Psychopathology: Depression (L8-10)

Question 1

What is depression?

Answer 1

• a mood disorder characterised by feelings of despondency and hopelessness
• there are 2 types, unipolar and bipolar depression
• unipolar is when the patient has a persistent low mood

Question 2

What does the diagnosis of depression include?

Answer 2

• at least 5 symptoms must be present every day for 2 weeks
• the 5 symptoms must include sadness or loss of interest and pleasure in normal activities
• the person will show impairment in general functioning that has not been caused by other events (death of loved one)

Question 3

What are the behavioural characteristics (actions) of depression (6)?

Answer 3

• shift in energy levels
• social impairment
• weight changes
• poor personal hygiene
• sleep pattern disturbance
• aggression and self harm

Question 4

BC, shift in energy levels:

Answer 4

• depressed people might have reduced amounts of energy resulting in fatigue, legarthy and high levels of inactivity
• might lead them to withdraw from work, education and their social life
• some may have high amounts of nervous energy whereby they become agitated and restless, called psychomotor agitation
• they may pace around, wring their hands and tear at their skin

Question 5

BC, social impairment:

Answer 5

• reduced levels of social interactions with friends and relations
• the person may distance themselves from friends and family

Question 6

BC, weight changes:

Answer 6

• significant increase or decrease in weight associated with depression
• some people might eat a great deal when they are depressed, and then put on a great deal of weight
• other people have a reduced appetite and eat very little, then lose a great deal of weight

Question 7

BC, poor personal hygiene:

Answer 7

• depressed people often have reduced incidence of washing and wearing clean clothes etc.

Question 8

BC, sleep pattern disturbance:

Answer 8

• depression is often characterised by constant insomnia whereby they have difficulty falling asleep, staying asleep and they might wake up very early
• or they might require large amounts of sleep and they might oversleep (hypersomnia)

Question 9

BC, aggression and self harm:

Answer 9

• sufferers of depression are often irritable and they can become physically or verbally aggressive
• such as quitting their job impulsively
• they may also be physically aggressive in the form of self harming, such as cutting themselves or attempting suicide

Question 10

What the the emotional characteristics (feelings) of depression (4)?

Answer 10

• loss of enthusiasm
• constant depressed mood
• worthlessness
• anger

Question 11

EM, loss of enthusiasm:

Answer 11

• depression is often characterised by a lessened concerned with and/or lack of pleasure in daily activities
• such as hobbies or things that the person used to enjoy

Question 12

EM, constant depressed mood:

Answer 12

• key characteristic is the ever present and overwhelming feelings of sadness/hopelessness and feeling empty

Question 13

EM, worthlessness:

Answer 13

• sufferers of D often have constant feelings of reduced worth and/or innappropraite feelings of guilt
• the might also experience very low levels of self esteem

Question 14

EM, anger:

Answer 14

• person might feel anger which might be directed towards others or turned inwards towards the self, which could result in self harm
• depression may arise from feelings of being hurt and wishing to retaliate

Question 15

What are the cognitive characteristics (thinking) of depression (6)?

Answer 15

• delusions
• reduced concentration
• thoughts of death
• poor memory
• negative thinking
• absolutist thinking

Question 16

CC, delusions:

Answer 16

• some depressive patient will experience delusions
• generally concerning guilt, punishment, personal inadequacy or disease
• some will also experience hallucinations, which can be auditory, visual, olfactory (smell) and haptic (touch)

Question 17

CC, reduced concentration:

Answer 17

• difficulty in maintaining attention
• may feel that they cannot stay on task for long periods of time
• might have slower thought processes than normal and difficulty making decisions
• can interfere with the persons ability to do their job

Question 18

CC, thoughts of death:

Answer 18

• people with D will have constant thoughts of death and/or suicide
• might believe that the world would be a better place without them
• might make plans to end their life

Question 19

CC, poor memory:

Answer 19

• will have trouble retrieving memories and their memory might be very poor in general

Question 20

CC, negative thinking:

Answer 20

• often have a negative view of the world and they expect things to turn out badly rather than well
• tend to have negative expectations about their lives and relationships, and the world in general
• leads to the self fulfilling prophecy whereby if you expect negative things to happen, then they probably will
• positive factors in their life will be ignored and they have a cognitive bias

Question 21

CC, absolutist thinking:

Answer 21

• most situations are not all bad or all good
• sufferers of D tend to think in this format, and they usually think about events in absolutist terms
• “it was a complete disaster” rather than, “that was good, but there are a few things that could have been better.”

