Depression

• Characteristics of depression: Behavioural: 1. Activity levels - Sufferers of depression have reduced levels of energy making them lethargic. In extreme cases, this can be so severe that the sufferer cannot cannot get out of bed 2. Disruption to sleep and eating behaviour - Sufferers may experience reduced sleep (insomnia) or an increased need for sleep (hypersomnia). Appetite may increase or decrease, leading to weight loss or weight gain Emotional: 1. Lowered mood - Feelings of despair. More pronounced than the daily experience of feeling lethargic or sad. Sufferers often describe themselves as "worthless" or "empty" 2. Anger - Anger can be directed at others or turned inwards on the self. On occasion, such emotions lead to aggression or self-harming behaviour. It could be due to feelings of being hurt and wishing to retaliate Cognitive: 1. Poor concentration - The sufferer may find themselves unable to stick with a task as they usually would, or they may find simple decision-making difficult 2. Absolutist thinking - 'Black and white thinking', when a situation is unfortunate it is seen as an absolute disaster
• Beck's negative triad: - Beck believed that depressed individuals feel the way they do as they have negative interpretations of the world and they lack a perceived sense of control. They have faulty information processing as they only pay attention to negative aspects of situations but ignore the positives. These are known as Automatic Negative Thoughts (ANTs) and they can be illogical and may lead to a cognitive bias - These cognitive biases can help develop into a negative self-schema - The negative triad; 1. Negative view of the self (eg. thinking "I'm ugly") 2. Negative view of the world (eg. "Everyone hates me") 3. Negative view of the future (eg. "I'll never have anyone who loves me") - Once the cognitive triad is activated, individuals will concentrate on processing information relevant to it and ignore more positive information. This leads to reinforcement of negative beliefs making the depressed state continue
• Cognitive bias A subjective thought process that automatically thinks in a certain way and may not be an objective view of reality. This is generally negtive for those who suffer with depression. For example; Over-generalisations - Sweeping conclusions are made on one single incident
• Negative self-schemas; People who struggle with depression tend to have a negative self-schema which leads them to interpret all information about themselves in a negative way. These may be due to their life experiences such as being a consequence of negative or traumatic events during childhood (loss of parents abuse etc.)
• Albert Ellis' ABC model: - Ellis focused on situations in which irrational thoughts are activated by external events. According to Ellis we get depressed when we experience negative events and these trigger irrational events A = Activating event - This can trigger our belief (Being told by your boss that he is unhappy with your work) B = Belief - What you believe is the truth about the event (Believing that you're a failure) C = Consequence - Your consequent emotional response (Feeling anxious or depressed)
• Musturbatory thinking: - Ellis suggested that the source of irrational beliefs lies in musturbatory thinking - This is the idea that certain assumptions must be true in order for an individual to be happy (eg. I must be approved of and accepted I must do well or I am worthless etc.) - Someone who holds these assumptions are likely to be disappointed and could at worst become depressed. These 'musts' need to be challenged in order to develop a healthier mental framework
• Strengths of cognitive explanations for depression: - There is supporting evidence. Grazioli and Terry assessed 65 pregnant women for cognitive vulnerability and depression before and after they gave birth. They found that those women judged to have been high in cognitive vulnerability pre-natality were more likely to suffer post-natal depression. These cognitions can therefore be seen before depression develops suggesting that Beck may be right about cognition causing depression at least in some cases - Both Ellis' and Beck's theories have practical applications. Both theories are the basis of cognitive-behavioural therapy (CBT) or rational emotive behavioural theory (REBT)
• Limitations of the cognitive explanation of depression: - Doesn't explain all aspects of depression (eg. anger hallucinations and bizarre beliefs). It only focuses on one aspect - Ellis' ABC model only partially explains depression. Despite some cases of depression following activating events (reactive depression) other cases of depression do not seem to have an activating event and depression arises without an obvious cause. This leaves Ellis' explanation redundant and suggests that it only applies to some with reactive depression - Cognition explanations assume that negative thoughts are the cause of depression however this may not necessarily be the case. Evidence of the link between negative thoughts and cognition is correlational and this may mean that negative thinking is a symptom/effect of depression rather than the cause. This means that a general limitation is establishing cause and effect between cognition and depression. - We may not be able to measure cognitions accurately. This is because depression is subjective and a diagnosis is based on the ability to verbalise thoughts - It does not consider the biological approach (eg. genes) - The cognitive approach suggests that individuals are responsible for their depression. In one sense this is good as it gives the client the power to change the way things are. However there are disadvantages as it may lead clients and therapists to overlook any situational factors that may have contributed to the disorder. - Not all irrational thoughts are irrational but may have an element of realism. Alloy and Abrahmson suggests that depressive realists tend to see things more accurately and that normal people can view the world through rose-tinted glasses. They also found that depressed people gave more accurate estimates of the likelihood of disasters than 'normal' control. This suggests that some irrational thoughts may be more negative but can also have an element of accuracy.
