Depression

• Depression


  • is a mood disorder
  • a diagnosis can be made when 5 symptoms are present for at least 2 weeks
• Beck's cognitive theory of depression

  Proposes that one has a cognitive vulnerability towards developing depression, through cognitive biases (faulty information processing), negative self-schemas and the cognitive triad of automatic negative thoughts
• Ellis' ABC model

  Activating event (A) leads to an irrational belief (B), which results in an emotional consequence (C) in the form of depression
• Cognitive Behavioural Therapy (CBT)

  1. Identify and challenge irrational thoughts, replacing them with more productive behaviours

  2. Guided by the cognitive triad, faulty information processing and negative self-schemas

  3. Patients test the reality of their beliefs
• emotional characteristics

  • low mood (lasting for months at a time and high in severity, therefore not simply ‘feeling down’)
  • low self esteem (low self image, often report self-loathing and self hatred and feel undeserving of attention)
  • high levels of anger (towards oneself and towards others)
• behavioural characteristics

  • change in activity levels (psychomotor agitation- appears agitated or lethargy- lack of energy)
  • disruption to sleep (insomnia or hypersomnia)
  • disruption to eating behaviours ( weight gain or loss- obesity or anorexia)
  • aggression (towards oneself and towards others, which may be verbal or physical)
• cognitive characteristics

  • poor concentration (cannot focus on a single task for long, distracted, indecisive, the consequent disruptions to school and work add to the feelings of worthlessness and anger)
  • irrational negative thoughts (patients with depression often recall only negative events in their lives, as opposed to positive)
  • absolutist thinking (jumping to irrational conclusions e.g. “I am unable to visit my mother today and so I am a failure of a son”)
• Beck's cognitive triad- negative self schema

  A schema is a package of ideas and information that develops through experience; a self schema is the information we have about ourselves.

  The patient interprets all information about themselves in a negative light, lowering self-confidence.
• Beck's cognitive triad- cognitive biases

  This is when the patient blows small problems out of proportion (exaggeration), dwelling on the negative, whilst thinking in ‘black and white’ terms.

  Can include:

  • overgeneralisation- make a sweeping conclusion based on a single incident
  • catastrophising- may exaggerate a minor setback and believe it is a complete disaster
• Beck's cognitive triad- the negative triad

  1. negative view of the world
  2. negative view of the future
  3. negative future of the self
• Ellis suggests that good mental health is the result of rational thinking which allows people to be happy and pain free whereas depression is a result of irrational thinking which prevents us from being happy and pain free
• +ve for cognitive explanations

  Practical application: an increased understanding of the cognitive basis of depression translates to more effective treatments i.e. elements of the cognitive triad can be easily identified by a therapist and challenged as irrational thoughts on the patient’s part. Thus, it translates well into a successful therapy and the consequent effectiveness of CBT is merit to the accuracy of Beck’s cognitive theory as an explanation for depression.
• -ve for cognitive explanations

  they cannot explain all aspects of depression e.g. hallucinations, anger, elevated mood and inflated self esteem. This poses a particularly difficult practical issue in that patients may become frustrated that their symptoms cannot be explained according to this theory and therefore cannot be addressed in therapy.
• +ve for cognitive explanations

  Explanatory power: Taghavi et al (2006) compared 29 individuals with clinical depression to 34 controls using a measurement of irrational beliefs. The study found that consistent with Elis's ABC model, depressed people scored higher on the measure of irrational beliefs compared to the control group.

  Population validity: In addition, this study was conducted in Iran and had replicated the findings and procedure of studies conducted in westernised cultures.
• -ve of cognitive explanations

  socially sensitive: they blame the patient for their symptoms of depression rather than the situation. This can cause individuals with depression to feel worse. Furthermore, they may miss important situational factors that contribute to the onset of depression. For example, if a patient is a victim of domestic abuse, the cognitive approach would ignore this situational factor and would instead encourage the patient to change the way he/she thinks about the situation. Therefore, the cognitive approach does not provide a valid explanation in such circumstances.
• Beck’s CBT stages

  • thought catching
  • thought testing
  • behavioural activation
• Beck‘s CBT: thought catching

  In stage one, the patient is taught to identify their irrational thoughts and their negative triad i.e. the negative view they have of themselves, the world and the future. Patients are encouraged to 'catch their thoughts'. For example: "No one likes me". This is done by encouraging the patient to keep a thought diary.
• Beck‘s CBT: thought testing

  In stage two, patients are encouraged to act as a scientist. They are told they must generate a hypothesis to test their irrational thoughts. Evidence is presented for and against their irrational thoughts and the therapist helps to challenge their negative thoughts and helps to reinforce their positive beliefs.
• Beck’s CBT: behavioural activation

  In stage three, patients are set specific tasks that help change their behaviour.
• Ellis’ rational emotive behaviour therapy (REBT)

  A = Activating event. Patients record events leading to disordered thinking

  B = Beliefs. Patients record negative thoughts associated with the event

  C= Consequence. Patient's record negative thoughts, symptoms or behaviours that follow, such as feeling upset

  D= Dispute. The therapist will dispute the patient's irrational beliefs to replace their irrational beliefs with more effective belief

  E= Effects. The desired effect will be that the patient will develop more rational thoughts, should be reinforced using behavioural activation
• REBT- dispute

  This can be done through

  • Logical disputes- this is when the therapist questions the logic of a person's thoughts "Does the way you think about that situation make any sense?"
  • Empirical disputes- this is when the therapist seeks evidence for a person's thoughts "where is the evidence that your beliefs are true?"
  • Pragmatic disputes- how helpful and useful are these irrational beliefs?
• behavioural activation

  encouraging client to be more active/ engaged in enjoyable activities.
• +ve for CBT

  Credible- March followed a group of 327 adolescents with a main diagnosis of depression. After 36 weeks - 81%, 81% and 86% were the respective improvement rates for each of the three experimental conditions (CBT, antidepressants, CBT+ antidepressants). Therefore, CBT emerged as just as effective as medication and helpful alongside medication.
• -ve for CBT

  individual differences- CBT may not be an appropriate treatment for all cases of depression, and particularly the most severe cases. This is because those with severe depression may not be able to attend the regular CBT sessions, due to a lack of motivation/ an inability to get out of bed in the morning, and also may feel completely hopeless. This means that CBT cannot be used to address all cases of depression, and arguably is not suitable for cases which need help the most!
• -ve for CBT

  Overemphasises the role of cognition in depression- assumed that the patient’s present life and challenges are responsible for their depression. However, there may be specific past events which may be responsible for their depression, such as a traumatic life event. Therefore, since CBT therapists are unwilling to ‘dwell on the past’, and ignore the role of early childhood trauma. This suggests that CBT does not offer an opportunity to uncover the underlying causes of the depression. Therefore, it may not be the most appropriate treatment method universally.
• +ve for CBT

  Comparison with drug therapy- patients do not suffer from physical side effects. E.g. anti-depressant medications can affect the heart, can lead to dependency and can even lead to an increase in suicidal thoughts. Furthermore, CBT attempts to address the cause of depression- irrational thoughts/activating event rather than simply mask the symptoms like antidepressant medications do. Therefore, CBT are perhaps more appropriate than drug therapies.