psychopathology - depression

• Behavioural characteristics of depression

  ~ activity levels

  ~ disruption to sleep and eating behaviour

  ~ aggression and self harm
• activity levels (depression)

  ~ people with depression have reduced energy levels

  ~ this has a knock on effect - they can withdraw from work, education and social life

  ~ can be so severe someone doesn't get out of bed

  ~ can also have the opposite effect - psychomotor agitation

  ~ agitated individuals can struggle to relax ad may end up pacing up and down
• Disruption to sleep and eating behaviour (depression)


  ~ depression is associated with changes to sleeping behaviour

  ~ can experience reduced sleep (insomnia) - particularly premature waking

  ~ can experience an increased need for sleep (hypersomnia)

  ~ appetite and eating may also increase or decrease, leading to changes in weight
• aggression and self harm (depression)


  ~ depressed people are often irritable, and can become verbally or physically aggressive

  ~ this behaviour can have serious effects on someone's life

  > may lead to losing a job or ending a relationship because of verbal aggression

  ~ can also lead to physical aggression directed to the self

  > self-harm and suicide
• emotional characteristics of depression


  lowered mood

  anger

  low self esteem
• lowered mood (depression)


  ~ not just feeling sad and lethargic during the day

  ~ depressed people could describe themselves as 'worthless' and 'empty
• anger (depression)


  ~ depressed people tend to experience more negative than positive emotions

  ~ negative emotion is not limited to sadness

  ~ people frequently experience anger, sometimes extreme anger

  > can be directed to the self or others

  ~ can lead to aggressive or self-harming behaviour
• lowered self-esteem (depression)


  ~ self esteem: the emotional experience of how much we like ourselves

  ~ depressed people tend to report reduced self-esteem ( they like themselves less than usual )

  ~ the lowered self esteem can be extreme

  ~ some describe a sense of self-loathing
• cognitive characteristics of depression


  ~ poor concentration

  ~ attending to and dwelling on the negative

  ~ absolutist thinking
• poor concentration (depression)


  ~ a depressed person may find themselves unable to sick with a task or make a decision they would normally find straightforward

  ~ poor concentration and poor decision-making are likely to interfere with the individual's work
• attending to and dwelling on the negative (depression)


  ~ people are inclined to pay more attention to the negative aspects of a situation and ignore the positives

  > glass half-empty

  ~ bias towards recalling unhappy events rather than happy ones - the opposite bias that people have when not depressed
• absolutist thinking (depression)


  ~ most depressed people tend to think that situations are all-good or all-bad

  > black and white thinking

  ~ when a situation is unfortunate they tend to see it as an absolute disaster
• What did Aaron Beck (1967) do?


  ~ took a cognitive approach to explaining why some people are more vulnerable to depression than others

  ~ suggested it's a person' s cognitions that create this vulnerability

  ~ suggested there are three parts to this cognitive vulnerability
• the three parts of cognitive vulnerability (negative triad)


  ~ faulty information processing

  ~ negative self-schema

  ~ the negative triad
• faulty information processing (Beck)


  ~ when depressed, people attend to the negative aspects of a situation and ignore the positives

  ~ people also tend to blow small problems out of proportion and think in 'black-and-white' terms
• negative self-schema (Beck)


  ~ schema: a 'package' or ideas and information developed through experience, act as a mental framework for the interpretation of sensory information

  ~ self-schema: the package of information people have about themselves

  ~ people use schema to interpret the world, so if a person has a negative self-schema they interpret all information about themselves in a negative way
• the negative triad (Beck)


  ~ Beck suggested that a person develops a dysfunctional view of themselves because of three types of negative thinking that occur automatically, regardless of the reality of what is happening at the time
• the three elements of the negative triad


  ~ negative view of the world - such thoughts create the impression of no hope

  
  

  ~ negative view of the future - such thoughts reduce any hopefulness and enhance depression

  
  

  ~ negative view of the self - such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem
• Strengths of Beck's negative triad


  ~ research support

  ~ real-world application
• research support (Beck) - strength


  ~ in a review Clark and Beck (1999) concluded that not only were cognitive vulnerabilities more common in depressed people but they preceded the depression

  ~ this was confirmed in a more recent prospective study by Joseph Cohen et al (2019)

  > they tracked the development of 472 adolescents, regularly measuring cognitive vulnerability - it was found that showing cognitive vulnerability predicted later depression

  ~ therefore, there is an association between cognitive vulnerability and depression
• real-world application (Beck)


  ~ Beck's model has applications in screening and treatment for depression

  ~ Cohen et al. concluded that assessing cognitive vulnerability allows psychologists to screen young people, identifying those most at risk of developing depression in the future and monitoring them

  ~ understanding cognitive vulnerability can also be applied in cognitive behaviour therapy (CBT)

  > these therapies work by altering the kind of cognitions that make people vulnerable to depression, making them more resilient to negative life events

  ~ this means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice
• weakness of Beck's negative triad - it's a partial explanation


  ~ depressed people do show particular patterns of cognition which can be seen before the onset of depression, meaning Beck's suggestion of cognitive vulnerabilities is at least a partial explanation for depression

  ~ there are some aspects to depression that are not particularly well explained by cognitive explanations

  > e.g. some depressed people feel extreme anger, and some experience hallucinations and delusions
• what did Albert Ellis (1962) suggest?


