Psychological problems

• Mental health


  The state of mental wellbeing in which one can cope with the demands of daily life and engage with society
• Individual effects of mental health problems

  • Affects the ability to talk to others which affects relationships because communication is important
  • Isolating as people avoid being with others as they feel bad about themselves and fear judgement
  • Difficulties coping with day-to-day life - mental health problems are linked to difficult with getting dressed, socializing, cleaning the house etc. This could cause a patient little distress but it may be distressing to other
  • Negative impact on physical well-being - If you are anxious or stressed the body produces cortisol. This prevent the immune system functioning properly, so physical illness is more likely
• Social effects of mental health problems

  • Need for more social care - Taxes are used to fund social care offering people who are in need of basic necessities ie food, water, shelter. Social care includes helping people to learn how to care for themselves and teaches new social and work skills
  • Increased crime rate - Increased risk of violence in people with mental health problems. However this may be explained by co-occurring problems eg substance abuse. Only 1 in 20 crimes were linked to mental health problems
  • Implications for the economy - Estimated that mental health care costs £22 billion a year. Cheaper drug treatments should be researched more. Increase in dementia is also a issue
• Clinical depression


  Medical name given for depression
• Sadness


  A 'normal' emotion where you can still function
• Depression


  Involves an enduring and all-encompassing sadness that stops the ability to function
• Unipolar depression


  One emotional state of depression. Feeling continually sad, losing interest and enjoyment in everyday life
• Bipolar depression


  Depression that causes a persons mood, energy and activity levels to move between emotional highs (mania) and lows
• Diagnosing depression


  1. The international classification of diseases (ICD-10) lists symptoms of different disorders and a person is diagnosed with any one disorder if they display the symptoms

  2. A diagnosis of mild unipolar depression requires two of the three key symptoms plus two others

  3. Moderate unipolar depression requires five or six symptoms and severe requires seven or more

  4. Symptoms should be present all or most of the time and for longer than two weeks
• Key symptoms of depression

  • Low mood - depressed mood most of the day and nearly everyday
  • Loss of interest and pleasure - diminished interest or pleasure in most activities of the day
  • Reduced energy levels - this has a knock on effect on work, education, and social life
• Other symptoms of depression

  • Changes in sleep patterns - reduced sleep (insomnia), early waking, or more need for sleep (hypersomnia)
  • Changes in appetite - this may increase or decrease leading to weight gain or loss
  • Decrease in self confidence - may have a sense of self loathing
  • Guilt, pessimism, ideas of self harm or suicide, reduced concentration
• Biological explanation of depression


  Focuses on physical influences (nature)
• Psychological explanation of depression


  Focuses on other factors like the influence of others or our thinking (nurture)
• Neurotransmitters


  Messages travel along the neuron electrically but the message is transmitted chemically across the synapse by neurotransmitters
• Serotonin


  • A neurotransmitter which has been linked to several behaviours including depression
  • High levels of serotonin in the synaptic cleft means the postsynaptic neuron is stimulated, improving mood
  • Low levels at the synapse means less stimulation of the post synaptic neuron, resulting in a low mood
  • Serotonin also affects memory, sleep and appetite. These are linked to the characteristics of depression e.g lack of concentration, disturbed sleep and reduced appetite
• Reasons for low serotonin levels

  • Genes may cause low serotonin levels where someone inherits a poor ability to produce serotonin
  • Diet (an environmental influence) may cause low levels of tryptophan, a key ingredient of serotonin. High-protein foods and carbohydrates contain tryptophan
• Evaluation of the biological explanation of depression

  • Strength - research support - McNeal and Cimbolic found lower levels of serotonin in the brains of people with depression. This suggests that there is a link between low levels of serotonin and depression
  • Weakness - cause or effect? - low levels of serotonin could be an effect of being depressed. Thinking sad thoughts and having difficult experiences could cause low serotonin levels. This means low level of serotonin may be an effect psychological experiences rather than the cause of them
  • Weakness - alternative explanations - depression may not be solely caused by abnormal levels of neurotransmitters. Some people with low levels of serotonin don't have depression and some people with depression don't have low levels of serotonin. This means that the neurotransmitter explanation isn't enough on its own
• Psychological explanations of depression

  • Faulty thinking - when a person is depressed they focus on the negative and ignore positives and think in black and white terms. This creates feelings of hopelessness and depression
  • Negative schemas - mental frameworks containing ideas and informations developed through experiences. Having a negative self-schema means you are likely to interpret all information about yourself in a negative way
  • Attributions - the process of explaining causes of behaviour - Seligman proposed that some people have a negative attributional style. These are internal, stable and global attributions which result in depression
  • The influence of nurture - Seligman suggested that a negative attributional style is learned. An unpleasant experience makes you try to escape but if you can't escape you learn to give up trying. This is called "learned helplessness"
• SSRI (selective serotonin reuptake inhibitor)


  Selectively target serotonin at the synapse and inhibits the reuptake of serotonin molecules
• How SSRIs work


  1. Serotonin is stored at the end of a transmitting (presynaptic) neuron in sacs called vesicles

  2. The electrical signal travelling through the neuron causes the vesicles to release serotonin into the synaptic cleft

  3. Serotonin locks into the postsynaptic receptors, chemically transmitting the signal from the presynaptic neuron

  4. Normally serotonin is taken back into the presynaptic neuron, broken down and reused. SSRIs block this reuptake so when new serotonin is released it adds to the amount held in the synaptic cleft
• Evaluation of antidepressants (SSRI's)

