Psychopathology - Depression

Question 1

How is depression diagnosed?

Answer 1

• at least 5 symptoms present everyday for 2 weeks
• these symptoms must include sadness/loss of interest and pleasure in normal activities
• impairment in general functioning is not caused by other events (e.g. death of loved one)

Question 2

What are the behavioural characteristics of depression (action)?

Answer 2

• shift in energy levels
  
  • reduced amounts of energy (fatigue, lethargy, high levels of inactivity), can lead them to withdraw from work/education/social life
  • high amounts of nervous energy (agitated, restless, pace around), this is called psychomotor agitation
• social impairment
  
  • reduced levels of social interactions with friends/relations
  • may distance themselves from friends/family
• weight changes
  
  • significant increase/decrease in weight
  • some may eat a great deal, others may have a reduced appetite
• poor personal hygiene
  
  • reduced incidence of washing/wearing clean clothes
• sleep pattern disturbance
  
  • constant insomnia (difficulty falling/staying asleep)
  • also may require huge amounts of sleep (hypersomnia)
• aggression and self harm
  
  • often irritable and can become physically/verbally aggressive (quitting job impulsively)
  • may be physically aggressive in the form of self harming

Question 3

What are the emotional characteristics of depression (feelings)?

Answer 3

• loss of enthusiasm
  
  • lessened concern with/lack of please in daily activities that a person used to enjoy
• constant depressed mood
  
  • overwhelming feelings of sadness/hopelessness and feeling empty
• worthlessness
  
  • constant feelings of reduced worth/inappropriate feelings of guilt
  • low levels of self esteem
• anger
  
  • this may be directed towards others or themselves (self harm)
  • may arise from feelings of being hurt and wanting to retaliate

Question 4

What are the cognitive characteristics of depression (thinking)?

Answer 4

• delusions
  
  • concerning guilt, punishment, personal inadequacy/disease
  • some may experience hallucinations (auditory/visual/olfactory/haptic)
• reduced concentration
  
  • difficulty in paying/maintaining attention
  • slower thought processes (can interfere with person’s ability to do their job)
• thoughts of death
  
  • constant thoughts of death/suicide
• poor memory
  
  • trouble retrieving memories
• negative thinking
  
  • negative view of the world (expect things to turn out badly)
  • negative expectations about lives/relationships
  • leads to self fulfilling prophecy (if you expect negative things to happen, they probably will)
• absolutist thinking
  
  • “it was a complete disaster”
  • use of absolutist terms

Question 5

What are the cognitive approaches to explaining depression?

Answer 5

• the cognitive triad by Beck (1960)
• the ABC model by Ellis

Question 6

What is the cognitive triad?

Answer 6

• the idea that people become depressed as they have a negative outlook and hence develop negative schemas
• these often develop in childhood
• e.g. self-blame, ineptness
• stage one = negative thoughts about self
• stage two = negative thoughts about the world
• stage three = negative thoughts about the future

Question 7

What are the strengths of the cognitive triad?

Answer 7

• influential model
  
  • this model has been based around sound experimental research (objective/permits testing)
  • distorted/negative thoughts are very common among patients
• supporting evidence
  
  • Terry (2000) assessed 65 pregnant women for cognitive vulnerability before/after birth
  • those who had a higher cognitive vulnerability were more likely to suffer post natal depression

Question 8

What are the weaknesses of the cognitive triad?

Answer 8

• limited explanation
  
  • it does not explain how some symptoms of depression develop
  • e.g. some patients show anger, hallucinations, and bizarre beliefs
• cause and effect is not clear
  
  • we could say that negative thoughts cause depression to develop or depression could develop from somewhere else and this causes the negative/irrational thinking to occur
• cognitive approach criticises this model
  
  • this approach states that depression is caused by learning and the environment
  • but the cognitive approach states that negative thinking causes it instead

Question 9

What is the ABC model?

Answer 9

• Ellis proposed the idea that depression is caused by irrational beliefs
• A = activating event
  
  • triggers the negative effect on the patient’s mood/outlook
• B = beliefs
  
  • thoughts associated with the event (rational/irrational)
• C = consequences
  
  • irrational beliefs lead to negative emotions

Question 10

What are the strengths of the ABC model?

