depression

• Miegels frustrated with herself because she feels like she has every reason to be happy, yet she can't seem to shake the sense of doom and gloom that deads each day
• Although she hasn't ever considered suicide, Jessica has found herself having frequent thoughts of wishing she was dead
• Sadra is a 20-year-old university student. Her parents have been very worried since she returned home for a holiday. They hear Sadra up late into the night and notice that she appears to have lost quite a lot of weight.
• Major depressive disorder


  Severe but often short term depression
• Persistent depressive disorder


  Long-term depression, including sustained major depression and what used to be called dysthymic
• Disruptive mood dysregulation disorder


  Childhood temper outbursts
• Premenstrual dysphoric disorder


  Disruption to mood prior to and/or during menstruation
• Behavioural characteristics of depression

  • Reduced activity levels
  • Disruption to sleep and eating behaviour
  • Aggression and self-harm
• Lowered mood


  People with depression experience more negative emotions and fewer positive ones during episodes of depression
• Anger


  People with depression tend to experience more anger and aggression
• Lowered self-esteem


  People with depression tend to have a lower opinion of themselves than usual
• Cognitive characteristics of depression

  • Poor concentration
  • Attending to and dwelling on the negative
  • Absolutist thinking
• Most situations are not all-good or all-bad, but when a person is depressed they tend to think in these terms. This is sometimes called black-and-white thinking.
• When experiencing a depressive episode people are inclined to pay more attention to negative aspects of a situation and ignore the positives - the opposite bias that most people have when not depressed.
• Depression is associated with poor levels of concentration. The person may find themselves unable to stick with a task as they usually would, or they might find it hard to make decisions that they would normally find straightforward.
• Cognitive approach


  Explaining depression by focusing on mental processes and thinking patterns
• Beck's negative triad


  Three negative ways of thinking that contribute to depression: negative view of the world, negative view of the future, and negative view of the self
• Ellis's ABC model


  A - Activating event, B - Beliefs, C - Consequences. Explains how irrational beliefs triggered by events lead to emotional and behavioural consequences like depression
• Cognitive Behavioural Therapy (CBT)

  1. Assessment to identify problems and goals

  2. Challenge negative/irrational thoughts

  3. Develop more effective behaviours
• Beck's cognitive therapy


  • Identifies and challenges automatic negative thoughts about the world, self, and future (negative triad)
  • Helps client test reality of negative beliefs
• Ellis's Rational Emotive Behaviour Therapy (REBT)


  • Identifies and disputes (challenges) irrational thoughts
  • Uses vigorous argument to change irrational beliefs
• Behavioural activation


  • Gradually decrease avoidance and isolation, increase engagement in mood-improving activities
• CBT is widely seen as the first choice of treatment for depression in public health care
• Severe depression or clients with learning disabilities


  CBT may not be effective
• CBT has high relapse rates, with 42% of clients relapsing within 6 months and 55% within a year
• Some depressed people prefer medication or exploring the origins of their symptoms over CBT