  ~ cognitive approach

  ~ he proposed that good mental health is the result of rational thinking (thinking in ways that allow people to be happy and free from pain)

  ~ according to Ellis, conditions like anxiety and depression result from irrational thoughts (not illogical or unrealistic thoughts, but thoughts that interfere with us being happy and free from pain)

  ~ Ellis used the ABC model to explain how irrational thoughts affect our behaviour
• A - Activating Event (ABC model)


  ~ situations in which irrational thoughts are triggered by external events

  ~ we get depressed when we experience negative events and these trigger irrational beliefs

  > e.g. failing an important test or ending a relationship
• B - Beliefs (ABC model)


  ~ Ellis identified a range of irrational beliefs

  ~ 'musturbation' - the belief that we must always succeed or achieve perfection

  ~ 'I-can't-stand-it-itis' - the belief that is it a major disaster whenever something does not go smoothly

  ~ 'utopianism' - the belief that life is always meant to be fair

  ~ there are triggered by activating events
• C- Consequences (ABC model)


  ~ when an activating event triggers irrational beliefs there are emotional and behavioural consequences

  > e.g. if a person believes that they must always succeed and then fails at something this can trigger depression
• strength of Ellis' ABC model - real world application


  ~ Ellis' approach to cognitive therapy is called Rational Emotive Behaviour Therapy (REBT)

  ~ the idea of REBT is that by vigorously arguing with a depressed person the therapist can alter the irrational beliefs that are making them unhappy

  ~ there is evidence to support the idea that REBT can both change negative beliefs and relieve the symptoms of depression (David et al. 2018)
• weaknesses of Ellis' ABC model


  ~ reactive and endogenous depression

  ~ ethical issues
• reactive and endogenous depression (ABC model)

  ~ Ellis' model of depression only explains reactive depression and not endogenous depression

  ~ no doubt that depression is triggered by activating events

  ~ how we respond to negative events also seems to be partly because of our beliefs

  ~ many cases of depression are not traceable to life events and it is not obvious what leads the person to become depressed at a particular time

  > endogenous depression

  ~ Ellis' model is less useful for explaining endogenous depression so therefore it's a partial explanation for depression because it cannot explain all cases
• ethical issues (ABC model)


  ~ the ABC model is controversial because it locates responsibility for depression purely with the depressed person

  ~ however, provided it is used appropriately and sensitively, the application of the ABC model in REBT does appear to help some people achieve more resilience and feel better
• cognitive element of CBT


  ~ CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the client's problems

  ~ they jointly identify goals for the therapy and put together a plan to achieve them

  ~ one of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge.
• behaviour element of CBT


  ~ CBT then involves working to change negative and irrational thoughts and finally put more effective behaviours into place
• Beck's Cognitive Therapy


  ~ an application of his theory

  ~ aim is to identify automatic thoughts about the world, the self and the future

  ~ once identified the thoughts must be be challenged

  > central component of the therapy

  ~ cognitive therapy also aims to help clients test the reality of their negative beliefs

  > might be set homework, such as to record when they enjoyed an event or someone was nice to them

  ~ 'client as scientist' - when they investigate the reality of their negative beliefs like a scientist

  ~ in future sessions if clients say no one is nice to them or there is no point in going to events, the therapist can then produce this evidence and use it to prove the client's statements are incorrect
• Ellis' REBT


  ~ rational emotive behaviour therapy

  ~ extends the ABC model to an ABCDE model

  > D - dispute, E- effect

  ~ central technique is to identify and dispute irrational thoughts

  > a client might talk about how unlucky they are or how unfair things are, the REBT therapist would identify these beliefs as utopianism and challenge them as irrational, which would involve a vigorous argument

  ~ the intended effect of the argument is to change the irrational belief and so break the link between negative life events and depression
• Ellis' methods of disputing


  ~ empirical argument: disputing whether there is actual evidence to support the negative belief

  ~ logical argument: disputing whether the negative though logically follows from the facts
• behavioural activation (BA)


  ~ as individuals become depressed, they tend to increasingly avoid the situations and becomes isolate, which may worsen symptoms

  ~ the goal of BA is to work with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood

  > e.g. exercising, going out to dinner

  ~ the therapist aims to reinforce such activity
• strengths of CBT


  ~ evidence for the effectiveness

  ~ newfound suitability for diverse clients
• evidence for effectiveness of CBT


  ~ many studies show CBT works

  ~ John March et al (2007) compared CBT to antidepressants and also to a combination of both treatments when treating 327 depressed adolescents

  > after 36 weeks, 81% of the CBT group, 81% of the antidepressant group and 86% of the combined group were significantly improved

  > CBT was just as effective when used on its own and more so when used alongside antidepressants

  ~ CBT is usually a fairly brief therapy requiring 6-12 sessions

  > cost-effective

  ~ CBT is widely seen as the first choice of treatment in public health care systems such as the NHS
• newfound suitability for diverse clients (CBT)


  ~ although the conventional wisdom has been that CBT is unsuitable for very depressed people and for clients with learning disabilities, there is now some more recent evidence that challenges this

  ~ Gemma Lewis and Glyn Lewis (2016) concluded in a review that CBT was just as effective as antidepressant drugs and behavioural therapies for severe depression

  ~ another review by John Taylor et al. (2008) concluded that, when used appropriately, CBT is effective for people with learning disabilities

  ~ this means that CBT may be suitable for a wider range of peeple than was once thought
• weaknesses of CBT


  ~ suitability for diverse clients

  ~ relapse rates

  ~ client preference