Lecture 2: Depression Flashcards
mood symptomen van mdd
- depressed, sad, empty mood
- loss of interest/pleasure
cognitive symptoms van mdd
- diminished ability to concentrate or think
- negative view of the self (worthlessness)
- guilt or self blame
- hopelessness
- suicidal thinking
motivational symptoms of mdd
- loss of energy/fatigue
- agitation/retardation
- difficulties making decisions
physical symptoms of mdd
- sleep disturbance
- eating disturbance
maar… wat is er met mdd
heel heterogeen, heel veel patienten hebben verschillende (combinaties van) symptomen. dus eigenlijk gek dat het als 1 groep getreat wordt.
the most common symptom profile of mdd has a frequency of only….
1.8%
beck’s cognitive model
(early) learning experiences -> dysfunctional schemata and core beliefs + critical indicent -> maladaptive beliefs/assumptions -> negative automatic thoughts -> depression
kijken naar schema!
voorbeeld dysfunctional schemata and core beliefs
- Inept, unlovable
- Triad: negative view on self, world and future
maladaptive beliefs/assumptions voorbeeld
“If I am not approved by everyone, then I am not worthwhile”
Cognitive errors such as:
- overgeneralization,
- selective abstraction
- dichotomous thinking
negative automatic thoughts
Center around:
- loss,
- failure,
- worthlessness,
- defectiveness,
- incompetence
- inadequacy
a cognitive perspective model
depression
cognitive control
cognitive biases:
- self-referential processing
- attention
- interpretation
- memory
cognitive emotion regulation:
- meer rumination
- minder reappraisal
- minder distraction
kijken in schrift
3 onderdelen van cognitive control
- updating
- shifting
- inhibition
working memory =
holding/manipulating information, regulating attention
inhibition =
pushing away irrelevant information
wat is de invloed van inhibition in depressie
the ability to control working memory by inhibiting irrelevant emotional information possibly plays an important role in various biases of depression
wat is er met updating in depressie
people had to memorize faces, and update the info on this (sometimes they looked angry, sometimes sad). people with depression are slower with this updating and had higher reaction times
wat is er met emotional regulation in depressie
depression:
- Diminished ability to think or concentrate
- Difficulties making decisions
- Especially when there is no clear assignment: when there is much possibility of ruminating and thinking about personal matters
-> Many forms of emotional regulation require these skills!
negative schemas: hoe leiden die tot cognitive biases
negative schemas influence perception.
depressed people were quicker to name negative things than positive things about themselves. they showed a bias to words that represent negative self talk.
wat werd bedoeld met attention in het model van een cognitive perspective
er is selective attention, attention bias towards negative stimuli
wat was tegenstrijdig aan de attentional bias
dat mensen het lastiger vonden om negatieve woorden in de stroop test te noemen.
ze moesten klikken waar het woord in het scherm was, en ze hadden steeds een veel langere reactietijd bij negatieve woorden (plant vs death)
wat werd gevonden met de dot probe task
selective attention to negative stimuli: maar alleen voor lange presentatie, niet bij korte presentatie van stimuli.
disengagement more effort
hoe was deze attention bij mensen met anxiety
juist heel gevoelig voor quick reactions (zoals bij priming)
wat betekent disengagement more effort
theory: dat depressed people een soort van glued zitten aan die negatieve woorden, en dat het veel moeite kost om zich hier los van te maken.
williams et al cognitive framework =
anxiety: priming omhoog, elaboration omlaag
depression: priming geen verschil, elaboration omhoog
uitleg williams et al
anxiety: really prone to quickly react to negative stimuli, but depressed people have more trouble with disengaging, instead of focus on the very quick reaction
wat is lastig aan williams
heel lastig om te testen, want veel comorbidity tussen anxiety and depressed (dus heb je wel mensen die het een of het ander hebben?)
dus welke processen volgens williams et al centraal in depressie vs anxiety
anxiety = attention
depression = memory
wat voor treatments obv williams
cognitive bias modification (try to practice your attentional bias, get it away from the negative things)
cognitive bias modification: wat is de science hierover
er leek een positief effect, maar later minder. sommigen zeggen dat het werkt, anderen dat het de therapeutische relatie is die het verschil maakt
waarom krijgen de eerste originele onderzoekers vaak een negatief effect
- publication bias (als het niet positief was was het ook nooit gepubliceerd)
- heel groot geloof in methode = positief naar participants
dodo effect =
everybody has won (like in alice in wonderland): all treatments are equally efficient
memory in depression
overgeneral memory
hoe is deze overgeneral memory in andere disorders
wel in andere mood disorders, maar niet in anxiety
dus misschien specifiek voor depressie?
