psychological problems

• what is mental health?


  the ability to function adequately and cope with everyday life.
• challenges of modern living

  • economic deprivation (worries about money, jobs)
  • social isolation (elderly living alone/longer, more poeple moving to cities)
• social affects -3

  • more need for social care
  • increased crime rates
  • implications for economy
• individual affects- 2

  damage to relationships (people may misunderstand why person with mhp is avoiding them)

  • difficulty with day to day life (getting up/dressed, eating regularly, attend work regularly, keep themselves clean)
• 2 types of depression

  • unipolar- only experience one state (depression)
  • bipolar- experience two states (mania vs depression)
• ICD symptoms of depression 


  1. persistent sadness or low mood
  2. loss of interest/pleasure
  3. fatigue/low energy
  4. disturbed sleep
  5. poor appetite
  6. low self-confidence
  7. poor concentration
  8. guilt
  9. pessimistic future views
  10. suicidal thoughts
• what do neurotransmitters do?


  • chemicals stored in vesicles that travel across the synapse
  • send messages from one neuron to another
  • messages cause excitation or inhibition of the next neuron
• what is the job of serotonin?

  • regulates mood
  • Low serotonin levels linked to depression
  • levels low the message does not get transmitted to the next neuron, resulting in low mood.
• nurture reason for low serotonin

  •Research shows that depression runs in families, suggesting that low levels of serotonin can be inherited.
• nature reason for low serotonin

  •substance called tryptophan is a key ingredient in the production of serotonin.

  •Tryptophan comes from high protein foods like eggs, cheese and fish and from eating carbohydrates.

  •A diet low in tryptophan will not produce much serotonin.
• evaluation- research support

  •There is evidence to support the serotonin hypothesis.

  •For example, one study showed that people with depression had lower levels of serotonin in their brains than those in a control group.

  •This supports the link between serotonin and depression.
• evaluation- cause/effect

  •A weakness of the serotonin explanation is the issue of cause and effect.

  •When a person is depressed it leads to them having negative thoughts about themselves, their place in the world and their chances in the future. These thoughts may lead to chemical changes in the brain.

  •This means that low levels of serotonin may be an effect of depression rather than causing it.
• evaluation- not just nature

  •It is unlikely that low levels of serotonin alone are responsible for depression. This is because some people have low levels of serotonin but don’t get depression.

  •Diathesis suggests a biological vulnerability – e.g. low levels of serotonin

  •Stress refers to a stressor in the environment such as a failed relationship or traumatic experience

  •The combination of the two can explain why some people become depressed when faced with adversity and others don’t.
• cognitive approach to depression

  • our thoughts determine our behaviours and emotion
  • suggests depression is caused by irrational thinking
• negative schemas

  •if we have a negative self-schema we are likely to have negative thoughts about ourselves, particularly if we face a negative life event.
• whqt are attributions?

  • ways of explaining behaviour.
• martin seligmans negative attributions

  •Internal attribution – it’s my fault

  •Stable attribution – people will never like me again

  •Global attribution – everything I do goes wrong

  makes people think that things can’t change and there is no hope for the future.
• what is learned helplessness?

  •When faced with a negative or unpleasant experience we try to escape.

  •If, however, we can’t escape eventually we give up trying, we believe that we are helpless.

  •A person starts to blame things on themselves (internal) and thinks things will always be this way (stable and global).
• evaluation of learned helplessness

  P: There is evidence to support the theory of learned helplessness.

  E: Seligman found that dogs did not try to escape from shocks that they previously had no control over. Seligman felt this was the same for depressed people who learn they have little control over their lives so give up.

  C: This supports the negative attribution explanation of depression.
• evaluation of cognitive approach

  P: The cognitive explanation has led to the real world application of therapy to treat depression.

  E: Cognitive behaviour therapy works by showing a person that they are thinking irrationally and that this is having a negative effect on their emotions and behaviour. They are then taught to think more rationally.

  C: This therefore is a successful way to treat people with depression, helping them and wider society.
• evaluation of negative attributions

  P:One weakness is that negative or depressing thoughts might actually be quite realistic and not irrational.

  E: Sometimes bad things happen and life isn’t good. If you were to have positive thoughts at this time it would be an unrealistic view of the situation.

  C: Therefore, a negative attributional style may actually be an accurate way of viewing the world.
• what is the most common anti-depressant?

  SSRIs (Selective Serotonin Reuptake Inhibitors)
• how do SSRIs work?

