depression

• clinical characteristics

  • affective mood disorder, involves the disturbance to emotions
  • affects about 20-25% of people
  • affects all ages, increasingly affecting younger people
  • woman twice as likely to be diagnosed
  • often occurs in cycles
  • atleast 5 symptoms must be apparent every day for 2 weeks in order to be diagnosed. must be impairing functioning and not attributable to any other medical conditions or events
• symptoms of depression


  major depression --> have atleast 5 of the symptoms

  minor depression --> have less than 5 symptoms

  • decreased pleasure in normal activities
  • difficulty sleeping
  • weight loss or gain
  • feelings of guilt or worthlessness
  • low energy levels
  • change in activity levels (thinking or moving slow)
  • difficulty making decisions or concentrating
  • suicidal thoughts
• unipolar (standard - one extreme)


  major depression, occurs without mania and manic episodes. up to 25% of women and 12 % of men will suffer it
• unipolar (standard - one extreme) - symptoms


  behavioural:

  • loss of energy
  • social impairment
  • weight changes
  • poor personal hygiene
  • sleep patterns disturbed

  emotional:

  • loss of enthusiasm
  • constant depressed mood
  • worthlessness

  cognitive:

  • delusions
  • hallucinations
  • reduced concentration
  • thoughts of death
  • poor memory
• bipolar (two extremes)


  about 2% suffering, usually appears in peoples 20s

  mixed mania and depression are more common than mania alone
• bipolar (two extremes) - symptoms

  in addition to unipolar, sufferers have alternating manic episodes

  behavioural:

  • high energy levels
  • reckless behaviour
  • talkative

  emotional:

  • elevated mood
  • anger/irritability
  • lack of guilt
  • low self esteem

  cognitive:

  • delusions
  • irrational thought process
  • dwelling on negative thoughts
  • black and white thinking (extremes)
• cognitive explanation


  main assumption is that depression is due to faulty, irrational, thought processing

  forms of faulty thinking:

  • maximisation and minimisation
  • overgeneralising
  • catastrophising
  • polarised thinking
  • arbitrary inference
  • selective abstraction
• becks cognitive triad


  suggests depression is the result of holding negative schema about the world, the self and the future

  sufferers get caught in a loop or cycle of negative thinking, each thought reinforcing the next

  • suggests these beliefs stem from childhood

  example:

  • the self: 'im undesirable'
  • the world: 'i understand why everybody hates me, everyone else is so much better'
  • the future: 'things will never change for me'

  pessimistic views become self-fulfilling prophecy and lead to cognitive bias

  interacts with negative schemas and cognitive bias to produce depressive thinking
• becks cognitive triad


  cognitive bias: distortions of thought processes

  schemas: can be seen as deeply held beliefs that have their origins primarily in childhood

  • beck believed depression prone individuals develop a negative self-schema
  • negative schemas may influence how a person interprets events and experiences in their life
  • negative schemas and cognitive biases maintain the negative triad
• becks cognitive triad - research

  lewinsohn et al

  • measured negative thinking in non-depressed adolescents. one year later, events in life assessed and also whether they had depression
  • showed those who had experienced many negative life events had an increased likelihood of developing depression, only if they were initially high in negative attitudes
  • supports theory that negative beliefs are a risk factor for developing depression when exposed to stressful life events
• ellis' ABC model


  focuses on irrational beliefs at the source of depression

  A= activating event

  B= belief

  C= consequence

  mustabatory thinking: certain ideas or assumptions 'must' be true in order to be happy
• ellis' ABC model - beevers et al (aim)


  aim:

  see if there is a difference between the activation of different parts of the brain and depression.

  also, whether neural mechanisms can show the degree of vulnerability an individual has for depression
• ellis' ABC model - beevers et al (procedure)


  procedure:

  • 27 females (18-27) responded to advertisements
  • depression in Ps measured through a scale
  • 12 Ps placed low in depression, 14 in high
  • showed Ps different facial expressions and shapes on screen, had to press a button each time they came up to indicate what stimulus it was
  • timed how long it took
  • simultaneously scanned brains with an FMRI (detects changes in blood, in brain)
• ellis' ABC model - beevers et al (findings)

  findings:

