Depression

• Depression


  Characterised by changes in mood
• DSM 5 categories of depression

  • Major depressive disorder: Severe and short term
  • Persistent depressive disorder: Long term and recurring
  • Disruptive mood dysregulation disorder: child tempter tantrums
  • Premenstrual dysphoric disorder: Disruption to mood prior and during menstruation
• Depression: Behavioural categories

  • Reduced anxiety levels, withdrawn or hyper-motor agitation
  • Disruption to eating, missing meals or binging
  • Disruption to sleeping, insomnia or hyper-insomnia
  • Aggressive behaviour towards others or themselves
• Depression: Emotional characteristics

  • Lowered mood, empty feelings, worthlessness
  • Anger, at yourself or others
  • Lowered self-esteem, self loathing
• Depression: Cognitive characteristics

  • Poor concentration, poor decision making, impacts social and work life
  • Attending to and dwelling on negative/pessimistic thoughts (glass half empty)
  • Absolutist thinking
• Cognitive approach to explaining depression

  • Number of cognitive explanations
  • The disorder is a result of disturbance in thinking
  • Focus on individuals negative thoughts, irrational beliefs and mis-interpretation of events as being the cause for depression
• Aaron Beck model


  • Faulty information processing
  • Negative self schemas
  • The negative triad
• Faulty information processing


  • depressed people make fundamental errors in logic
  • they selectively attend to the negative aspects of a situation and ignore the positives
  • A tendency to blow small problems out of proportion
• Negative self-schemas


  • a self-schema is a package of ideas that we have about ourselves
  • people with negative self-schemas interpret all the information about themselves in a negative way
  • Weissman and Beck 1978
• The negative cognitive triad

  • Beck suggested that people with depression become trapped in a cycle of negative thoughts
  • Pessimistic view of self, the world and the future (triad of impairments)
  • Low self-esteem, hopelessness etc...
• Albert Ellis


  • Good mental health is the result of rational thinking
  • Depression: Irrational thinking
• Ellis ABC Model


  • A: Activation event
  • B: Beliefs about the event
  • C: Consequence (depression)
• Mustrubation


  Belief that everything must be perfect
• Evaluation of Beck


  Good supporting evidence: Strength

  • Cohen et al. (2019) tracked 473 adolescents regularly measuring cognitive vulnerability
  • Findings: Correlation/association between CV and developing depression
• Evaluation of Beck


  Practical applications in CBT: Strength

  • helps the screening process
  • forms the basis of cognitive behavioural therapy
  • all cognitive aspects of depression can be challenged in CBT
• Evaluation of Beck


  Does not explain all aspects of depression

  • complex disorder
  • range of symptoms
  • cannot always be explained cognitively (eg, delusions)
• Evaluation of Ellis


  Only offers a partial explanation: Limitation

  • some depression does occur as a result of an activating event (reactive depression)
  • not all depression arises as a result of an obvious case (endogenous depression)
  • May be due to a chemical imbalance
  • Reductionist
• Evaluation of Ellis


  Practical applications in CBT: Strength

  • Irrational and negative beliefs are challenged
  • Help to reduce depressive episodes
• Evaluation of Ellis


  Ethical issues: Limitation

  • Blame game
  • locates responsibility with the person
  • May not be helpful but rather damaging
• Cognitive treatment of depression

  CBT:

  • A method for treating mental disorders based on cognitive and behavioural techniques
  • Cognitive element: identify and replace negative thoughts which lead to depression
  • Encourages patients to test their beliefs through behavioural experiments
• Format for CBT:


  • initial assessment to identify the patients problems
  • patient and therapist agree on a set of goals and plan of action to achieve these goals
  • 5-20 sessions, 30-60 minutes long
  • 2 forms of CBT: aim to identify the negative and irrational thoughts
• Beck 1976: Treatment for depression


  • Challenge the negative triad with the patient
  • Replace this thoughts with more realistic ones
  • The patient and therapist relationship is mutual (patient as the scientist)
  • Encouraged to test the validity of their negative thoughts
  • Set homework alongside sessions
• Order for Beck's CBT therapy style

  1. Therapist helps client identify negative thoughts and keep a diary
  2. Therapist challenges dysfunctional cognitions by drawing to positive incidents
  3. Reality testing: homework between sessions to test theories
  4. Shows how negative thoughts are irrational and unrealistic
  5. Patient creates more realistic thoughts ready to discuss for the next session
  6. Small goals are set to encourage a sense of personal effectiveness
• Ellis' CBT: Rational emotive behaviour therapy (REBT)

  A: Activation event

  B: Belief

  C: Consequence

  D: Dispute -> disputing irrational thoughts (logical, empirical, pragmatic)

  E: Effect
• Disputing beliefs (Ellis REBT treatment)

  • Logical disputing: self defeating beliefs do not follow logically from the information available
  • Empirical disputing: Self-defeating beliefs may not be consistent with reality
  • Pragmatic beliefs: Emphasises the lack of usefulness of self-defeating beliefs
• Behavioural activation:


  • depressed patients tend to avoid difficult situations, maintaining symptoms
  • Gradually decreases avoidance/isolation
  • Increases engagement suggested to improve mood
  • Therapist aims to reinforce these activities
• Key difference of Beck and Ellis

  • The quality of the therpeutic relationship
  • how direct the approach is
  • adapting a therapy to the client vs the disorder
• Evaluation of CBT treatment

  Evidence for effectiveness: Strength

  • March et al. compared CBT to antidepressant drugs through 327 depressed adolescents
  • After 36 weeks: 81% CBT group, 81% drug group and 86% of CBT and drug group improved
  • Just as effective on its own but even more with drugs
  • Cost effective
  • Seen as the first choice of treatment in NHS
• Evaluation of CBT treatment

  Suitability for diverse clients: Limitation

  • Sometimes clients cannot motivate themselves to engage with CBT
  • May not be able to pay attention
  • Complex rational thinking is unsuitable for treating clients with learning disabilities
  • Sturmey (2005) -> any form of psychotherapy is not suitable
  • Not an accessible treatment
• Evaluation of CBT treatment

  Relapse rates: Limitation

  • Effective in tackling the symptoms of depression but concerns over how long the benefits will last
  • long term outcomes not as good as has been assumed
  • Ali et al. (2017) -> assessed depression in 439clients every month for 12 months following CBT
  • 42% of clients relapsed after 6 months
  • 53% within the year
• Evaluation of CBT treatment

  Does not suit all patients: Limitation

  • not all clients want to tackle their depression this way
  • Some people want symptoms gone quicker (want medication)
  • Yrondi et al. (2015) found that depressed people rated CBT as their least preferred psychological therapy