Depression (Psychopathology) Flashcards
Depression
depression and depressive disorders are characterised by changes to mood. DSM-V has the following categories:
Major depressive disorder - severe but short term.
Persistent depressive disorder - long term or recurring depression including sustained major depression.
Disruptive mood dysregulation disorder - childhood temper tantrums.
Premenstrual dysphoric disorder - disruption to mood prior to and/or during menstruation.
Neuroses disorders
Unipolar disorder: an episode of depression that can occur suddenly
-can be reactive (for example to the death of a loved one)
-can be endogenous (neurological factors)
Bipolar disorder: manic and depressive
-change of mood in regular cycles
-Mania: over-activity, rapid speech and feeling happy or agitated
Emotional characteristics of depression
Lowered mood: defining emotional element of depression, feeling worthless and empty.
Anger: sufferers can experience extreme anger that may be at self or others.
Lowered self-esteem: sufferers tend to report lowered self-esteem, describing a sense of self-loathing.
Behavioural characteristics of depression
Anxiety levels: reduced levels of energy (lethargic). Leads to withdrawal from work, education and social life.
Psychomotor agitation: inability to relax and end up pacing.
Disruption to sleep and eating behaviour: can lead to insomnia and hypersomnia. Appetites increases or decreases leading to weight gain or loss.
Aggression and self harm: can be irritable, leading to verbal or physical aggression.
Anhedonia: decreased ability to feel pleasure and loss of interest.
Cognitive characteristics of depression
Poor concentration: difficulty concentrating on a problem and may ruminate, poor decision making.
Attending to and dwelling on the negative: focuses on more negative aspects than positive, a bias towards recalling unhappy events rather than happy ones
Absolutist thinking: all good or all bad or black and white thinking. Situations seen as complete disasters.
Assumptions of the cognitive approach to depression
-Individuals who suffer from mental disorders have distorted and irrational thinking- which may cause maladaptive behaviour.
-It is the way you think about the problem rather than the problem itself which causes the mental disorder.
-Individuals can overcome mental disorders by learning to use more appropriate cognition. If people think in more positive ways, they can be helped to feel better.
Aaron Beck 1967
Beck suggested that there is a cognitive explanation as to why some people are more vulnerable to depression than others. He suggested three parts to this cognitive vulnerability:
-faulty information processing
-negative self-schemas
-the negative triad
Faulty information processing (Beck)
Beck believed that people who are depressed make fundamental errors in logic. Proposed that people who have depression tend to selectively attend to the negative aspects of a situation and ignore the positive aspects. There is a tendency to blow small problems out of proportion with thinking on terms of black and white and ignoring the middle ground; you are a success or a failure.
Negative self schema (Beck)
People who have depression have developed negative self-schemas and therefore they interpret all the information about themselves in a negative way.
The negative triad
Build on the idea of maladaptive responses and suggested that people with depression become trapped in a cycle of negative thoughts. They have a tendency to view themselves, the world and the future in pessimistic ways- the triad of impairments.
Albert Ellis
Ellis proposed that good mental health is the result of rational thinking. Argued that there are common irrational beliefs that underlie much depression and sufferers have based their lives on these beliefs. For example: “I must be successful, competent and achieving in everything I do if I am to consider myself worthwhile.”
Ellis’ ABC Theory
-Activating event A: We get depressed when we experience negative events and these trigger irrational beliefs
-Beliefs B: Ellis identified a range of irrational beliefs: we must always succeed or achieve perfection ‘musturbation’, perceiving whatever doesn’t go smoothly as a disaster, utopianism (life is always meant to be fair)
-Consequence C: When an activating even triggers irrational beliefs, there are emotional and behavioural consequences.
Weissman and Beck 1978 (method, result and conclusion)
Thought processes were measured using the dysfunction attitude scale (DAS). Participants filled in a questionnaire by ticking wether they agreed or disagreed with statements.
They found that participants with depression made more negative assessments than those who weren’t depressed. When given therapy to counter their negative schemas there was an improvement in their self-ratings
Depression involves the use of negative schemas.
Supporting evidence for Beck 2 (evaluations for the cognitive approach to depression)
Much research has supported the proposal that depression is associated with faulty information processing, negative self schemas and the triad of impairments.
Grazioli and Terry 2000 assessed 65 pregnant women for cognitive vulnerability and depression before and after birth
Those high in cognitive vulnerability were more likely to suffer post-natal depression
Cognitive Behaviour Therapy
CBT is the most commonly used psychological treatment for depression as well as other mental health problems.
-based on both behavioural and cognitive techniques.
-The therapist aims to make the client aware of the relationship between thought, emotion and actions.
-can help people to change how they think (‘cognitive’) and what they do (‘behaviour’). These changes can help them to feel better.
breaking the cycle maladaptive thinking, feelings and behaviour.
