

Answer 7

Reassurance seeking behaviour is a risk factor for depressive symptoms

Question 8

What support is there for Beck’s cognitive theory of depression?

Answer 8

Studies have shown that depressed people have:

• Attentional biases to negative infoin depressed individuals results in them prioritising that negative info:
  
  • Emotional stroop procedure- depressed individuals are slower at naming the colour of negative words that positive words, suggesting that their attention is drawn towards the meaning of such words (Gotlib & Cane 1987)
  • Dichotic listening studies- show depressed individuals have difficulty ignoring the negative words.
• Memory biases for negative info -
  
  • recall test - depressed individuals remember more negative than positive information about themselves (Alloy et al 1997)- they have a biased recall of autobiographical memories.
  • Child abuse linked with reduced autobiographical memory specificity (Raes et al 2005)
• Interpretational bias – depressed people interpret ambiguous events negatively or judge events more negatively.

Question 9

What variations of depression are there?

Answer 9

1) dysthymic depression 2) premenstrual disorder 3) Seasonal affective disorder 4) Chronic fatigue syndrome

Question 10

Describe the research and evidence for neuroendocrine factors that are associated with depression.

Answer 10

Depression found to be associated with abnormal levels of certain brain neurotransmitters. - Low levels of: Serotonin, dopamine & norepinephrine. in the 1950’s= high blood pressure meds resulted in depression due to meds increasing serotonin! - developed tricyclic drugs which block reuptake of norepinephrine and serotonin & MEO inhibitors. Later= found that dopamine also plays role- involved in rewards systems- low dopamine= lack of motivation, initiative & pleasure. Simplistic theory= depression is the result of an imbalance of neurotransmitters Advanced theory= low levels of serotonin interact with low levels of norepinephrine in complex ways – so low levels of both = depression but low serotonin & high norepinephrine = mania.

Question 11

What are some of the problems with the cognitive theories of depression?

Answer 11

Not a full and comprehensive account because…

1. studies with humans have suggests prior experience with uncontrollable neg events facilitate performance!
2. depressed individuals appear to blame themselves rather than feel ‘helpless’

Question 12

What is the attributional theory?

Answer 12

• Formed to overcome problems with learned- helplessness.
• believe that people learn to become helpless, or ‘hopeless’ because they possess certain attributional styles that generate pessimistic thinking. Attributions are the explanations that individuals have for their behaviour and the events that happen to them.

Abramson et al (1978) found people become depressed when they attribute negative life events primarily to factors that cannot easily be manipulated or are unlikely to change. They attribute neg life events to…

• Internal rather than external factors (personal traits rather than outside events)
• Stable rather than unstable factors.
• Global rather than specific factors. (causes that effect many parts of life rather than being specific to one area)

Peterson et al (1982) developed the attributional style questionnaire (ASQ) which measures tendencies to make thekinds of causal inference that are hypothesesized to play a causal role in depression.

Question 13

What are the thinking bias that Beck refers to in his model of depression?

Answer 13

• Arbitrary influence - e.g. my friends didn’t pick up the phone therefore they must be avoiding me!
• Selection abstraction - abstracting detain out of context
• Overgeneralization - e.g. if you have an argument with a friend, you start to think that everyone hates you
• Magnification and minimization - over planning potential negative events and underplaying positive ones.
• Personalisation - this involves attributing negative events to you (internal attribution), despite evidence of the country.
• Absolute dichotomous thinking - this is all-or-nothing approach (e.g. if i fail my exams, my life is ruined). There is no room for alternatives
• ‘Should’ and ‘must statements - beliefs about what a person should and shouldn’t do and generally reflect the schemata that a person has (e.g perfectionalisation, ‘ I must be the best at everything’).

Question 14

what are the criticisms of Abramson (1978) attribution theory?

Answer 14

• Coyne and Gotlib (1983) suggests that there is only equivocal support for the revised learned helplessness model
• Also this model doesn’t say anything about cause and effect - there is no explanation as to what causes the pessimistic attribution style, and whether this style develops because of other factors that actually, ultimately cause depression
• Also, there is no attempt (like Beck’s model) to explain manic episodes

Question 15

What is the prevalence of depression?

Answer 15

• Experiencing depression is the 3rd most common reason for consulting a doctor or GP in the UK – Singleton et al (2001)
• In 2004, unipolar depression was 3rd in the leading causes of burden of disease in the world, and 1st in high-income countries.
• Lifetime risk for major depression may be as high as 20% for men & 30% for women (Kruijshaar et al 2005) 350 million people worldwide of all ages suffer (WHO, 2012)
• Age & gender most prevalent in women at 30-44 years most prevalent in men at 18-29 years

Question 16

what support is there for lewishons lack of reinforcer view?

Answer 16

Most obvious characteristic of depression is lack of motivation and initiative, a considerably diminished behavioural repertoire and a view of the future that lacks positive and fulfilling experiences.

Question 17

what are the critisims to the genetic theories of depression

Answer 17

• specific gene largley unkown

Question 18

What was Sieglman’s theory (1975) of depression?

