Depression

• Depression is a mood disorder characterised by a consistent and long lasting sense of sadness and loss of interest in activities
• Behavioural characteristics:

  • Reduction in activity levels - This may include psychomotor agitation, lethargy and lacking the energy to carry out everyday tasks (eg personal hygiene).

  Anhedonia is the lack of pleasure usually felt doing enjoyable activities, leading to a reduction in social behaviour.
• Behavioural characteristics:

  • Change in appetite and sleeping patterns - This can result in obesity and insomnia on one end of the scale, or anorexia and lethargy on the other end.
• Behavioural characteristics:

  • Increased aggression - This can be either towards oneself (in the form of self harm) or towards others, which can be verbal or physical.
• Emotional characteristics:

  • Constant poor mood - Usually sadness and anger. This low mood can last for months at a time and in high severity.
• Emotional characteristics:

  • Low self-esteem - Negative and self depicting thoughts about ones image and mind.
• Cognitive characteristics:

  • Poor concentration - This is due to the consequent disruptions to school and work which adds to the feeling of worthlessness and anger. It also makes it hard for patients to make decisions.
• Cognitive characteristics:

  • Negative schemas - This includes absolutist thinking which is negative thoughts about oneself, the world and the future.
• Cognitive approach to explaining depression:

  • Depression is due to irrational thoughts, resulting from maladaptive internal mental processes.
• Cognitive approach to explaining depression:

  • Beck (1967) - Negative triad.

  A person may have cognitive vulnerability towards developing depression through faulty information processing, negative self-schemas and the cognitive triad of automatic negative thoughts.

  • Faulty information processing - Small problems out of proportion, dwelling on the negative and thinking in 'black and white' terms.
  • Negative self-schemas - Lowering self confidence by interpreting information from the world in a negative light.
  • Cognitive triad - Negative thoughts about oneself, the future and the world.
• Cognitive approach to explaining depression:

  • Ellis' ABC model

  An ACTIVATING event leads to an irrational BELIEF, which results in an emotional CONSEQUENCE.

  • Mustabatory thinking - The consequence of not accepting that we do not live in a perfect world. This is failure to achieve unrealistic goals and having people acting in ways which we do not want them to, leading to disappointment.

  Ellis: There are 3 musts that hold us back: "I MUST do well. You MUST treat me well. The world MUST be easy".
• Strengths of Beck's negative triad:

  • Supporting research evidence - Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and 6 weeks after birth. They found a positive correlation between an increased vulnerability and likelihood of developing depression after birth in women who had negative thinking styles. This supports the link between faulty cognition and depression, increasing the validity of Beck's theory and showing there is a diathesis-stress mechanism to it.
• Strengths of Beck's negative triad:

  • Effective treatments - Elements of the cognitive causes can be identified by a therapist and challenged as irrational thoughts on the patient's part. Therefore, it means for more successful therapies and the effectiveness of CBT is due to the accuracy of Beck's theory.
• Limitations of Beck's negative triad:

  • Alternative explanations - A biological explanation suggests depression can be caused by a chemical imbalance of dopamine (too much) and serotonin (too little). This theory is supported by the use of drug therapy (antidepressants) to treat depression. This suggests we can not solely rely on cognition to explain all routes of depression as biological aspects also play a role in this.
• Strengths of Ellis' ABC model:

  • Practical application - Rational emotive behavioural therapy (REBT), which was developed from the ABC model, and CBT are effective in challenging irrational beliefs causing depression. These therapies have been successful in treating depression, hence supporting the cognitive explanations for depression.
• Limitations of Ellis' ABC model:

  • Limited explanation - Unable to explain all types of depression, aside from those which have a clear activating event (eg reactive depression). However, many individuals suffer from depression without an apparent cause, suggesting the model is limited.
• Cognitive approach to treating depression:

  • Beck's CBT - Cognitive behavioural therapy

  Aims to identify and challenge irrational thoughts by replacing them with more productive behaviours.

  • Patient as a scientist - Patients make tests and hypotheses about the validity of their irrational thoughts. Once they realise their thoughts do not match reality, they can be discarded.
  • Thought catching - Identifying irrational thoughts coming from negative schemas.
• Cognitive approach to treating depression:

  • Beck's CBT - Cognitive behavioural therapy

  Aims to identify and challenge irrational thoughts by replacing them with more productive behaviours.

  • Homework tasks - Recording each time a person was nice to them for a week and reflecting on it as counter-evidence in times of despair.
  • Behavioural activation - Taking part in activities which the patient previously found enjoyable.
• Cognitive approach to treating depression:

  • Ellis' REBT - Rational emotional behavioural therapy:

  Aims to identify patients thoughts and challenge them as irrational, leading to a vigorous argument.

  • Dispute - Therapist confronting the irrational beliefs.
  • Empirical arguments - Challenge patient to provide evidence for their irrational belief.
  • Logical arguments - Attempt to show the beliefs don't make sense.
• Cognitive approach to treating depression:

  • Ellis' REBT - Rational emotional behavioural therapy

  Aims to identify patients thoughts and challenge them as as irrational, leading to arguments.

  • Effect - Reduced irrational thoughts (reconstructed beliefs) leading to better consequences in the future.
  • Shame attacking exercises - Client performs their fear behaviour in front of others and realise they are able to cope with the emotions of the unpleasant experience.
• Strengths of the cognitive approach to treating depression:

  • Supporting research evidence - March (2007) allocated 327 patients to one of three groups; CBT, drug therapy and CBT + drug therapy. After 3 weeks, CBT and drug therapy had an effectiveness rate of 81%. CBT had a more significant reduction in suicidal events compared to drug therapies. The best results had an effectiveness rate of 86% and was a combination of both CBT and drug therapy.
• Limitations of the cognitive approach to treating depression:

  • Limited application - CBT may not be appropriate for all cases of depression, particularly in more severe cases. This has been reflected in March's study where a combination of CBT and drug therapy was the most effective combination. This is because those with severe depression may not be able to attend all sessions of CBT due to lack of motivation and the feeling of complete hopelessness.
• Limitations of the cognitive approach to treating depression:

  • Economic implications - CBT takes up to 16-20 sessions with a trained therapist which can be very costly. However, it has more long term effects as it identifies the main cause rather than reducing symptoms, as drug therapies do, so patients are able to return to their daily lives. There is also less side effects to CBT which patients also prefer.