Question 22

What are the 2 models to explaining depression through the cognitive approach?

Answer 22

• Beck’s Cognitive Triad
• Ellis’s ABC Model

Question 23

What idea does the cognitive model propose?

Answer 23

• individuals who are suffering from depression often have distorted and negative thinking
• people who think in a very negative or irrational way might be more prone to developing the illness of depression

Question 24

What are Beck’s beliefs?

Answer 24

• believes that people become depressed because they have a negative outlook + develop negative schemas that dominate their thinking
• these negative schemas often develop in childhood whereby parents or adults have been overly critical toward them
• negative schemas continue into adulthood + provide a negative framework
• life is then viewed in a negative way
• this could cause depressive thoughts

Question 25

Examples of negative schemas (2):

Answer 25

• Self blame: depressed people feel that they are responsible for all misfortunes
• Ineptness: depressed people expect themselves to fail at everything
  could cause depression, + faulty negative thinking can lead to depression + possible suicidal tendencies

Question 26

What are the stages of the Cognitive Triad?

Answer 26

Stage one: Negative thoughts about self:
- negative thoughts about themselves
- might feel worthless and helpless
- criticise themselves at every opportunity
- e.g. “I am useless and I am no good at Mathematics”

Stage two: Negative thoughts about the world:
- negative thoughts that extend to the wider world around them
- negative and distorted thinking continues on a larger scale
- e.g. “I am useless at everything I do.” The statement becomes more global and negative.

Stage three: Negative thoughts about the future:
- begins to think negatively about their future which might seem bleak and negative
- can cause low self-esteem
- thinks negatively and gets depressed about the future
- e.g. “I will always be useless at everything I do, and this will never improve.”
- such negative thinking according to Beck’s cognitive triad can lead to suicidal thoughts that have initially been caused by negative thinking

Question 27

Evaluation of Cognitive Approach by Beck +ve:

Answer 27

• has become very influential within Psychology during the last 30 years
• especially as the theory has been based on sound experimental research that is objective and permits testing
• seems that distorted and negative thoughts are very common amongst depression patients, and these negative thoughts play a key role in the development of the illness
  = (links to a -ve) have been attempts to combine the cognitive and behavioural approaches together to form the “Cognitive Behavioural approach.”
  = CB approach would aim to look at both the cognitive (negative and irrational thinking) and behavioural (classical and operant conditioning and social learning) elements to look at causes of depression
• supporting evidence to suggest that depression is caused by negative and irrational thinking, as well as the cognitive triad
• Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after birth.
• was found that women who had a high cognitive vulnerability (to think negatively) were more likely to suffer post natal depression
• supports the cognitive approach that negative thinking can cause depression

Question 28

Evaluation of Cognitive Approach by Beck -ve:

Answer 28

• cause and effect is not clear
• negative and irrational thoughts cause depression to develop? or depression develops first (from a different source) and causes the patient to think in a negative and irrational way?
• cause and effect needs to be investigated further so that psychologists can be sure that negative thinking causes depression to occur
  = (links to +ve) cognitive approach would criticise the Behavioural approach when examining causes of depression
  = behavioural approach would state that depression is caused by learning and the environment but the cognitive approach would disagree and state that negative thinking causes depression to occur
• does not explain how some symptoms of depression might develop
• some depressed patients show symptoms of anger, hallucinations and bizarre beliefs (e.g. Cotard syndrome is where the patient believes they are a zombie)
• Beck’s theory fails to account for how these symptoms of depression occur

Question 29

What does Ellis belief + ABC model explain?

Answer 29

• he proposed that depression is caused by irrational beliefs
• devised the ABC model to explain how irrational and negative beliefs are formed

Question 30

What are the parts of Ellis’s ABC model?