  • Weakness - side effects - SSRIs have serious side effects e.g nausea, insomnia, anxiety and suicidal thoughts. Side effects mean that people stop taking the drugs, affecting the effectiveness of dug therapies
  • Weakness - questionable evidence of effectiveness - research shows that the serotonin levels of depressed people may not actually be that different from the normal population. Only 30% of the people who take SSRIs have reduced symptoms. This suggests the effectiveness of the drug may not be related to serotonin (placebo effect)
  • Weakness - reductionist approach - antidepressant medication targets serotonin so it only focuses on one kind of factor. This suggests other treatments are not necessary but a more successful treatment might include both biological and psychological approach
• CBT (cognitive behaviour therapy)

  Focuses on what a client thinks. Negative irrationally or faulty thinking causes depression because people tend to catastrophise and think in all or nothing terms. Aim of therapist is to change this to rational thinking to reduce depression
• How CBT works


  1. Behaviour - CBT aim to change behaviour by indirectly changing thinking. Direct Change to bahviour e.g bahvioural activation where a pleasant activity is planned each day creates more positive emotions and mood

  2. Therapist dealing with irrational thoughts - "disputing" is used to deal with the negative and irrational thoughts. The clients irrational thoughts are challenged. More rational thinking leads to greater self-belief and self-liking

  3. Client dealing with irrational thoughts - any negative thoughts are recorded in a diary where the client also records the "automatic" thoughts created by these emotions. The client rates how much they believe in these thoughts. A rational response to the automatic thoughts is then recorded and rated
• Evaluation of CBT


  • Strength - lasting effectiveness. The "tools" learned in CBT to help challenge irrational thoughts can help the client deal with future episodes of depression. Therefore this therapy offers long term solutions where they can draw on skills they learned in thr future
  • Weakness - takes a long time and it may not always be successful. Therapy takes months, homework is expected so a lot of effort is needed in comparison to just taking a pill. This means that many people drop out or fail to engage enough for it to work
  • Strength - holistic approach. CBT focuses on treating the whole person and what they think/ feel. This may be preferable because it deals with the core symptoms of depression (e.g feeling sad)
• Only 30% of patients with depression respond fully to antidepressants. The remaining 70% are 'treatment resistant' and need an alternative therapy
• There is evidence that treatment resistant patients do improve when receiving a combination of medication plus cognitive behaviour therapy (CBT)
• Wiles study


  1. Aim - to test the benefit of a hollistic approach (CBT + antidepressants) for treating people with treatment-resistant depression, compared to antidepressants alone

  2. Method - 469 patients with treatment-resistant depression were randomly assigned to either usual care (just antidepressants) or usual care and CBT

  3. Improvement was assessed using the Beck Depression Inventory (BDI) before and after

  4. Results - after 6 months, 21.6% of usual care group and 46.1% of usual care + CBT had more than a 50% reduction in symptoms. After 12 months those having usual case + CBT continued to show greater levels of recovery

  5. Conclusion - CBT + antidepressant medication is more effective in reducing depressive symptoms than antidepressant medication alone
• Evaluation of the Wiles study

  • Strength - well designed study - extraneous variables were carefully controlled. The two groups has the same average depression score at the start and participants were randomly assigned to groups. This means that we can conclude that changes in the dependent variable (reduction in symptoms) were not affected by extraneous variables
  • Weakness - assessment of depression - the use of self-report methods to determine levels of depression. This means that participants have to make subjective judgements about how they felt. Some people might have underestimated how sad they feel and others might have overestimated. This questions the validity of the information collected about depression
• The Wiles study focused on developing a useful therapy with real world application
• CBT continued to show greater levels of recovery
• Well designed study


  • Extraneous variables were carefully controlled
  • The two groups had the same average depression score at the start
  • Participants were randomly assigned to groups
• Real world application


  • Focused on developing a useful therapy
  • Shows that a more holistic approach to treating depression is more successful than antidepressant medication alone
  • Was relatively cheap
• Addiction


  Being unable to stop or control substance use or a frequently repeated behaviours
• Dependence


  Frequently using a substance or carrying out a behaviour because of the psychological reliance and to prevent withdrawal symptoms
• Addiction


  Where a person is dependent on the substance/activity but also does it to experience a buzz or sense of escape
• Misuse


  Not following the "rules" of usage like taking it longer then the recommended amount or using it for other reasons
• Abuse


  Using the substance to "get high" or to escape because a person's intentions are about the outcome of taking the drug
• A diagnosis of addiction should usually be made only if three or more characteristics have been present together at some time during the year
• Characteristics from ICD-10 for diagnosing addiction

  • A strong desire to use the substance
  • Persisting despite known harm
  • Difficulty in controlling use
  • A higher priority given to the substance
  • Withdrawal symptoms if substance/activity is stopped
  • Evidence of tolerance, i.e needing more to achieve the same effect
• Hereditary factors


  • Research suggests that addictions are moderately to highly inherited
  • Genetic information passed down from parents may determine whether a person is likely to become addicted or not