  •blocking the reuptake of serotonin into the presynaptic neuron by the reuptake transporters.

  •SS – it only selects (or works on) serotonin

    RI – it inhibits the reuptake of serotonin

  •Blocking the reuptake of serotonin means that more of it is left in the synaptic cleft making it more likely that it will pass its message to nearby neurons.

  •The blockage happens because the serotonin molecules occupy the reuptake transporter.
• evaluation of SSRIs

  •P: One issue with using drugs such as SSRIs to treat depression is that they can have serious side effects.

  •E: These include nausea, insomnia, dizziness, weight loss or gain, anxiety, sweating and in extreme cases raising the risk of suicide.

  •C: These side effects mean that people may stop taking their medication, making drug treatment ineffective.
• How long does it typically take for anti-depressants to show a positive effect?

  3 to 4 weeks
• What does the delayed positive effect of anti-depressants suggest about serotonin levels?

  Simply raising serotonin levels is not the answer
• What does some evidence suggest about serotonin levels in people with depression compared to non-sufferers?

  They do not have serotonin levels that are significantly different
• What is the placebo effect in the context of anti-depressants?

  Improvement due to expectations from a non-medical tablet
• What are the key points regarding the effectiveness of anti-depressants based on the study material?

  • Anti-depressants raise serotonin levels immediately.
  • Positive effects often take 3 to 4 weeks to manifest.
  • Simply raising serotonin levels may not be sufficient.
  • Evidence suggests serotonin levels in depressed individuals may not differ significantly from non-sufferers.
  • The placebo effect may explain some apparent successes of anti-depressants.
• evaluation of anti-depressants being reductionist

  •P: The use of antidepressants is a reductionist approach to treating depression.

  •E: This means that it is reducing the explanation for depression down to levels of serotonin.

  •C: It may be better to use a holistic approach to treatment, combining drugs with psychological treatment like cognitive behaviour therapy (CBT).
• what is cbt?

  •CBT is the most commonly used psychological treatment of depression.

  •directly targets the client’s behaviour, for example by using behavioural activation.

  •This is where the client is encouraged to perform one positive activity each day, such as going to the cinema or having a nice meal.

  •These activities should create more positive emotions.
• how is a thought diary used?


  •patients asked to note any unpleasant emotions they experience.

  •record the automatic negative thoughts they have during these experiences and rate them on a level of 1-100%

  •They then write a more rational response to the automatic thoughts and rate this out of 100%
• evaluation- strength of cbt

  •P: CBT can be effective in treating depression in the long term.

  •E: CBT aims to change the client’s underlying thought processes and teach them techniques to challenge future episodes of depression.

  •C: Therefore CBT doesn’t just treat the symptoms of depression but addresses the causes and helps to avoid further problems.
• evaluation of cbt- limitataion

  •P: takes a lot of time and commitment to be successful.

  •E: Unlike antidepressants which are a passive treatment, with CBT the client needs to regularly meet a therapist, consider their irrational thoughts, emotions and behaviours, keep a diary etc.

  •C: This can lead to CBT having large drop-out rates.
• evaluation of cbt- type of therapy effectiveness

  •P: It may be that it doesn’t really matter what type of therapy the client is receiving.

  •E: Rosenzweig (1936) suggested that all therapies share essential ingredients - therapists tend to be good at talking to people and clients improve by having somebody to talk to, regardless of the approach used. He called this the ‘Dodo bird effect’.

  •C: This suggests that the most important thing is that the client-therapist relationship is supportive.
• what was the aim of Wiles' et al study

   to investigate how effective combined therapy is for people with depression who are treatment-resistant
• sample of Wiles' study

  469 treatment-resistant patients with depression from Bristol, Exeter and Glasgow, recruited via their GP
• method of Wiles' study

  patients were randomly allocated to one of the following two conditions:

  • Condition 1: Usual care (each patient continued to take the antidepressant they had been prescribed)
  • Condition 2: Usual care + CBT(their usual antidepressant plus 12-18 sessions of CBT lasting an hour per session)
• results of Wiles' study

  • at the end of 6 month 422 participants (90%) remaianed
  • usual care: 21.6% had more than 50% reduction in symptoms
  • usual care + CBT: 46.1% had more than 50% reduction in symptoms
• conclusion of Wiles' study

  amongst those that don't respond to anti-depressants, cbt in addition to them is an effective method of treating depression