• Beck's cognitive behaviour therapy (CBT): - The overall view is to get the patient to think more rationally and reinforce any positive responses to encourage them to happen more frequently. 1. Identification - Identify any negative thoughts. Once any irrational thoughts are identified the client is encouraged to consider realistic thoughts which challenge these negative thoughts 2. The patient is encouraged to provide a more rational positive response to the automatic negative thoughts. - They are asked to generate a hypothesis to test out their negative thoughts. - Scientific testing the therapist may then ask the client to demonstrate their ability to succeed. - Homework task - They may also gather data (eg. diary keeping) 3. Reinforcement of rational thoughts. The therapist rewards or praises the client for more rational thoughts which should therefore encourage more positive thoughts through the use of positive reinforcement 4. Cognitive restructuring - Irrational thoughts are replaced by more rational beliefs
• Ellis' rational-emotive-behaviour therapy (REBT): - The therapist has vigorous arguments with the patient to challenge/dispute their irrational beliefs. This is known as rational confrontation - He extends the ABC model to the ABCDE model A - Activating event B - Belief C - Consequence D - Dispute - This is when the therapist engages in rational confrontation to challenge the client's irrational beliefs. They use empirical and logical arguments. - The therapist could use two other aspects to challenge their irrational thoughts; - Behavioural activation; Clients are encouraged to make behavioural changes to their daily life for the positive. - Shame attacking exercises - Clients undergo shame attacking exercises (such as taking a banana for a walk) to challenge their negative schemas. This is done to challenge their irrational thoughts ("people are judging me") E - Effect - This should improve mood and create fewer negative thoughts
• Strengths of the treatments for depression: - Lots of evidence to support the effectiveness of CBT. March et al. compared the effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents. After 36 weeks 81% of the CBT group 81% of the antidepressant group and 86% of the CBT + antidepressant group group were significantly improved. CBT was just as effective as medication and was even more helpful alongside medication - There is research support for behavioural activation. Babyak et al found that depressed patients who were assigned to a four-month aerobic exercise showed a significant improvement at the end of the four months. Six months after the end of the study the clients showed much lower relapse rates than patients who did not have the treatment - particularly if they continued with the exercise on their own afterwards. This suggests that behavioural activation is effective in reducing depressive symptoms
• Limitations of treatments for depression: - CBT may not work for more severe cases of depression. Hard cognitive work is needed for CBT and those suffering may not have the motivation. It may be better to give medication first and then give CBT as CBT may not work as a sole treatment. - The quality of the therapist-patient relationship may determine success rather than the technique of the therapy. The differences between the various methods of psychotherapy might actually be quite small - CBT focuses on the present and future rather than the patient's past - There may be an overemphasis on cognition minimising the importance of the circumstances in which the patient is living. Someone living in abuse needs to change their circumstance and any approach which emphasises what is in the patient's mind rather than their environment can prevent this. - There is a reliance on self-report so data may be unreliable and potentially inaccurate