Answer 30

A = Activating Event
- patients record events leading to negative thinking
- this is triggered by an event in the environment around them
- e.g. exam failure, or getting fired from work
- activating event has a negative effect on their mood and outlook

B = Beliefs
- interpretation of the event, can be rational or irrational
- Patients record their thoughts associated with the event (these can be rational or irrational)
- an example is that they think they are useless and stupid for failing the exam
- examples might be recording thoughts in a diary or journal so they can keep track of their thinking

C = Consequences
- patients record the emotional response to their beliefs
- irrational beliefs can lead to negative emotions such as feeling upset
- consequences could be debated with many different options
- e.g. “If I fail Maths and I feel that I am not good at it”, the consequences could be that I feel upset, useless and demotivated, and it could lead to me dropping out of the course or school

Question 31

What is mastabatory thinking, ABC?

Answer 31

• Ellis identified that mustabatory thinking can cause irrational and negative thinking that can be emotionally damaging and can lead to depression
• include ‘I must be loved by everyone’ and ‘I must excel in all areas….otherwise I am worthless’
• an individual who holds these beliefs is bound to be disappointed or depressed, because these thoughts are too idealistic and the expectations are too high

Question 32

Evaluation of Ellis’s ABC Model +ve:

Answer 32

• research to support the idea of Ellis’s ABC model as a cause of depression
• Bates (1999) found that depressed participants who were given negative thought statements became more and more depressed supporting the view that negative thinking helps to cause depression
• if psychologists know what causes depression (negative thinking), then this can help provide effective treatments for curing depression (cognitive therapy via changing negative thoughts into positive ones)
  = based on sound scientific evidence that permits objective testing
  = allows improvement of the model and a greater understanding for the causes of depression as a whole
• supporting evidence that people who develop depression in adulthood, tended to experience insecure attachments in childhood
• therefore there seems to be a link with insecure childhood attachments contributing to negative thinking which can cause depression in adulthood

Question 33

Evaluation of Ellis’s ABC Model -ve:

Answer 33

• not clear whether negative thinking actually causes depression
• could be that depression occurs first (maybe through biology or genetics) and then this causes the person to think in a negative and irrational way
• cause and effect needs to be established when looking at causes of depression
  = it blames the client when looking at the causes of depression
  = gives the client some power to change the situation and improve their symptoms of depression
  = however it could mean that situational factors that have helped to cause the depression are overlooked, e.g. family problems
  = as psychologist would examine negative and irrational thoughts alone as a cause for depression
• biological approach to understanding depression would criticise the cognitive approach
• biological approach suggests that genes and neurotransmitters (low levels of serotonin) may cause depression
• Zhang (2005) found that there is a gene related to depression that makes it ten times more likely for someone to develop the illness
• biological approach would state that biological factors are more likely to cause depression than cognitive factors

Question 34

What are the depression treatments (2)?

Answer 34

• cognitive behavourial therapy (CBT) by Beck
• rational emotive behavourial therapy (REBT) by Ellis

Question 35

What is the central idea of CBT by Beck?

Answer 35

• to challenge and restructure negative ways of thinking so that they become more positive and rational

Question 36

What does CBT (Beck) do?

Answer 36

• allows the patient to have some control over their thinking
• focuses on present experiences
• therapist needs to be highly trained
• can help the depressed patient to think in a more positive way, which can positively influence their behaviour
• positive thinking will have a positive impact on behaviour
• negative thoughts challenged
• Beck used cognitive triad as the basis for his cognitive behavioural therapy (negative thoughts about self, world and future addressed)
• patients encouraged to identify their negative thoughts, thought catching!!!
• patient encouraged to challenge their negative thoughts and test them out, e.g. is it really the case that you are useless at all of your subjects at school? This cannot be true because …….
• patient must test out their negative thinking/hypotheses and act as a scientist
• patients encouraged to 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
• reinforcement of positive thoughts is encouraged e.g. positive thinking makes someone feel good about themselves

Question 37

CBT, group size + regularity?

