Depression

• What is Depression?


  An affective mood disorder characterised by feeling sadness and general withdrawal from those around us
• What are the categories of depression?

  • Major depressive disorder - severe short term depression
  • Persistent depressive disorder - long term reoccurring depression
  • Disruptive mood dysregulation disorder - childhood temper tantrums
  • Premenstrual dysphoric disorder - disruption in mood prior or during menstruation
• What are the 2 types of depression?

  1. Reactive - Caused by a stressful event
  2. Endogenous - Caused by a biological factors
• Behavioural Characteristic of Depression - Activity levels

  • Have reduced levels of energy making them lethargic.
  • Withdrawal from work, education and social life
  • Be so severe that the person cannot get out of bed.
  • In some cases depression can lead to psychomotor agitation - agitated individuals struggle to relax and may end up pacing up and down a room
• Behavioural Characteristic of Depression - Disruption to sleep and eating

  • Insomnia - reduced sleep and waking early
  • Hypersomnia - increased need for sleep
  • Increase in appetite
  • Decrease in appetite
• Behavioural Characteristic of Depression - Aggression and self-harm

  • Irritable
  • Verbally or physically aggressive
  • Can lead to ending relationships or quitting jobs
  • Self-harm
  • Suicide attempts
• Emotional Characteristics of Depression

  • Lowered mood - feeling empty and worthless
  • Anger
  • Lowered self esteem - self loathing and hating yourself
• Cognitive Characteristics of Depression

  • Poor concentration - unable to stick to tasks, hard to make decisions that would be easy and interference with work
  • Negative thoughts - only focus on the negative ignoring the positive thoughts and bias towards recalling unhappy memories
  • Absolutist thinking - Most situations are not all good or all bad, think in black and white terms
• What are the 2 cognitive explanations of depression

  • Beck's cognitive theory
  • Ellis's ABC Model
• What are the 3 parts of Beck's cognitive theory?

  1. Faulty information processing
  2. Negative self schema
  3. Negative triad
• What is faulty information processing?

  • Only think of the negative aspects of a situation and ignore the positives
  • Depressed people think in 'black and white' thinking all is good or bad
• What is a negative self schema?

  • A schema is a ‘package’ of ideas and information developed through experience
  • A self-schema is the package of information people have about themselves
  • Negative self-schema - interpret all information about themselves in a negative way
• What is the negative triad?

  A person develops depression because of three types of negative thinking: negative thoughts about the world, the future and oneself
• Examples of the negative triad

  1. Negative view of the world – ‘the world is a cold hard place’ creating the impression that there is no hope anywhere
  2. Negative view of the future – ‘there isn’t much chance that the economy will really get better’ reduces any hopefulness and enhances depression
  3. Negative view of the self – ‘I am a failure’ enhance any existing depressive feelings and confirm the existing emotions of low self-este
• What are the 3 parts of the ABC model?

  1. Activating Event
  2. Beliefs
  3. Consequences
• ABC Model

  1. Activating event - irrational thoughts are triggered by external events e.g failing an important test or ending a relationship
  2. Beliefs - Range of irrational beliefs: achieve perfection, ‘I-can’t-stand-it-itis’ and utopianism
  3. Consequences - an activating event triggers irrational beliefs there are emotional and behavioural consequences e.g if a person believes that they must always succeed and then fails at something this can trigger depression
• What are the 3 types of irrational beliefs

  1. Must always succeed or achieve perfection
  2. ‘I-can’t-stand-it-itis’ is the belief that it is a major disaster whenever something does not go smoothly
  3. Utopianism is the belief that life is always meant to be fair
• Beck's Cognitive Theory AO3: Research Support

  • ‘Cognitive vulnerabilities' - ways of thinking that may lead to people becoming depressed e.g faulty information processing, negative self-schema and cognitive triad
  • Researchers concluded that not only were these cognitive vulnerabilities more common in depressed people but they preceded depression
  • In a more recent study 473 adolescents had their cognitive vulnerability measured and found that showing cognitive vulnerability predicted later depression showing that there is an association between cognitive vulnerability and depression
• Beck's Cognitive Theory AO3: Real World Application

  • Assessing cognitive vulnerability allows psychologists to screen young people, identifying those most at risk of developing depression in the future and monitoring them
  • Understanding cognitive vulnerability can also be applied in cognitive behavioural therapy (CBT)
  • Work by altering the kind of cognitions that make people vulnerable to depression, making them more resilient to negative life events
  • This means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice
• Beck's Cognitive Theory AO3: Partial Explanation

