Depression

• Depression

  A mood disorder
• Types of depression

  • Unipolar - major depressive episode without manic phase
  • Major depression disorder - severe but short term
  • Bipolar depression - manic depression
  • Persistent depressive disorder - long term or recurring depression
  • Disruptive mood dysregulation disorder - childhood temper tantrums
  • Premenstrual dysphoric disorder - disruption to mood prior/during menstruation
• The cognitive approach to explaining depression looks at mental processes (thoughts, attention, perceptions) and how they affect behaviour.
• Cognitive biases

  • Over-generalisation - assuming that one negative experience will recur in other situations
  • Catastrophising - exaggerating a minor setback and believing that it is a complete disaster
• Cognitive Behavioural Therapy (CBT)

  Commonly used psychological treatment for depression, combining cognitive and behavioural elements
• Beck's cognitive therapy

  1. Identify automatic thoughts about the world, the self and the future (Negative Triad)

  2. Once identified, these thoughts are then challenged

  3. Client is the SCIENTIST: CBT helps client test the reality of their negative beliefs. They encourage client to investigate their beliefs

  4. HOMEWORK: clients might be asked to record when they enjoyed event or when people were nice to them

  5. FUTURE SESSIONS: homework is useful in further session. If client falls back into patterns of thought the therapist can use evidence to prove client's thoughts are incorrect

  6. Reinforcing positive beliefs
• Ellis's Rational Emotive Behaviour (REBT)

  • Extends Ellis's ABC model to ABCDE (D is for Dispute and E is for Effect)
  • The main technique for REBT is to identify and challenge irrational thoughts
• Behavioural characteristics

  Change in activity levels:

  • can be an increase in activity such as restlessness
  • can be a decrease in activity such as social withdrawal

  Change to sleep and eating behaviour:

  • person may suffer from insomnia or may sleep more than usual
  • person may eat more for comfort or experience a loss of appetite

  Aggression and self-harm:

  • person may be aggressive towards themselves through self-harm e.g, cutting and possible suicide attempts
• Emotional characteristics

  Lowered mood

  • person feels hopeless, worthless and empty

  Lowered self-esteem

  • person likes themselves less than usual, with some suffering from self-loathing e.g. hating themselves

  Anger

  • person may often have angry outbursts; this can be directed at themself or others
• Cognitive characteristics

  Poor concentration:

  • person may have poor levels of concentration, where they are unable to focus or they find it hard to make decisions

  Attending to and dwelling on the negative:

  • person suffering holds unrealistic expectations about themselves and their relationships

  Absolutist thinking:

  • person suffering from depression is likely to think that everything will turn out badly and there is no hope. This is sometimes called 'black and white thinking.'
• Beck‘s cognitive theory of depression

  He proposed a 3 part explanation…

  Faulty information process (cognitive bias):

  • individuals with depression tend to focus on the negative aspects of a situation and ignore the positive.
  • they are prone to distorting and misinterpreting information, a process known as cognitive bias

  Negative self-schema:

  • individual interprets information about themselves in a negative way

  Negative triad:

  1. Negative view of world
  2. Negative view of future
  3. Negative view of self
• A strength of Beck’s cognitive explanation is that it has strong supporting evidence. For example, in a review David Clark and Aaron Beck (1999) concluded that not only were cognitive vulnerabilities more common in individuals with depression but also preceded the depression. This strengthens Beck’s explanation as it suggests that Beck may be right about the influence of cognition on depression.
• Aaron Beck (1967) proposed the cognitive explanation as to why some individuals are more vulnerable to depression than others. Beck suggested an individual's cognition creates this vulnerability
• A strength of Beck’s cognitive explanation is that it has practical application. This is because it forms the basis of cognitive behaviour therapy (CBT), which is a type of therapy that aims to change the way people think about themselves and their problems. A therapist would identify the cognitive aspects of their client’s depression then challenge them and encourage the client to test whether they are true. This is a strength of the explanation because it can be successfully applied in therapy to treat depression.
• A weakness of Beck’s cognitive explanation is that it doesn’t explain all aspects of depression. This is because it doesn’t explain why some people with depression feel extreme anger, and some experience hallucinations and delusions. This weakens the cognitive explanation because it only provides a partial explanation and ignores the complexity of depression.
• Ellis proposes that anxiety and depression can result from irrational thinking. These are thoughts that interfere with us being happy and free of pain.