Focused on present struggles, not past.
When the parts of the sequence are clearly outlined and understood, they can be changed.
CBT aims to get the person to a point where they can fix their problems independently.
CBT 1 (Beck’s CBT)
Challenges the negative triad of the client.
The client will be assessed to discover the severity of their condition.
The therapist will establish a baseline prior to treatment, to help monitor improvement.
-Thoughts influence emotions and behaviour: To feel better you must think positively, The client is asked to provide information on how they see themselves, the future and the world
-The therapist would use a process of reality testing (finding wether or not their negative opinions of themselves are contradicted by some of their successes).
-The therapist might ask the client to do something to demonstrate their ability to succeed.
CBT 2 (Ellis’ Rational Emotive Behavioural Therapy)
REBT extends the ABC model to an ABCDE model
-D= Dispute (challenge the thoughts)
-E= Effect (see a more beneficial effect on thought and behaviour)
Therefore the central technique of REBT is to identify and dispute the patient’s irrational thoughts
1962, Ellis argued that irrational thoughts are the main cause of all types of emotional distress and behaviour disorders. REBT is based on the premise that whenever we become upset, it is not the events taking place that upset us, but the beliefs that we hold.
REBT challenges the client to prove their negative statements and replace them with a more reasonable realistic view.
Implications of depression/treatments of depression for the economy
-how knowledge of psychology is a benefit to employers
-anything to do with treatment of mental health disorders and people’s ability to work and contribute as effective members of society would be relevant, as finding an effective treatment would reduce the number of days people have off work sick so improving productivity.
Supporting Evidence for Beck
-research has supported the idea that depression is associated with faulty information processing, negative self schemas and the triad
-Clark and Beck 1999 reviewed research on depression, concluding that there was solid support for all the cognitive vulnerability factors.
-Cognitions can be seen before depression develops
(Evaluation of Beck’s CBT) practical application
Beck’s cognitive explanation forms the basis of cognitive behavioural therapy.
All cognitive aspects of depression can be challenged in CBT.
(Evaluation of Beck’s CBT) It does not explain all aspects of depression
It can explain the basic symptoms, but not all of them.
Cotard Syndrome is the delusion that you are a zombie.
(Evaluation of Ellis’ theory) Partial explanation
Some depression doesn’t have an activating event.
There is not always a positive cause.
(Evaluation of Ellis’ theory) Practical application in CBT
Like Beck, Ellis’ explanation has led to successful therapy.
Irrational negative beliefs are challenged and this can help to reduce depressive symptoms suggesting that the irrational beliefs had a role in the depression (Lipsky et al 1980)
(Evaluation of Ellis’ theory) It does not explain all aspects of depression
It doesn’t explain why some individuals experience anger related to their depression or suffer hallucinations and delusions.
(Evaluation of Ellis’ theory) Cognitive primacy
Involves the idea that emotions are caused by cognition.
Other theories see emotion as stored, relying on the idea that they are repressed and then emerge later.
(Evaluation of Ellis’ theory) Attachment and depression
Link between insecure attachment to parents and vulnerability to depression in adulthood
Newark et al 1973
Aim: discover link between psychological problems and irrational attitudes
Method: a group of people with anxiety and a group with no psychological problems were asked if they agreed with these statements: it is essential to loved or approved by everyone, one must be perfectly competent and adequate.
Result: more of the anxious group agreed with the statements than the non anxious participants.
Conclusion: people with emotional problems think in irrational ways.
(Evaluation of CBT) Effectiveness
-March et al 2007 supports its effectiveness in reducing symptoms and preventing relapse
-Fava et al 1994 observed that it is as effective as antidepressants for many types of depression
(Evaluation of CBT) CBT and Drug Treatment
Keller et al 2000
Recovery rates from depression
-55% with drugs
-52% with CBT
-85% when used together
(Evaluation of CBT) may not work in severe cases
Depression can be so severe that patients cannot motivate themselves to engage in therapy
It may instead be possible to treat with antidepressants and then CBT later on
This means that CBT cannot be the sole treatment in all cases
(Evaluations of CBT) Therapist-Patient relationship (Rosenzweig 1936)
There is little difference between CBT and other forms of psychotherapy
It may be the quality of the relationship built that makes the difference rather than the treatment itself
The opportunity to speak to someone may be the most important thing
(Evaluation of CBT) Patients wanting to explore their past
CBT is focused on the present even though there may be links to childhood and current depression. Patients may want to talk about this.
(Evaluation of CBT) Emphasis on cognition
The focus on what happens in the mind may minimise the importance of the individual’s circumstances.
There is thus an ethical issue and it is important to remember not all problems are in the mind (McCusker 2014)