Answer 10

• research support
  
  • Bates (1999) found that depressed patients became even more depressed when given negative thought statements
  • knowing the cause of depression can help provide patients with effective treatments for curing it
  • evidence that those who develop depression in adulthood, experienced insecure attachments in childhood
  • this shows the link between childhood attachments and negative thinking (causes depression)
• it is based on sound scientific evidence that permits objective testing

Question 11

What are the weaknesses of the ABC model?

Answer 11

• unclear cause and effect
  
  • it is not certain that negative thinking actually causes depression
  • depression may occur first and then causes negative thinking
• blames the patient
  
  • it gives them the power to control and change the situation (to improve their symptoms)
  • but the situational factors that may have also played a role are overlooked
• biological approach criticises the cognitive approach
  
  • Zhang (2005) found that a gene related to depression makes it ten times more likely for an individual to develop it
    it the biological approach states that biological factors are more likely to cause depression than cognitive factors

Question 12

What is the cognitive behavioural therapy (CBT) by Beck?

Answer 12

• can be used on individual patients and in small groups
  · it allows the patient to have some control
  · focuses on present experiences
  · it can help the patient to think in a more positive way (positively influences their behaviour)

· patients are encouraged to identify/challenge their negative thoughts by testing them out

· they keep a record of events in their life that can be used to help challenge their negative thinking (e.g. diary entries, test results, birthday cards etc. to try to prove the existence of positive events)

Question 13

What are the strengths of CBT?

Answer 13

• effective
  
  • especially for patients with mild depression
  • it stops it from possibly getting worse
• supported by lots of research
  
  • offered as a cost effective treatment for many disorders by the NHS (especially for depression)
  • quite economical compared to other treatments
• gets to the root of the depressive problem
  
  • can uncover the underlying issues that caused depression in the first place
  • other treatments like medication tend not to do this and only mask/cover up these symptoms
• long term cure for depression

Question 14

What are the weaknesses of CBT?

Answer 14

• not a popular treatment
  
  • anti-depressant drugs are a much more common treatment
  • patients find that this requires less effort than CBT
  • Cujipers found that CBT is much more effective when combined with drugs
• CBT is only applicable to patients with mild symptoms
  
  • if the depression is very severe, then drugs/medication might be more appropriate than CBT

Question 15

What is the rational emotive behavioural therapy (REBT) by Ellis?

Answer 15

• irrational thoughts also cause negative self-statements,so the therapy involves making patients think in a more rational/positive manner
• therapist challenges depressed patients’ thinking and shows them how irrational their thoughts are
• the patients are told to practise positive/optimistic thinking (reinterpret the ABC model in a more positive and logical way)
• patients are given homework between therapy sessions (vital for testing irrational beliefs out in the real world, and replacing them with more positive ones)
• CBT encourages depressed clients to become more active and engage in pleasurable activities
• D = disputing irrational thoughts/behaviour
• E = effects of disputing/effective attitude to life
• F = feelings/emotions

Question 16

What are the strengths of REBT?

Answer 16

• supporting evidence
  
  • Flannaghan (1997) supports the use of REBT as an effective way to treat depressive stroke victims
  • suggests that REBT is a suitable treatment for specific groups of people with depression/can help them become more positive over time
• research support
  
  • David (2008) compared 170 depressive patients (14 weeks of REBT) and compared them to depressive patients who were treated fluoxetine
  • 6 months after the treatment ended, they found that REBT was a better long term treatment for depression compared to the drug therapy

Question 17

What are the weaknesses of REBT?

Answer 17

• unclear ideas/symptoms
  
  • not certain if the distorted negative thinking is the cause of depression or just a symptom
  • if it is only a symptom of depression then REBT is not tackling the root cause of depression
  • this may cause it to return in the future (has not been cured properly)
• dependent articulate patients
  
  • REBT would not work for people with severe depression if they were unable to communicate properly/do not feel comfortable talking about their feelings
  • other treatments (drug therapy) would be considered instead
• depends on the skills of the therapist
  
  • the more skilled the therapist, the better the therapeutic outcomes for the depressed patient (essential for its effectiveness)
  • so psychologists need to be highly skilled and develop a good relationship with their client in order for REBT to be successful