Answer 18

Depression linked specifically to uncontrollable negative life events, and these give rise to a ‘cognitive set’ that makes the individuals learn to become ‘helpless’ (lethargic and depressed) .

The uncontrollability of the negative events is what leads to individual to pessimistic beliefs that neg events will happen whatever they do.

He derived this hypothesis from animal learning experiments involving dogs.

dogs that were given prior unavoidable electric shocks were unable to learn the avoidance response – this is learned helplessness theory.

Question 19

What are the central ideas of the psychodynamic theories of depression?

Answer 19

Importance of early childhood experiences Role of hostility Role of self esteem

Question 20

What was Walker (2000) learned helplessness theory on depression?

Answer 20

• Battered woman syndrome- pattern of repeated partner abuse leads women to believe that they are powerless to change their situation.

Question 21

What did Freud’s theory of depression?

Answer 21

Depression is a response to loss, and this can be either:

• An actual loss (e.g. loss of a parent)
• Symbolic loss (e,g loss of a job)

The person introjects their feelings of this loss onto themselves and regresses to the oral stage of development. This allows them to integrate the feelings they have towards the ‘loss’ unto themselves

During their depressed state, the regression to the oral stage the become very dependent on others. They may also trigger memories of inadequate parenting during childhood (poor parenting seems almost a necessary factor)

Question 22

What is Coyne’s model of depression?

Answer 22

the fact that life losses are likely to result in the reduction of reinforcing events for the depressed individual also leads to a vicious cycle that can establish depression as a chronic condition.

e.g. once individual becomes depressed, then their lack of initiative and withdrawal is unlikely to lead to the development of other alternative sources of reinforcement.

Question 23

What is dysthymic depression?

Answer 23

Experiencing at least 2 years of depressed mood more days than not. Less severe than major depressive disorder

Question 24

what are the critisism of interpersonal theories of depression?

Answer 24

We must be cautious of interpreting this a a causal factor because most of the research has been retrospective in nature

Also e need to be careful in interpreting the evidence as reassurance seeking behaviour as a risk for depressive symptoms or whether depressive symptoms themselves elicit these symptoms

Question 25

What does the attachment theory say about depression?

Answer 25

• Avoident and resistant forms of attachment can influence the child’s working model of themselves and create a vulnerability for depression later in life

Question 26

What is premenstrual disorder ?

Answer 26

a condition in which some women experience severe depression symptoms between 5-11 days prior to the start of the menstrual cycle-which after menstrual onset significantly improve.

Question 27

Describe the neuroendocrine factors associated with depression?

Answer 27

Depression associated with problems regulating body cortisol levels (hormone secreted at times of stress) poor regulations of the hypothalamic pituitary –adrenocortical network, Cortical influences depressed symptom by causing enlarged adrenal glands which in turn lowers serotonin / frequency of serotonin transmitters in the brain.

Question 28

What are the psychological theories of depression?

Answer 28

• Psychodynamic theories- Freud
• Behavioural theories - Fester (1973) & Lewinshohn (1976)
• Interpersonal theories - Coyne
• Attachment theory - Bowlby (1969)
• Cognitive theories - Beck, Nietzel & Harris (1990)
• Learned helplessness theory - Seligman (1975), Walker (2000)
• Hopelessness theory
• Learned Rumination

Question 29

What are the limitations of the hopelessness theory?

Answer 29

• Many of the studies claim to support the theory are carried out on healthy or mildly depressed individuals
• Majority of studies testing the model are correlational and so cannot provide evidence on the possible causal role of hopelessness cognitions in generating depression
• Model doesn’t explain all depressive symptoms required for DSM-5 diagnosis.
• Evidence that negative attributional style disappears during remission from depression (Hamilton & Abramson 1983)

Question 30

Why do we need to be cautious of the interpersonal theories of depression?

Answer 30

• much of the research on the link between lack of reinforcement and depression has been retrospective in its nature, depressed individuals may underestimate rewards in their life. need to understand whether excessive reassurance seeking and seeking negative feedback are dispositional factors that create a risk for depressive symptoms or whether depressive symptoms themselves elicit these characteristics

Question 31

How is depression assessed?

Answer 31

1. Interview = e.g GP may conduct clinical interview (DSM or ICD) may consider diagnosis or psychological distress
2. Questionnaires = validated self-completed measures May use…

• Patient health questionnaire (PHQ-9) -Beck depression inventory -
• Hospital anxiety depression scale OR Clinical outcomes in routine evaluation (CORE- OMM) (look at subjective wellbeing, problems/symptoms, functioning & risk)

Question 32

what is the attribution theory (Abramson, 1978)?

Answer 32

The idea of the learned helplessness theory was later extended to suggest that human differ from animals in that they make attributions about the events and their consequences. A causal attribution is simply an explanation to why something happened. Abramson et al (1978) suggested that people explain negative events by:

• Internal attributions - blame themselves for the event
• Stable attributions - will continue to happen
• Global attributions - will filter across to other areas

Abramson (1978) suggested that people make these types of casual are more likely to blame themselves for negative events and expect these negative events in the future. The result would be that they would increased their feelings of helplessness and loss of self esteem (these are also not entirely dissimilar from Beck’s cognitive triad)

Abramson et al (1978) then went onto argue that in human experiences of uncontrollable outcomes are not enough for helpessness to develop. Instead, these events need to be an objectively uncontrollable event but they must also perceive this event and past event as uncontrollable. The crucial factor is the attribution leads to expectations that future events will be uncontrollable and this will lead to expectations of helplessness.

