Depression

• What is depression?

  • Depression is a mood disorder affecting a person’s internal emotions.
  • Mood disorders such as depression are indicative of dramatic changes or extreme moods.
  • Depression occurs in 1 in 10 adults in the UK.
• Emotional characteristics of depression?

  • Sadness is common as well as feeling empty.
  • People report differences in negative feelings like feeling worthless and general low self-esteem.
  • People report feeling a loss of interest and pleasure in hobbies as well as social withdrawal.
  • They are associated with feelings of despair and loss of control. 
  • Anger is also associated with depression, either directed at others or turned inwards against themselves
• Behavioural characteristics of depression?

  • In most patients, there is a shift in energy level reduced or increased.
  • Many can report tiredness or can feel agitated and restless.
  • Sleep can also be affected with some sleeping more but some may lay awake worrying about things.
  • Appetite may be affected.
  • This can be eating more or less than usual. 
• Cognitive characteristics of Depression?

  • Negative emotions are associated with negative thoughts.
  • People develop a negative self-concept about themselves, which is self fulfilling.
  • People may feel like they will not do well so they don’t try as hard and fail.
  • These are irrational thoughts and do not reflect reality.
• What is Elli's ABC model?

  Albert Ellis proposed that depression was due to irrational thinking. The ABC model goes as following:

  • Activation: An activating event like getting fired at work
  • Belief: Rational or irrational belief
  • Consequence: Rational beliefs lead to healthy emotions and behaviours. Irrational ones lead to unhealthy emotions like depression. 
• What was the source of irrational beliefs?

  • The source of irrational beliefs is in “mustabatory thinking”.
  • This is thinking that certain assumptions must be true in order to be happy.
  • There are 3 main beliefs: 
  • Being approved of or accepted by people
  • You must do well or you are worthless
  • The world must give happiness or I will die

  People who think like this will be disappointed. These “musts” must be challenged.
• What was Becks' cognitive triad?

  • Beck believed that people with depression develop a negative self-schema in which they adopt a set of beliefs and expectations of themselves that are negative and pessimistic. 
  • Beck believes that these could be obtained in childhood as a result of traumatic experiences negative self-schemas, leading to confirmation bias where we look for confirmation of our beliefs at that point.
  • People with negative self-schemas become prone to errors in their thinking. Beck called these errors ‘cognitive biases’.
• Negative evaluation regarding correlational data?

  • Data between negative thinking and depression is correlational, so we can’t infer cause and effect.
  • Many argue that it is an effect of depression rather than the cause.
  • However, a study supports negative thinking causing depression.
  • Grazioli and Terry looked at cognitive vulnerability in 65 women in their third trimester where they found that people with higher cognitive vulnerability were much more likely to develop post-natal depression.
  • Bad thoughts came first during pregnancy and then the depression came after the pregnancy
• Positive evaluation regarding treatment?

  • Cognitive model has led to the development of CBT, which aims to challenge negative thoughts like cognitive restructuring. 90% of patients show improvement with CBT.
• Evaluation regarding accurate perception?

  • Appropriateness - some irrational beliefs are actually more accurate than the beliefs of most normal people.
  • This is known as depressive realism.
  • Depressed people give more accurate estimates of the likelihood of disaster.
• Negative evaluation regarding determinism?

  • Deterministic - Negative thinking is suggested to always lead to depression, however it links to anxiety and eating disorders.
  • This means that it is deterministic as negative thinking may not always lead to depression but rather other disorders.
• Negative evaluation regarding reductionism?

  • It reduces depression to faulty thinking, this is way too simplistic as there are other factors like biological factors.
  • Depression is caused by certain genes that lead to an imbalance of neurotransmitters, serotonin levels are too low in people with depression.
  • It is likely that depression is caused by a combination of factors like the diathesis-stress model.
  • An individual with a genetic vulnerability for depression who is living in a negative environment may develop negative thinking that leads to depression. 
• Why was REBT developed?

  • Common irrational ideas include “Everyone should approve of me” and “it would be awful to fail” - Ellis and Harper (1975). These can transform small mistakes into catastrophes.
  • People can talk themselves into emotional traumas yet believe it is the events rather than thoughts upsetting themselves, this is called “awfulising”. 
  • REBT helps them understand these irrationalities. It substitutes these beliefs for more effective problem-solving methods.
  • This is called “cognitive restructuring”, which is used in a variety of situations like depression and addiction. 
• How is REBT done?

  • Patients can develop a dispute system so they can challenge these beliefs, they will no longer suffer such emotional problems.
  • Client is encouraged to dispute the beliefs:
  • Logical disputing - self-defeating beliefs do not follow logically from the information available - Does thinking make sense this way?
  • Empirical disputing - self-defeating beliefs not consistent with reality  - Where is proof?
  • Pragmatic disputing - usefulness of self-defeating beliefs - how does this new belief help?
  • Clients get homework where they consider what beliefs are rational
• Evaluation of effectiveness of REBT?

  • Effectiveness: Ellis (1957) claimed a 90% success rate for REBT with patients taking 27 sessions to complete treatment.
  • However, results may be biased as Ellis devised REBT and carried out the support study for it.
  • Regardless, more supporting evidence for REBT, in a meta-analysis of different therapy, REBT is cited as having the second highest average success rate of 10 different forms of therapy.
  • REBT is an effective treatment for depression.