Depression

Characteristics and Cognitive Explanations

What is depression?

A mental disorder characterised by low mood and energy levels

Diagnostic features of Depression

Can affect thoughts, feelings, behaviour and, physical well-being. Clinical depression is not just feeling sad (but this is part of it), its a set of complex symptoms. The symptoms must be causing distress or impaired functioning in social and/or occupational roles.

How are forms of depression and depressive disorders characterised?

All forms of depression and depressive disorders are characterised by changes to mood.

Categories of depression:

• Major depressive disorder – severe but short term.

• Persistent depressive disorder – long term and recurring.

• Disruptive mood dysregulation disorder – childhood temper tantrums.

• Premenstrual dysphoric disorder – prior to menstrual cycle

Behavioural Characteristics

• Activity Levels

• Disruption to sleep and eating

• Aggression and self-harm

Activity Levels and depression

• Sufferers have reduced energy levels (lethargy). Leads to withdrawal from work, education and social situations.

• It can result in sufferers not getting out of bed. (Extreme)

• There can be an opposite effect – psychomotor agitation, where individuals struggle to relax and may continuously pace.

Disruption to sleep and eating

• May experience insomnia, premature waking, or hypersomnia.

• Also, appetite and eating may increase or decrease (with weight gain or loss). Key point: These behaviour are disrupted by depression.

Aggression and self-harm

• Sufferers of depression are often irritable, and can become verbally or physically aggressive.

• This can have a serious knock-off effects on different aspects of their life e.g. someone experiencing depression might display verbal aggression by ending a relationship or quitting a job.

• Depression can also lead to physical directed against the self. This includes self-harm or suicide attempts.

Emotional Characteristics

• Lowered mood

• Anger

• Lowered self-esteem

Lowered mood

Lowered mood is still a defining emotional element of depression, however it is more than just feeling lethargic and sad. Patients often describe themselves as ‘worthless’ and ‘empty’

Anger

Although sufferers tend to experience more negative emotions and fewer positive episodes of depression, this experience of negative emotion is not limited to sadness. Sufferers of depression also frequently experience anger, sometimes extreme anger – This can be directed at the self or others. On occasion such emotions lead to aggressive or self-harming behaviour.

Lowered self-esteem

Sufferers of depression tend to report reduced self-esteem, in other words they like themselves less than usual. This can be quite extreme, with some sufferers of depression describing a sense of self-loathing i.e. hating themselves.

Cognitive Characteristics

• Poor Concentration

• Dwelling on the Negative

• Absolutist Thinking

Poor Concentration

Unable to stick with a task as they usually would, or they might find it hard to make decisions that they would normally find straightforward. Likely to interfere with the individual’s work.

Dwelling on the Negative

Included to pay more attention to negative aspects of a situation and ignore the positives. Sufferers also have a bias towards recalling unhappy events rather than happy ones – the opposite bias that most people have when not depressed.

Absolutist Thinking

Most situations are not all-good or all-bad, but when a sufferer is depressed they tend to think in these terms. They sometimes call this ‘black and white’ thinking. This means that when a situation is unfortunate they tend o see it as an absolute disaster.

Information processing

People suffering from depression tend to process information about several aspects of the world quite differently from the ‘normal’ ways that people without depression think.

The cognitive approach

• Negative thought patterns

• Maladaptive ways of thinking

• Disrupted cognitive processes i.e. schemas, attention etc

Basic assumptions of the cognitive approach in this context

The mind is like a computer. Abnormality is due to irrational or faulty thought processes.

INPUT → PROCESSING → OUTPUT

Background information of C.A

Abnormality through:

• cognitive distortions (dysfunctional thought processes) 

• cognitive deficiencies (absence of sufficient thinking and planning) 

NB- a person is in control of their thoughts, so abnormality is a result of faulty control

Schemata

• We develop these from our early experiences.

• Traumatic or negative experiences - could lead to negative automatic thoughts (NATs).

