Depression (PSYCHOPATHOLOGY 3/4) Flashcards
depression
mental disorder characterised by change in mood, typically low mood
DSM-5
diagnostic and statistical manual used to diagnose patients
DSM-5 depression criteria
five or more symptoms during same two week period
at least one should be depressed mood or loss of interest and pleasure
nearly every day
symptoms must cause individual clinically significant distress or impairment in social, occupation or other important areas of functioning
must not be a result of substance abuse or medical condition
behavioural characteristics
ACTIVITY LEVELS - reduced levels of energy, lethargy, withdrawing from work, education, social life, prevent getting out of bed, can lead to psychomotor agitation - struggle to relax
DISRUPTION TO SLEEP AND EATING - insomnia, premature waking, hypersomnia, appetite increase or decrease, weight loss or gain
AGGRESSION AND SELF-HARM - irritable, aggressive, affects work and relationships, physical aggression towards themselves, self-harm, suicide attempts
emotional characteristics
LOWERED MOOD - defining emotional element, more pronounced that daily lethargy or sadness, worthlessness, empty
ANGER - more negative emotions than positive, at self or others, aggression or self-harm
LOW SELF-ESTEEM - how much like ourselves, far as self-loathing
cognitive characteristics
POOR CONCENTRATION - unable to stick with a task, hard to make decisions, likely to interfere with work
ATTENDING TO AND DWELLING ON THE NEGATIVE - more attention on negative aspects of situation, bias to recalling unhappy events
ABSOLUTIST THINKING - situations as all good or all bad ‘black and white thinking’, when unfortunate, see as disaster
Ellis’ ABC Model, 1962 (cognitive approach to explaining depression)
emotions and behaviour were due to faulty cognition
mistakenly blame external events when it is interpretation of events to blame
poor mental health as result of irrational thinking
explains how irrational thinking/beliefs can negatively impact emotions and behaviour, causing depression
ABC model steps
ACTIVATING EVENT - something happens externally e.g. fail test
BELIEFS - event triggers belief or irrational thoughts about situation e.g. believe they are unintelligent
- utopianism –> life should be perfect
- musturbation –> meet perfectionist targets before success and comfort
CONSEQUENCES - emotional and behavioural consequences follow belief e.g. start to feel worthless, diminished interest in studying, quitting
ABC model strengths
real world application, development of treatments
REBT is effective, must be some truth in model, helps patients recover, credible and useful
evidence for role of irrational thinking
Hammen and Krantz depressed patients made more errors in logic when interpreting written material
shows activating event is able to trigger irrational beliefs leading to errors
increase validity of model
unnatural task may lead to errors - unrepresentative of how act in real world, decrease validity
ABC model weaknesses
only explains reactive depression, not all cases can be traced back to life events or environment
some patients unsure why they are depressed
activating event isn’t crucial to depression
may be endogenous (come from within the person), reducing validity of theory
discounts neurotransmitters
bio explanation is monoamine hypothesis - depression is result of low levels of serotonin and noradrenaline
more than just faulty cognition
reductionist, too simplistic
Beck’s Negative Triad, 1967 (cognitive approach to explaining depression)
depression caused by early experiences which affect thinking
schemata
schemata built from early interactions and experiences - patterns of maladaptive thoughts and beliefs formed
mood product of pessimistic schema held about world
develop during childhood - trauma and unhappy experiences
negative cognitive triad
negative beliefs formed about
- themselves (worthless, useless)
- world/environment (overwhelming, full of obstacles)
- future (hopeless)
cognitive bias / distortions
negative schemas fuelled by cognitive biases (person with depression will think in negative way)
- trigger or event later in life will help confirm earlier negative beliefs / schemas
- existing dysfunction beliefs are activated
reinforcement of negative beliefs
person with negative schemas will concentrate on information relevant to those schemas
lead to reinforcement of negative beliefs
thinking has affect on all aspects of person - feel, physical, behaviour, symptoms of depression
examples of cognitive biases / distortions
SELECTIVE ABSTRACTION / PERCEPTION - detail taken out of context and believed over everything else
OVERGENERALISATION - overall negative conclusion about all situations based on one trivial event
MAGNIFICATION AND MINIMISATION - magnifying small bad events and minimising large good events
ABSOLUTIST THINKING - unless everything is perfect, considered a failure