   
• A strength of Ellis’ ABC model is that it has real world application. This is because Ellis’ used his model to create REBT (a form of CBT) that uses the ABC model to identify irrational thoughts and challenge them to treat depression. This is a strength of this model because it has led to successful therapy which then supports the idea that irrational thinking plays a role in depression.
• A strength of Ellis’ ABC model is that it has supporting evidence. An example, is Taghavi et al. who replicated previous research on western samples that had shown that irrational belief systems were associated with depression on Iranian samples. He compared the scores of 29 clinically depressed to 34 normal controls on the ‘Irrational Beliefs Test’ and discovered that depressed patients scored higher in irrational beliefs. This strengthens Ellis’ model as it supports how irrational beliefs have an influence on depression.
• A weakness of Ellis’ ABC model is that it doesn’t account for all types of depression. This is because it only explains reactive depression, where the individual has had an activating event but does not explain endogenous depression, where the depression is not traceable to life events. This limits the model as it is a partial explanation that doesn’t include all forms of depression.
• Beck and Ellis both refer to the person in therapy as a ‘client’ because they believed the word ‘patient’ took the power away from the person.
• A strength of Beck’s cognitive behavioural therapy as a treatment of depression is that it has evidence supporting its effectiveness. An example is March et al, where researchers compared CBT to antidepressants drugs and a combination of both in 327 adolescents. It was discovered after 36 weeks, the rates of response to treatment was 81% for CBT alone and 86% for a combination of CBT and antidepressants. This strengthens CBT as a treatment for depression as it showcases how it is not only effective on its own, but also when combined with drug therapy.
• A weakness of Beck’s cognitive behavioural therapy is that it may not be suitable for all clients. This is because it lacks effectiveness for clients with learning difficulties as they may struggle to engage with the cognitive element of the therapy. Sturmey et al suggested that in general, any form of therapy is not suitable for people with learning difficulties. Therefore, this limits CBT as a treatment for depression as it is only suitable for a certain range of people.
• A weakness of Beck’s CBT is that it may not work for the most severe cases. This is because in some cases of depression the individual is too distressed to engage with the hard cognitive work of CBT, as they may find it difficult to focus. Also, for CBT to be effective they must meet with their therapist for between 6-20 weekly or fortnightly sessions, with each session lasting 30-60 minutes, a severely depressed client may struggle to find the motivation. This limits this treatment because it means that CBT cannot be used as the sole treatment for all cases of depression.
• Ellis’ REBT

  1. therapist identifies irrational thoughts and uses strong arguments to challenge client’s irrational thoughts
  2. therapist intends to break link between negative life events and depression by challenging client’s irrational beliefs
• There are different types of arguments identified by Ellis to be used in REBT:

  • Empirical arguments: Disputing if there is real evidence to support the irrational belief
  • Logical arguments: Disputing if the negative effect follows logically from the facts
  • Pragmatic arguments: challenging how helpful or benefits of their thoughts.
• Behavioural activation in REBT

  • Goal of behavioural activation is to work with individuals to gradually decrease their avoidance and isolation.
  • This should ideally increase their engagement in activities that have been shown to improve mood e.g. exercise
  • Therapist will aim to reinforce such activities.
• A strength of Ellis’ REBT as a treatment of depression is that it has research support. For example, Ellis claimed a 90% success rate after 27 sessions and David et al. found that REBT has lasting positive effects even after therapy has ended, and is as effective as cognitive therapy and medication for treating depression. This strengthens this treatment because it has good supporting evidence demonstrating its effectiveness.
• A strength of Ellis’ REBT is that it has support for the effectiveness of behavioural activation. Babyak et al studied 156 depressed clients and they were split into aerobic exercise, drug treatment and both. It was discovered that those in the exercise group had lower relapse rates. This strengthens REBT as a treatment for depression as behavioural activation has been shown to reduce symptoms.
• A weakness of Ellis’ REBT is that it doesn’t account for individual differences. Elkins suggested that REBT is less suitable for clients who have high irrational beliefs that are resistant to change. This limits this treatment as it is unlikely to work for the most severe cases of depression where the strong arguments Ellis suggested may not be enough to challenge and break irrational thought patterns.