Depression

• Depression:

  • depression is described as a mood disorder. It involves the disturbance of mood, mainly having a low mood
  • a characteristic is a symptom of a psychological disorder, which can be categorised in to 3 types: behavioural (how the individual acts and their observable behaviours), emotional (how the individual feels) and cognitive (how the individual thinks and their internal mental thought process)
• Behavioural characteristics of depression:

  • changes in sleep - persistently sleeping too much (hypersomnia) or too little (insomnia)
  • aggression and self harm - acting aggressively towards others such as shouting or hurting themselves such as cutting or burning
• Emotional characteristics of depression:

  • low mood - having a low, sad mood all the time or, persistent presence of feeling lost and empty inside
  • poor self esteem - having negative feelings about yourself, such as feeling unlikeable by peers or having poor body image
• Cognitive characteristics of depression:

  • poor concentration - not being able to focus on one task or, having problems with making decisions
  • negative schema - viewing everything negatively e.g. getting a B on an assessment may be seen as not getting an A rather than achieving a good grade
• The cognitive approach to explaining depression:

  • the cognitive approach suggests that behaviour is based on internal mental processes therefore, depression is caused by dysfunctional thinking, specifically, negative and irrational thoughts
  • there are two models used to explain depression: Ellis's ABC model and Beck's negative triad
• Ellis's ABC model:

  • this model is used to describe reactionary depression
  • this model was proposed by Ellis, and it is the idea that irrational thoughts lead to depression

  A - refers to activating the event

  B - the belief we have, which may be rational or irrational e.g. utopianism and musterbation

  C - the consequence of having this belief - in terms of feelings and behaviours. Rational beliefs lead to positive consequences and irrational beliefs lead to negative consequences

  • for example, the activating event of failing an exam activates the belief that they are a failure as faulty thinking states that they need to be perfect (utopianism) and get high grades in every assessment (musterbation), therefore as a consequence they leave education
• Ellis's ABC model:

  • thoughts and cognitions determine our behaviour
  • abnormalities and mental illnesses are a result of irrational or faulty thoughts and beliefs

  to explain depression, faulty thinking would include;

  • utopianism - the expectation that everything should always be perfect
  • musterbation - living by unrealistic demands

  when we think rationally, we behave rationally. When we think irrationally, we behave irrationally (abnormal)
• Beck's negative triad:

  • this explanation is used to explain endogenous depression
  • this was proposed by Beck and is the idea that negative thoughts lead to abnormality
  • faulty thinking in this model includes magnification of an undesirable event. This means the event is exaggerated in importance

  this involves three negative schemas for;

  • negative view of the self - blaming yourself for all failures
  • negative view of the world - generalising the failure to all aspects of life
  • negative view of the future - believing things will always be this way

  people with these negative schemas are more likely to suffer from depression
• Evaluation of the cognitive explanation of depression:

  S - empirical evidence - Grazioli and Terry

  S - practical application

  W - oversimplified explanation

  W - alternative explanations
• Empirical evidence - Grazioli and Terry (identify):

  • a strength of the cognitive explanation of depression is that there is empirical evidence to support
• Empirical evidence - Grazioli and Terry (explain):

  • Grazioli and Terry (2000) examined 65 pregnant women for evidence of faulty thinking before and after birth
  • they found that those women who had shown signs of dysfunctional thinking in questionnaires before birth were significantly more likely to develop post-natal depression
• Empirical evidence - Grazioli and Terry (conclusion):

  • this adds to the validity of the cognitive explanations of depression because there is evidence to support the idea that faulty thinking can be linked to depression
  • however questionnaires are used (social desirability bias)
• Practical application (identify):

  • a strength of the cognitive explanations of depression is that it has led to the development of an effective therapy
• Practical application (explain):

  • cognitive behavioural therapy (CBT) is a talking therapy that aims to identify and dispute the faulty thought processes and therefore change their thinking to something that is more positive
  • generally considered the most effective treatment for depression, with low relapse rates and no known side effects
• Practical application (conclusion):

  • this adds to the ecological validity of the cognitive explanations of depression because it has been used to develop a treatment, meaning it has had a positive impact on society
  • for example, somebody with depression may not leave the house and struggle to work, so this would be beneficial to their wellbeing and have positive implications for the economy
• Practical application (counterargument):

  • a weakness however is that the cognitive explanations has issues with determining causality. It is not clear whether depression is caused by irrational and negative thoughts or whether the thoughts occur as a result of suffering from depression due to cognitive symptoms like dwelling on the negative
  • this questions the internal validity of the cognitive explanations of depression as it is hard to establish a cause and effect relationship between irrational and negative thoughts and depression, which questions whether the explanation is accurate and may result in an inaccurate treatment that doesn't tackle the cause of the problem
• Oversimplified explanation (identify):

  • a weakness of the cognitive explanation of depression is that the explanations are overly simple
• Oversimplified explanation (explain):

  • the cognitive explanations explain depression in the simplest terms of dysfunctional thinking which can be criticised as being reductionist; reducing the complexity of depression as a disorder down to negative and irrational thoughts
  • it therefore ignores other factors, for example how depression could be learnt via operant conditioning. It could be that depression may be due to learned helplessness; when a repeated punishment leads people to giving up
• Oversimplified explanation (conclusion):

