MDD Psychological models Flashcards
What is persistent depressive disorder (fka dysthymic)?
milder, chronic depression
for at least 2 years
without remission >2 months
MDD symptoms
4 types
emotional= sadness/ numbing +- anxiety, anger, agitation
cognitive= negative self-view, guilt/ self-blame, pessimism/ hopelessness
motivation= trouble starting, physical inertia, indecisiveness
somatic= appetite, sleep, fatigue, libido, hypochondriac
single episode/ recurrent
MDD diagnostic criteria
at least 5 symptoms
nearly daily
for at least 2 weeks
daily depressed mood (for most of the day) +//
daily diminished interest/ pleasure (")
may include psychotic featuresHarre+ Finlay-Jones (1986)
emotional talk in history
accidie= boredom, disgust with fulfilling one's religious duties melancholy= black bile, gloomy, clever men mopishness= impaired senses, idleness in those born to work 20thC= MDD= accidie+ mopishness= linked to unfulfilling work
Kessler+ Bromet (2013)
higher lifetime prevalence in richer countries
median AOO= early adulthood
course= often chronic- recurrent
women lifetime risk roughly double mens (worldwide)
separated/ divorced have higher rates of MDD than married
prevalence decreases with age
Behavioural aetiology
Mair+ Seligman (1976)= learned helplessness (perceived uncontrollability of aversive stimuli)
Support:
Hiroto (1974)= non-depressed stopped trying to stop a noise when previously unsuccessful
Lewisohn (1979)= reduced rewards
Constantino (2012)= negative spiral of reduced social rewards
Behavioural Rx
operant conditioning (test uncontrollability) classical (learn non-depressive association to stimuli)
Behavioural evaluation
lab created motivational deficits seen in depression
behavioural Rx rarely used alone
Cognitive aetiology
Who created the attributional reformulation of learned helplessness?
Abramson, Seligman and Teasdale (1978)
internal (personal failing)
stable (will persist over time)
global (will persist over different situations)
Depressive attributional style (Beck)
Cognitive aetiology
Negative cognitive triad
-pessimism of self, world+ future
(stems from our childhood/ schemata/ how we evaluate)
Schemata what is it? what's it for? what's it triggered by? what does it determine?
unspoken/ inflexible assumptions/ beliefs
for screening/ discriminating/ processing stimuli
triggered by negative life events
determine content of cognitions+ affective processes
CBT 4 stages
education= teach relationships between cognition, emotion and behaviour
behavioural= reinforce/ reality test, pleasant event scheduling (increase engagement/ activity)
cognitive rehearsal= develop coping strategies (detecting thoughts/ bias) and correct dysfunctional thinking
behavioural hypothesis testing= test validity of negative assumptions
Carter+ Garber (2011) longitudinal study predicting MDD onset
cognitions ?cause/consequence of MDD
predicted by high negative cognitions (even with low interpersonal stress) or increased stress (regardless of cognitions)
Hiroto (1974)
non-depressed volunteers stopped trying to stop a loud noise when their past efforts were unsuccessful
(support for learned helplessness theory)
Lewishon (1979) and Constantino (2012)
further support for learned helplessness theory (reduced rewards)
Cognitive aetiology (5)
Negative cognitive triad Learned helplessness Schemata Cognitive biases Negative automatic thoughts (steady train of unpleasant ideas pop into head)
Moore+ Fresco (2012)
depressed people have less illusion of control
Roshanhaei-Moghaddam (2014)
MDD patients show relatively similar effects for CBT+ psychopharmacology Rx
Freud’s psychodynamic aetiology of MDD (1917)
defence mounted by the ego against the intra-psychic conflict
reaction to loss (real/symbolic/ imagined)- regression to oral stage of dependency
unconscious anger turned upon self- despair/ self-hatred
Blatt+ Homann (1992) core assumptions of modern psychodynamic theories of MDD
rooted in early losses
wound reactivated by a recent blow
regression to stage of help/hopelessness
ambivalent feelings= central unconscious conflict
overly seek self-esteem from others
ensuing dependency has a relationship function
Psychodynamic Rx= traditional psychoanalysis
uncover childhood roots of MDD explore ambivalent feelings towards lost object -free association -dream analysis -analysis of resistance/ transferance IPT
Klerman (2004) IPT
Interpersonal psychotherapy (IPT) focuses on
- present problems> past
- MDD use in relationships
- core problem+ possible solutions
Psychodynamic evaluation
Bornstein (1992)
some depressed people= highly dependent
Psychodynamic evaluation
Willoughby (2013)
poor parenting is a risk factor for MDD
consistent with attachment theory (Ainsworth+Bowlby, 1991)