• These negative automatic thoughts could cause cognitive biases and depression

Beck’s Cognitive Theory of Depression

American psychiatrist Aaron Beck (1967)

• Some people are more vulnerable to suffering from depression the others

• It is a person’s cognitions that create this vulnerability.

Beck suggested three parts to this cognitive vulnerability:

1. Faulty information processing

2. Negative self-schemas

3. The negative triad

Faulty Information Processing

• Those who suffer from depression attend to the negative aspects of a situation and ignore the positives.

• They also tend to blow small problems out of proportion and think in ‘black and white’ terms.

Negative Self-schemas

• A schema is a mental framework for the interpretation of sensory information developed through experience.

• A self-schema is the package of information we have about ourselves. We use schemas to interpret the world, so if we have a negative self-schema we interpret all information about ourselves in a negative way.

The Negative Triad

A person develops a dysfunction view of themselves because of three types of negative thinking that occur automatically, regardless of the reality of what is happening at the time.

Examples:

Negative view of the world: ‘The world is a cruel place’

Negative view of the future: ‘I will never be happy’

Negative view of oneself: ‘I am a hopeless failure’

Grazioli and Terry (2000)

Assessed 65 pregnant women for cognitive vulnerability and depression before they gave birth. They found that women who were judged with a high cognitive vulnerability were more likely to suffer from post natal depression.

Clark and Beck (1999)

Reviewed research on this topic and concluded that there was solid support for all these cognitive vulnerability factors. Critically, these cognitions can be seen before depression develops, suggesting that Beck may be right about cognition causing depression (at least in some cases).

Practical Application - CBT

• An increased understanding of the cognitive basis of depression leads to more effective treatments.

• For example, elements of the cognitive triad can easily be identified by a therapist and challenged as an irrational thoughts.

• This shows that, it translates well into a successful therapy.

• The effectiveness of CBT is merit to the accuracy of Beck’s cognitive theory.

Limitations of Beck

• Some depressed patients are deeply angry and Beck can not easily explain this extreme emotion.

• Some sufferers of depression suffer from hallucinations and bizarre beliefs – very occasionally patients suffer from Cotard’s syndrome, the delusion that they are zombies (Jarrett, 2013).

Ellis ( 1962) A-B-C model

A = Activating agent

 

B= Belief → which may be rational or irrational

C = consequence –

• Some depressed patients are deeply angry and Beck can not easily explain this extreme emotion.

• Some sufferers of depression suffer from hallucinations and bizarre beliefs – very occasionally patients suffer from Cotard’s syndrome, the delusion that they are zombies (Jarrett, 2013).

Strengths of Ellis’ ABC model

• Recognises that complex cognitive processes are important

• It has proved to be effective in treatment

• Individual Control

• It has led to a successful therapy. The idea is that, by challenging irrational negative beliefs, a person can reduce their depression is supported by research evidence (Lipsky et al., 1980)

Limitations of Ellis’ ABC model

• Narrow explanation (It takes no account of biological or genetic factors).

• Blames the patient rather than situational factors (may overlook situational factors which could be key!! i.e. major life events).

• Cause and effect is unclear.

• Not all irrational beliefs are irrational.

• Alloy and Abrahamson ( 1979): depressive realists see things for what they are

• Can not explain all aspects of depression e.g. hallucinations, anger, Cotard’s Syndrome. 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.

Cognitive Primacy

• Cognitive explanations for depression share the idea that cognition causes depression.

• This is closely tied up with the concept of cognitive primacy, the idea that emotions are influenced by cognition (your thoughts). This is certainly the case sometimes, but not necessarily always.

• Other theories of depression see acknowledge that emotions don’t always influence cognition.

Attachment And Depression

• Studies of attachment have shown that those infants that develop insecure attachments to their parents are more vulnerable to depression in adulthood.

• Attachment theory holds that early attachment relationships influence brain development in terms of cognitive and emotional development.

• Thus, if children learn maladaptive or unhealthy though patterns in relation to their primary caregivers this is likely to influence their thought process in adulthood.

• Such research concurs with cognitive theories of depression.