waardoor wordt overgeneral memory veroorzaakt
delayed retrieval of positive memories (rather than fast retrieval of negative memories)
hoe gaat het mis door die overgeneral memory
delayed retrieval of positive memories -> inappropriate retrieval strategies that yield general rather than specific memories -> overgeneral memory -> ineffective problem solving skills -> limited ability to repair negative mood -> relayed recovery + problems in imagining specific future events
hoe hebben ze overgeneral memory getest
Autobiographical Memory Test (AMT):
Cue-word procedure:
- positive and negative words
- task: retrieve specific personal memories to - positive or negative cue words
voorbeelden van overgeneral memory
relaxed
- “when I sit on the chair next to my husband at home”, “when I used to visit my grandparents as a child” (overgeneral or categorical memories)
- instead of: “last year in center-parcs when we went to the sauna with the family on the last evening of our holiday” (specific memories)
disappointed
- “Every time my partner leaves me”, “when girlfriends cancel dates at the last minute” (overgeneral or categorical memories)
- instead of: “when my new partner let me know via text message that she was no longer interested in me“(specific memories).
you need ….. memories to counter ….
you need specific, positive memories to counter a negative mood!!!!!!!!!!!!
wat is er met memory nog meer aan de hand in depressie (de soort memories die mensen ophalen)
memories often start as verbal, depressed people tend to stop there. others go more into detail, via sensory or perceptual input (what were the details?). depressed people avoid going into sensory/perceptual, and ruminate on the verbal/abstract.
dus eerst verbal/abstract -> dan sensory/perceptual.
hoe ga je van verbal/abstract naar sensory/perceptual
cue word - semantic association - categoric memory - specific memory
wat is de clinical implication van dit gedeelte van memory
- Training of focusing on specific elements
- Learning to accept negative emotions
- Mindfullness based CT
cognitive emotion regulation strategies =
Strategies to cope with event or emotional experience
wat is de kritiek op cognitive emotion regulation strategies
mainly self-report studies
rumination =
Thinking repetively and passively
bij welke disorders komt rumination voor
Rumination is common to depression, generalized anxiety disorder, social anxiety, post-traumatic stress disorder, and eating disorders
rumination mediates differences between sexes
oke
wat voor rol speelt rumination in depressie
- Brooding seems to be elevated among current and former depressed individuals
- Prolonged emotional response to stress
- Poor problem solving behavior
- Higher levels of social exclusion and victimization
- Rumination plays a role in inhibiting and updating information in working memory
clinical implications of rumination
- Change (core) beliefs: cognitive therapy. For example: identifying core beliefs: I am a failure
- Challenging these thoughts, what is the evidence?
- Replacing these thoughts
how can we change core beliefs, which therapy
cognitive therapy
waar staat cognitive therapy in science
- by far most examined
- more effective than other therapies but the difference is small
- no different than pharmacotherapy on short run but more effective on the long term
wat voor soorten episodes heb je
- acute episode
- relapse
- recurrence (als het vaker terugkomt)
acute - continuation - maintenance
verschil rumination and worrying
Rumination is especially important, different from worrying (although it also correlates) worrying is more about the future, rumination about the past
Women tend to ruminate more than men
oke
Rumination is brooding, negativity, not being able to let things go, etc about the past. Brooding seems to be elevated among current and former depressed individuals.
oke
waarom hebben sommige mensen relapses/recurrences?
- latent variables
- cognitive vulnerability
wat bedoelen ze met latent variables
some processes have an inactive (latent) state but can be more easily activated in vulnerable individuals. The schemas can still be there latently (they may be suppressed), and therefore they are easily activated. -> recurrence.
or some times negative schemas can be inhibited better.
Cognitive vulnerability=
depressed patients have this vulnerability to have negative thoughts -> depressed patients endorse the statements shown more often.
Maar… Many studies found no difference between formerly depressed and never depressed people. (Formerly Depressed and Never Depressed)
Russia piano nummer: use this in experiments to..
make people melancholic -> mood induction tasks. Maar je kan ook een situatie inbeelden dat je een slechte dag hebt, and then try to answer these questions (try ot get ppl in a more negative state).
wat liet dit experiment van cognitive vulnerability (met Formerly Depressed en Never Depressed) zien
people who were depressed in the past, the mood gets more activated easily by a small induction of mood. Therefore they think depressed patients are more vulnerable: they get in these negative moods more easily. vulnerability does not reside in dysfunctional attitudes per se, but rather in the relative ease in which the mood changes. dus basically dat ze minder goed weer naar een blije mood gaan. Dit kan je ook wel zien als een soort scar. More vulnerable people have a more strongly related network. Dus als een ding naar beneden gaat, gaat het hele netwerk naar beneden.
wat liet nesda zien over networks
if you look at patients who were still depressed after 2 years, they had a much more dense network than people who were not depressed any more. Symptoms are more highly correlated with each other, therefore creating a more strong network.