  • this questions the validity of the cognitive explanations of depression because it doesn't take other important factors, such as genes into account when explaining depression, meaning it can be argued that it is too simplistic as an explanation and therefore a more holistic approach would be appropriate
• Alternative explanations (identify):

  • a weakness of the cognitive explanations of depression is that there is alternative explanations
• Alternative explanations (explain):

  • research has indicated that depression can be explained as having a biological component, being caused by imbalances in brain chemistry
  • in particular, this biological explanation focuses on the role of neurotransmitters such as serotonin, which is responsible for regulating mood and emotions
• Alternative explanations (conclusion):

  • this questions the validity of the cognitive explanation of depression because it doesn't take other important factors, such as biological factors into account when explaining depression, meaning it can be argued that its too simplistic as an explanation and therefore a more holistic approach would be appropriate
• Alternative explanations (counterargument):

  • a better explanation of depression considers both biology and environmental factors such as the diathesis stress model
  • this states that while biology may pre-dispose someone to phobias (e.g. through biological factors such as neurotransmitters) environmental stress factors also need to be present (such as having a negative experience) for the symptoms to manifest and present as a disorder
  • it is therefore a combination of nature and nurture
• The cognitive approach to treating depression:

  • the aim of cognitive behavioural therapy (CBT) is to identify and dispute dysfunctional thoughts, which will lead to improved emotions and behaviours
  • the patient is treated as a scientist who has to test and challenge their beliefs
  • one specific type of CBT is Ellis's rational emotive behaviour therapy (REBT)
  • it works by extension of Ellis's explanation, adding disputations of beliefs and effective new beliefs to his ABC model (ABCDE)
• Ellis's rational emotive behaviour therapy:

  it works in 3 stages;

  • identify irrational thoughts
  • dispute the beliefs
  • rational confrontation
• Identify irrational thoughts:

  • the patient and therapist complete and initial assessment to identify irrational thoughts. The patient is required to keep a diary to help identify these
• Dispute the beliefs:

  the therapist and patient will challenge the irrational beliefs through 3 types of disputing;

  • logical disputing - using logical to question the thoughts ('does the way you think about this situation make sense?')
  • empirical disputing - providing evidence for a thought ('where is the evidence that your beliefs are true?')
  • pragmatic disputing - questioning the practicality of the thought and how it benefits the patient ('does this thought help you in any way?')
• Rational confrontation:

  • the patient is set homework which challenges the irrational beliefs and implements new adaptive beliefs
  • for example, someone who is anxious in social situations may be set a homework assignment to meet a friend for a drink
• Evaluation for treatments for depression:

  S - there is evidence to support - Hollon

  W - not appropriate for severely depressed patients

  W - ignores the role of the past

  W - relies on self-report
• There is evidence to support - Hollon (identify):

  • a strength of the cognitive treatments of depression is that there is evidence to show the effectiveness of CBT as a treatment for depression
• There is evidence to support - Hollon (explain):

  • Hollon (2005) studied depressed patients who had a successful response to drug therapy or CBT
  • he found that 31% of CBT patients had relapsed after 12 months, compared to 76% of patients using antidepressants
• There is evidence to support - Hollon (conclusion):

  • this adds to the effectiveness of CBT as a cognitive treatment for depression because it has been shown to decrease the rate of relapse for clients after treatment, suggesting it must target the causes of the problem not just the symptoms and be successful in treating depression long term
• Not appropriate for severely depressed patients (identify):

  • a weakness of the cognitive treatments of depression is that it may not be appropriate for the most severely depressed patients
• Not appropriate for severely depressed patients (explain):

  • cognitive behaviour therapy is a talking therapy and therefore may not be accessible to patients who lack the motivation or desire to discuss their depression
  • biological therapies like SSRI antidepressants may be more appropriate for these patients in the short term, being a lot more accessible than challenging your own thought processes
• Not appropriate for severely depressed patients (conclusion):

  • therefore, this questions the appropriateness of the treatment as it cannot successfully treat all clients with depression and is not accessible for a wide range of individuals, meaning other treatments of depression might be more suitable
• Ignores the role of the past (identify):

  • a weakness of CBT is that it focuses too heavily on the present and ignores the past
• Ignores the role of the past (explain):

  • cognitive behavioural therapy works by identifying current irrational thoughts
  • it focuses purely on what is happening in the present which means that is may overlook previous traumatic experiences or difficult childhoods which need addressing for the client, instead of focussing too much on their day to day experience
• Ignores the role of the past (conclusion):

  • therefore this questions the effectiveness of the treatment as it may be missing factors that contribute to the symptoms of depression therefore not treating the underlying causes
  • this would increase the likelihood of relapse
• Relies on self report (identify):

  • a weakness of cognitive treatments of depression is that they rely on the patient self-reporting their thoughts
• Relies on self report (explain):

  • cognitive behavioural therapy relies on the patient's ability to identify their own thoughts, in particular being able to communicate these to a therapist
  • patients who are experiencing depression may not want to share their true negative feelings to a therapist
  • they may mask their underlying feelings, leading to an inaccurate account of their experiences
  • the self-reports may be unreliable and difficult to verify leading to difficulties in accessing the therapy