Answer 37

• can be used on individual patients and in small groups
• patients attend weekly sessions either independently on their own or with a group (known as group therapy) in order to overcome their negative thinking

Question 38

Evaluation of CBT +ve:

Answer 38

• very effective to use when a client has mild depression
• CBT stops the mild depression from getting much worse
• CBT is more applicable to clients who had mild depressive symptoms rather than severe symptoms
  = widely respected and supported by vast amounts of research as a therapy for depression
  = offered as a cost effective treatment for many disorders by the NHS in Britain, especially for depression
  = treatment is quite economical compared to other treatments such as the psychodynamic approach
• tends to get to the root cause of the depressive problem
• CBT can uncover the real underlying issues that caused the depression in the first place such as job loss or divorce etc
• other treatments for depression such as medication and drugs tend not to get to the root cause of the problem of depression, but merely act as a, “plaster” that cover up and mask the symptoms of depression
• CBT actually works as a cure for depression
  = can be used as a long term cure for depression
  = once a patient has undergone CBT, it has lasting positive outcomes and there is a high chance that the patient has actually been cured
  = they are less likely to suffer a relapse compared to other treatments (such as medication or placebos)
  = CBT cost effective for the NHS as when a depressed patient has successfully completed CBT treatment they are very unlikely to return to hospital needing further treatment in the future (relapse rates are low)

Question 39

Evaluation of CBT -ve:

Answer 39

• CBT is more applicable to clients who had mild depressive symptoms rather than severe symptoms
• if the depression is very severe then drugs/medication might be more appropriate than CBT

Question 40

What is REBT (Ellis)?

Answer 40

• involves challenging negative thoughts by reinterpreting the ABC model in a more positive and logical way
• irrational thoughts also cause negative self-statements and so the therapy involves making depressed clients think in a more rational and positive manner
• e.g. the exam was difficult or the client did not spend enough time on revision, (rather than them believing they are useless and stupid)
• therapist aims to challenge depressed patients’ thinking and show them how irrational their thoughts are
• depressed patients are told to practice positive and optimistic thinking, which can then have a positive impact on their behaviour

Question 41

What is homework, REBT?

Answer 41

• depressed clients are asked to complete homework assignments between therapy sessions
• vital for testing irrational beliefs out in the real world, and replacing them with more rational and positive beliefs

Question 42

What is behavourial activation?

Answer 42

• CBT encourages depressed clients to become more active and engage in pleasurable activities
• many depressed clients often do not engage in activities that they used to enjoy, so the therapist would encourage active participation

Question 43

What is DEF in REBT (Ellis)?

Answer 43

Disputing irrational thoughts and behaviour:
- logical disputing, getting the client to think about whether their though patterns ‘make sense
- empirical disputing, asking the client if there is evidence to support their beliefs

Effects of disputing and effective attitude to life:
- effective disputing can change self defeating beliefs into more rational beliefs
- the depressed client can move away from negative and irrational thinking
- e.g. “No one likes me” to more rational interpretations of events, e.g. “My friend has not replied to my text message because she is busy, not because she hates me.”

Feelings/emotions:
- depressed patient will begin to think in a more positive and rational way and they will begin to feel better
- can have a positive impact on their behaviour

Question 44

Evaluation of REBT (Ellis) +ve:

Answer 44

• Flannaghan et al. (1997) supports the use of REBT as an effective way to treat depressive stroke victims
• therefore suggests that REBT is a suitable treatment for specific groups of people with depression and can help them become more positive over time in terms of their thoughts and behaviour
  = research evidence to support the use of CBT as a therapy for depression
  David (2008) compared 170 depressive patients who had 14 weeks of REBT and compared them to depressive patients who were treated with the drug fluoxetine
  = outcomes were compared 6 months after the treatment ended
  = was found that REBT was a better long term treatment for depression compared to the drug therapy

Question 45

Evaluation of REBT (Ellis) -ve:

Answer 45

• unclear if the distorted negative thinking is the cause of depression or merely a symptom
• if it is only a symptom of depression then REBT is not tackling the root cause of the depression, and the depression might return in the future
• this means that the depression has not been cured properly
  = dependent on the depressed clients being articulate and being able to talk about their thought processes coherently
  = REBT would not work for people with severe depression if they were unable to talk or communicate properly, or those who feel uncomfortable talking about their feelings with a psychologist
  = so other treatments would have to be considered such as drug therapy
• success of the treatment depends upon the skill and expertise of the therapist
• the more skilled the therapist, the better the therapeutic outcomes will be for the depressed client, and this is essential for the treatments effectiveness
• therefore psychologists need to be highly skilled and develop a good bond with their client in order for REBT to be successful