  • different brain activation was recorded between low and high depression groups, when presented with sad or happy faces
• ellis' ABC model - beevers et al (conclusions)


  conclusions:

  • those with mild to moderate depression have difficulty activating brain areas associated with cognitive control of emotional info, and parietal brain regions
• ellis' ABC model - beevers et al (evaluation)


  evaluation:

  • gender specific - only females tested
  • limited age range
  • didnt take into account hormone levels - may have effected findings
• cognitive explanation - research

  mcintosh and fischer:

  • tested negative triad to see if it does contain 3 distinct types of negative thoughts, found no clear separation

  boury:

  • monitored students negative thoughts with beck depression inventory, finding depressive misinterpret facts and experiences in a negative fashion and feel hopeless about the future
  • supports becks cognitive explanation

  saisto:

  • expectant mothers, those who didnt adjust personal goal to match specific demands of the transition of motherhood, had increased dedpressive symptoms
  • supporting becks theory
• cognitive explanation - evaluation

  pros:

  • scientific explanation: lots of reliable lab experiments. do brain scans to identify where in the brain the faulty thinking is occurring
  • takes into nature and nurture: nature - faults in the brain that may cause faulty thinking. nurture - life experiences
  • not as reductionist as some explanations, as takes a number of factors into account
  • CBT is often used to treat it and is very effective

  cons:

  • deterministic: example of soft determinism. controlled by our faulty schemas. CBT can change these
  • doesnt explain all types of depression
• cognitive therapies

  becks CBT

  ellis' CBT - rational emotive behavioural therapy (REBT)

  • CBT aims to change the way a client thinks - will lead to a change in behaviour as a response to new thinking patterns
• cognitive therapies - CBT


  most therapists draw on both ellis's and becks models:

  1. focuses on challenging the negative thoughts about oneself, the world and the future. thoughts can be directly challenged and the client is encouraged to test the reality of their negative beliefs
  2. focuses on: affect - how client feels, behaviour - how they act, cognition - how they think
  3. not an easy option: can be expensive and time consuming. patient must be motivated and really want to change. relies on a good relationship being formed between the client and therapist
• cognitive therapies - REBT (D)

  this model is an extension of ellis' ABC model which is used to explain depression

  
• cognitive therapies - REBT

  D= disputing (encourages the client to think of alternative explanations or possibilities)

  E= effects (of new beliefs and attitudes that emerge)

  F= feelings (emotional responses that arise)
• cognitive therapies

  • both have homework tasks which may involve putting themselves into situations which they would have previously avoided or telling a family member or friend how they really feel

  behaviour activation: client is encouraged to become more active and take part in pleasurable activities

  • ellis strongly believed in the importance of unconditional positive regard
• CBT - evaluation


  motivation:

  • patients with severe depression may not engage with CBT. this treatment will be ineffective in treating these patients
  • CBT cannot be used as the sole treatment for severely depressed patients

  some psychologists have criticised CBT, as it suggests that a persons irrational thinking is the primary cause of their depression and CBT does not take into account other factors
• elkin et al - procedure

  procedure:

  • across several treatment centres. 240 Ps with depression were treated with CBT, psychotherapy or anti-depressant drugs
• elkin et al - findings

  findings:

  • large placebo effect of 35-40%, all therapies were significantly more effective than placebo, and overall had similar levels of effectiveness
  • drugs tended to be the most effective therapy for severe depression
  • individual therapist was a significant factor in the effectiveness of psychotherapy
  • across all treatment groups, 30-40% of patients did not respond to therapy. no treatment is ever 100% effective
• elkin et al - conclusion

  conclusion:

  • drugs, CBT and psychotherapy are all more effective than a placebo
• march et al


  found CBT was as effective as antidepressants

  • examined 327 adolescents with depression and looked at the effectiveness of CBT, antidepressants and a combination of CBT plus antidepressants
  • after 36 weeks, 81% of antidepressant group and 81% of CBT group had significantly improved
  • 86% of CBT plus antidepressants group had significantly improved
  • suggests that a combination of both treatments may be more effective