2 kenmerken invulnerable network
- weak connections
- large distances between the tiles (dobbelstenen)
2 kenmerken vulnerable network
- strong connections
- small distances between the tiles
dus welke is meer aanwezig in depressie en welke meer in healthy individuals
depressie = vulnerable, sterke connecties
healthy = invulnerable zwakke connecties
wat laat het alternative stability landscape zien
landschap = a persons psychological state
shape of landschap = how resilient a person is to psychological stressors/external shocks
ball = the current state of the system
A. the system shows a strong (deep) attractor.
B. the system is destabilizing and the attractor has weakened.
C. the ball has tipped over into the new attractor and the old attractor has dissappeared.
welke staat correspondeert met low vulnerability en welke met high vulnerability
low vulnerability = een gat, gaat er niet uit kunnen komen
high vulnerability = twee gaten, omslagpunt
It is not a continuum, you are in a healthy state and there become more and more vulnerable, once your resilience comes down, you also get stuck into a stable state, but then this state is more depressed. The shape of the system represents how vulnerable a person is. If the network is less connected, you are more likely to be resilient, you don’t get to the next point (depression) because your whole network is not related. In ppl who are depressed, when one node gets activated, the whole system gets activated.
oke
waar focussen ze nu op met die stable states enzo
Nu: focus op wat mensen meer en minder resilient maakt. Most literature: two stable states. Er wordt veel gepraat over tipping points. It is difficult to get out of this low point because your resilience has to get back up again.
The system has a few warning signals: you can prevent these tipping points via these warning signals. The idea is that people can be tracked and then prevented from getting into another one of these low points.
wat is een andere kijk op dit landschap
sommigen zien het eigenlijk als meer een soort S vormige grafiek: op een tipping point kunnen mensen opeens niets meer (burnout: werken) -> en dan is het heel lastig om weer terug te gaan naar een normale staat, omdat je helemaal terug moet naar het begin om je weer normaal te voelen. Dus het is niet zo dat je weer terug moet naar het tipping point, maar je moet echt weer helemaal naar het begin. Forbidden zone is the time you need to take to get back to your normal position, to get back into a healthy state. Dit is ook weer een tipping point, om terug te komen in een normale staat.
Het doel van therapie is ook dat je weer terugkomt naar een meer resilient punt dan je eerst in was.
zie schrift
wat is lastig aan die tipping points grafiek
Studie naar transitiepunten nadat mensen waren gestopt met antidepressants: main message was that it was difficult to find criteria if the recurrence occurred -> some people did have some tipping points, others did not. Therefore it is very difficult to find these general points, people are very unique and have unique patterns. Er zijn zoveel variabelen die lastig te controleren zijn, bijvoorbeeld ook urbanisatie etc, populatie groei, city size etc. daardoor is het onduidelijk of we menselijk gedrag überhaupt ooit kunnen voorspellen.
wat is er met de medisch vs latent vergelijking
- Latent variable models and network models are statistically interchangeable…
- Latent variables can also be viewed as a statistical summary of symptoms, rather than as a cause of symptoms.
- Comparison with the medical model is too simplistic: there are also medical conditions where symptoms are interrelated (for example, with a tumor: coughing and chest pressure).
- There are also medical conditions where the symptoms constitute the condition itself (psoriasis).
what could also cause relapse
when you treat the symptoms, but forget the mental representation (dit is hypothetisch tho -> denken we should go beyond symptom reduction and also come back to the underlying issue). Dus we focusen nu op schemata and core beliefs, instead of early experiences.
Childhood trauma seems to be a feeding factor, veel grotere kans om later depressief te raken. But how do you target childhood trauma?
-> one thing is imagery rescripting for depression. We cannot change the past, but we can change its meaning (re-imagine the childhood trauma by reliving it).
- in knight armour
- imagine that you are stronger
interpretation =
Drawing a conclusion about an ambiguous situation
attribution =
the process by which people determine the cause of an outcome
bias =
difference from reality and/or difference from healthy group
appraisal =
value assessment (good for me or bad for me?)
schema =
mental structure of preconceived ideas about a particular aspect, including feature of this concept and relationships of these features. often not conscious. holistic & associative
cognition =
container term for all mental activity
(implicit) association=
evaluative association between two categories
latent =
hidden, something that is present but not noticable right now
inhibit=
reducing, decreasing
