Lecture 9 - Depression Flashcards
Learning outcomes from the lecture
- What is depression
- Theories of depression
- Interventions & real-world example
What is the criteria for depression
at least 5 of the following:
Depressed Mood (dysophia)
Diminished Interest (anhedonia)
Weight Changes
Sleep Disturbances
Psychomotor Changes
Fatigue
Feeling worthless or excessively guilty
Diminished Concentration
Suicidal Thoughts
And all of the following:
Symptoms persist for at least two weeks.
Significant distress or impairment in daily
functioning.
Not attributable to a substance or medical
condition.
No history of a manic or hypomanic episode.
Commonly
comorbid with
other
presentations,
like anxiety
at least one of
these two symptoms
Timeline on theories of depression
- Ancient
world:
melancholia - Psychoanalysis - anger turned inward
- Behaviourism
(1st wave CBT):
lack of positive
reinforcement - Cognitive (2nd &
3rd wave CBT):
the role of
thinking
Psychoanalysis:
anger turned
inward
NICE guidelines for less severe depression
Guided self-help, group CBT, group
behavioural activation (BA), individual
CBT, individual BA, group exercise,
group mindfulness, Interpersonal
Psychotherapy (IPT), SSRIs
NICE guidelines for depression - more severe
BA, anti-depressants, individual problem
solving, counselling, IPT, Couples, Brief
Psychodynamic, Counselling, (STPP), IPT,
guided self-help, group exercise
NICE guidelines - relapse depression
Continuation on anti-depressants, group
CBT, group mindfulness
Interventions for depression: 1st wave CBT
Based on theories of conditioning (e.g., Skinner).
Depression is based on a lack of positive reinforcement (Ferster, 1971).
This forms the basis of behavioural activation:
Activity Monitoring
Activity Scheduling
Graded Task Assignment
May be better than CBT for severe depression, and often used prior to CBT.
What are 2nd wave and 3rd wave CBT interventions?
2nd wave (CBT)
What are your thoughts?
(focus on content)
3rd wave (e.g., mindfulness)
What is your relationship to your
thoughts? (focus on process)
Modern-day CBT is a formulation-driven blend of techniques that often target both content and process.
The specific way in which this is done depends on the presentation, and there are guidelines for the treatment of panic, social anxiety, eating disorders, etc.
What is the underlying philosophy for this?
- Ellis’ ABC model
Underlying philosophy
- Beck’s Negative Triad
Negative thoughts about the world, self and future
Depressogenic schemas = rigid, extreme and
counterproductive ways of thinking
- select, code, and evaluate stimuli
- accompanied by memory biases
- formed by experience
Triad = self, world, & future
Evidence for Beck’s cognitive theory (1967)
Depressed people have reduced positivity
bias (Mezulis et al., 2004)
Cognitive vulnerability (dysfunctional
attitudes, e.g., “If I fail at my work, then I am
a failure as a person”) predicts onset and
recurrence (Otto et al., 2007)
Diathesis stress: stressful life events
moderate the association between cognitive
vulnerability (dysfunctional attitudes) and depression (Lewinsohn et al., 2001)
Beck’s formulation for depression - longitudinal formulation
1) Early experiences influence 2) core beliefs which influences 3) assumptions which influences 4) rules and strategies which influences 5) negative automatic thought
This influences 6) emotions but emotions can also influence negative thoughts. Same for physcial response and behaviours.
Situation can also influence negative thoughts
Example longitudinal formulation
1) Bullied 2) I am unlikeable 3) If people get to know me they will reject me 4) I don’t let anyone get to know me 5) my colleagues don’t like me 6) emotion of sad
Behaviour may be stay up all night and drink alcohol, physical response might be feeling heavy
What is some evidence for CBT
CBT is effective (40% reduction in symptoms after 16 week
treatment, but some relapse; Hollon et al., 2005)
In recovered depressed patients, inducing negative mood
creates thinking patterns similar to when people are depressed
(Teasdale & Dent, 1987)
What is mindfulness based cognitive theory (MBCT)?
Derived from Buddhist principles
* Started as mindfulness-based stress reduction for chronic pain – Jon Kabat-Zinn
* MBCT devised by Segal, Williams, Teasdale
* Goal of treatment is to accept thoughts and feelings without judgement
* Involves meditation as core component of treatment
* Facets include living in the present moment, engaging fully in current actions, letting
feelings and thoughts ‘come and go’ without acting upon them