  • Depressed people show particular patterns of cognition which can be seen before the onset of depression
  • It appears that Beck’s suggestion of cognitive vulnerabilities is at least a partial explanation for depression
  • However, there are some aspects to depression that are not particularly well explained by cognitive explanations.
  • Some depressed people feel extreme anger, and some experience hallucinations and delusions
• Ellis's ABC Model AO3: Real World Application

  • Ellis’s approach to cognitive therapy is called rational emotive behaviour therapy (REBT)
  • The idea of REBT is that by vigorously arguing with a depressed person the therapist can alter the irrational beliefs that are making them depressed
  • There is some evidence to support the idea that REBT can both change negative beliefs and relieve the symptoms of depression so REBT has value
• Ellis's ABC Model AO3: Only explains one type of depression

  • Reactive depression is when depression is triggered by life events
  • Many cases of depression are not traceable to life events and it is not obvious what leads the person to become depressed
  • This type of depression is called endogenous depression - caused by biology
  • Ellis’s model can only explain some cases of depression and is therefore only a partial explanation
• Ellis's ABC Model AO3: Ethical Issues

  • The ABC model of depression is controversial because it locates responsibility for depression purely with the depressed person
  • Critics say this is blaming the depressed person which would be unfair
  • But provided it is used appropriately and sensitively the application of the ABC model in REBT does appear to make at least some depressed people achieve more resilience and feel better
• What is Cognitive Behavioural Therapy?

  • Method for treating mental disorders based on both cognitive and behavioural technique
  • Assess the patient and work together to clarify the patient's problems
  • Identify where the negative or irrational thoughts are and put more effective behaviours in place
• What is Beck's Cognitive Therapy?

  • To identify automatic thoughts about the world, the self and the future (negative triad) and once identified these thoughts must be challenged
  • Cognitive therapy aims to help clients test the reality of their negative beliefs
  • They might be told to record when they enjoyed an event then in future sessions if clients say there is no point in going to events the therapist has evidence and can prove that the client’s statements are incorrect
• What is Ellis's Rational Emotive Behavioural Therapy?

  • REBT extends the ABC model to an ABCDE model – D stands for dispute and E for effect
  • The central technique of REBT is to identify and challenge irrational thoughts to break the link between negative life events and depression
  • A client might talk about how unlucky they have been or how unfair things seem and an REBT therapist would identify this as utopianism and challenge this as an irrational belief and this would involve a vigorous argument
  • Ellis identified different methods of disputing:
  • Logical , empirical and pragmatic
• What is logical disputing?


  Involves disputing whether the negative thought logically follows from the facts
• What is empirical disputing?


  Disputing whether there is actual evidence to support the negative belief
• What is pragmatic disputing?


  Checking if the irrational belief is useful and practical in believing
• What is Behavioural Activation?


  Patients are set tasks that encourage them to be more active and engage in more enjoyable activities
• What is unconditional positive regard?

  • Ellis realises clients need to realise their importance
  • If they felt worthless they were less likely to change their beliefs
  • If the therapist provides respect and appreciation they may be able to change their beliefs
• CBT AO3: Evidence for effectiveness

  • One study compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents
  • After 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved
  • CBT is usually therapy requiring 6 to 12 sessions so it is also cost-effective.
  • CBT is widely seen as the first choice of treatment in public health care systems such as the NHS
• CBT AO3: Not suitable for everyone

  • Lack of effectiveness for severe cases and for clients with learning disabilities
  • Depression can be so severe that clients cannot motivate themselves to engage with the cognitive work of CBT
  • They may not even be able to pay attention to what is happening in a session
  • The complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities
  • CBT may only be appropriate for a specific range of people with depression
• CBT AO3: Relapse rates

  • CBT is quite effective in tackling the symptoms of depression but there is concerns over how long the benefits last
  • Recent studies suggest that long-term outcomes are not as good as had been assumed
  • In one study depression was assessed in 439 clients every month for 12 months following a course of CBT
  • 42% of the clients relapsed into depression within six months of ending treatment and 53% relapsed within a year.
  • CBT may need to be repeated periodically
• CBT AO3: No side effects

  • CBT can be seen to be a good alternative to someone who does not enjoy taking drugs or does not want to have any side effects as a result of drugs
  • There will be no issue with having to find the right dose and other things to do with medication