change perception, trigger anxiety and negative emotions and depressive behaviour
negative cognitive triad strengths
D’Alessandro students’ negative views abut futures associated with increase in depressed mood, dysfunction beliefs about themselves who did not get into first choice college doubted future and developed depression, consistent with application of cognitive distortion linking to negative belief
whether faulty thinking is causal factor, still led to effective form of therapy CBT (Kugken many studies shows reduce depression, validity to theory)
Koster demonstrated depressed people selectively attend to negative stimuli, presented with positive, negative and neutral words for 1.5 seconds on computer screen
had to press button when they saw each one. depressed patients took longer to disengage from negative words, those with depression had negative distortions, in line with theory
negative cognitive triad weaknesses
hard to find evidence for models’ claim that negative thinking causes depression, rather than being present with symptoms, disappears when depression stops
causation not established, only link - cause necessary to treat
same issues with neurochemical explanation, depressed thoughts alter brain chemistry, brain chemistry causes depressed thoughts
negative thinking is perfectly reasonable - depressive realism - people with good mental health are less realistic in thoughts
could just be a realist
fails to explain gender bias - women suffer more, no evidence to suggest females have more negative schemata
cognitive behavioural therapy (CBT)
cognitive approach to treating depression
includes REBT
general rationale - turning negative thoughts into positive ones, live normal life
general strategies - automatic negative and irrational thoughts through thought catching
CBT process
irrational thoughts challenged
gathers evidence of behaviours and compares with thoughts expressed to check whether they match, testing validity of irrational thoughts
homework tasks - keep diary to record and monitor events to target negative thinking
cognitive restructuring encouraged - thought processes restructured to overcome cognitive distortions and focus on reinforcement of positive ones
Ellis REBT (1962)
rational emotive behavioural therapy
people with depression interpret events irrationally and blame external factors for distress
aim to reframe - challenge negative thoughts and reinterpret ABC in positive, logical way
logical dispute
questions logic of thoughts
does the way you think make sense?
empirical dispute
seeks evidence for thoughts
DEF
DISPUTING INTERVENTION - mindfully examining, questioning and challenging beliefs, logical and empirical dispute
EFFECTIVE NEW PHILOSOPHY / BELIEF - create an alternative line of thinking upon more plausible and reasonable beliefs
NEW FEELING - how does new belief make you feel
CBT strengths
most effective therapies for depression
Hollon 40% depressed patients treated for 16 weeks relapsed within a year, 45% for drug treatment and 80% for placebo
CBT has low relapse rate, more effective
cause and effect not established - faulty cognition likely to be involved, but other factors - 0% relapse rate if truly effective - potential problem with treatment
CBT weaknesses
emphasises what is happening in the mind at risk of minimising importance of living circumstances
patient in poverty, suffering abuse needs to change circumstances
therapy cannot help
individual differences influence effectiveness
not effective for people with rigid attitudes and are resistant to change
difficult to change viewpoints
limits usefulness
variations in effectiveness due to competence and passion of therapist
Kuyken and Tsiurikos therapists more competent, experienced and compassionate had better patient outcomes, regardless of complexity
not able to engage with therapist can affect outcome
CBT vs drugs
as effective as drugs - debate over main treatment
Amick systematic review and meta analysis comparing antidepressants and CBT for initial treatment of depression
no substantial differences in short term efficacy and tolerability
while CBT is effective, not neccessarily best first line treatment for some, people should not be pressed into it, other options
personal preference for first line treatment
good choice, both work, provides hope if first didn’t work
drugs more frequently offered - 20% do not complete
lack of adherence to drugs - frequency and severity of side effects (drowsiness, fatigue, nausea, risk of suicide)
CBT has no side effects but lack of adherence to diminished interest, worthlessness, negativity, not enough effort put in (common in depression patients)
cost of CBT
cost effective in long run
may have to be on antidepressants indefinitely
mindset change, although initially expensive will pay off
waste of money if can’t change view
cheaper, less sessions, better for economy