Question 33

What does Lewishon say about lack of reinforcers and depression?

Answer 33

The loss of someone or something important results in the loss of an important reinforcer. This leads to lack of reinforcement for positive and constructive behaviours, leading to the extinction of these behaviours and the person learns to become inactive and withdrawn . This can lead to a cycle that make the symptoms chronic.

Question 34

What is Seasonal affective disorder?

Answer 34

a condition of regularly occurring depressions in winter with a remission the following spring or summer.

Question 35

What is the rumination theory?

Answer 35

Rumination= tendency to repetitively dwell on the experience of depression or its possible causes.

The tendency to ruminate has been shown to predict the osnet of depressive episodes (nolen-hoesema 2000) and relapse. Rumination is driven by meta=cognitive beliefs that rumination is a necessary process in order to resolve depression.

Rumination= vulnerability factor during the transition from early to middle adolescence.

Question 36

what is introjection?

Answer 36

a response where individuals regress to the oral stages of development, which allows them to integrate the identity of the person they have lost with their own.

Question 37

what are the criticisms for the monoamine theories?

Answer 37

There has been much inconsistent evidence to suggest that there is a difference in their levels of neurotransmitters in blood and urine of patients with and without depression. This could suggest that there may not be a difference.

Question 38

What is the hoplessness theory?

Answer 38

This is a refined from the attributional/helpless account of depression to account for the fact that attributional style appears to interact with a number of factors to cause depression. It is similar to attribution/helplessness theory in that negative life events are viewed as interacting with a global/stable attributional style to generate depressed symptomatology.

HOWEVER, it differs in that it also predicts that other factors such as low self-esteem may also be involved as vulnerability factors.

Question 39

What are the problems with Freud’s theory fo depression?

Answer 39

• Many people who go through loss of say, for example, a parent do not develop depression
• Many of the key aspects are difficult to test (operationalize and measure )

Question 40

Describe the evidence for genetic associations with depression?

Answer 40

• Partial evidence for inherited genes
• Twin studies indicate that heritability is moderate (between 30-40%) (Kendler et al, 2000)

Question 41

What is Beck’s cognitive theory of depression?

Answer 41

• Goes by the idea that during early life we develop a set of schema based on our experiences . In depressed people these schemata, or assumptions develop from negative early experiences such as the loss of a parent, rejection or criticism from friends etc.
• These negative experiences lead to dysfunctional beliefs about the world, which are triggered by critical incidents in the future.
• Once the negative schemata is activated this leads to a stream of negative automatic thoughts (a set of thoughts that a person has no voluntary control over).
• These negative automatic thoughts are interpreted as being true by the individual and are not evaluated and therefore lead to other negative thoughts (negative triad of thoughts). It is this negative stream of consciousness that lead to the symptoms of depression.
• NAT’s disrupt mood, reduce motivation, increase anxiety/arousal disrupt cognitive processing especially through misattributions and interpretive bias, and lead to behavioural changes

Beck (1967) further elaborated on the types of cognitions in depressions and the relationship between them.

• He argued that the negative schema maintain the negative cognitive triad, which are a set of three far reaching global views:
  
  • Pessimistic views of the self - person’s subjective evaluation of themselves
  • Pessimistic view of the world - person’s subjective views of them not being able to cope with the demands of the environment
  • Pessimistic view of the future - beliefs about the negative state of the future

The negative schemas also lead to cognitive bias and distortion.

Question 42

What is Chronic fatigue syndrome?

Answer 42

depression and mood fluctuations together with physical symptoms such as extreme fatigue, muscle pain, chest pain, headaches and noise /light sensitivity.

Question 43

What is the support for Freud’s psychodynamic theory of depression ?

Answer 43

• Some studies have shown a relationship between the risk for depression and a particular parenting style called affectionless control (overprotected, lack of warmth)
• Many people with depression report that their childhood needs were not adequate and they are more likely to become depressed after experiencing a loss (Goodman, 2002)
• Link between parental loss and depression (Harris and Brown, 1978)

Question 44

what are the monoamine theories of depression?

Answer 44

• Increase in the levels of noradrenergic neurotransmitters in the monoamine group (dopamine, serotonin, norepinephrine) are believed to be linked to depression. This could occur in two ways:
  
  • Increased degradation in they synapses (too many neurotransmitters absorbs in the synapses, leaving low levels in the synaptic gap)
  • Impaired release or reuptake (little of the neurotransmitter being released in the first place or too much reuptake after the nerve pulse has been transmitted).
• The theories come from testing of a drug as an antipsychotic agent in schizophrenia and the experiment noticed that these had an antidepressant effect on these patients.
• These drugs affected the noradrenergic transporters for serotonin, dopamine and norepinephrine.
• It has also been found that drugs that block the reuptake of serotonin also reduce the symptoms of depression.