Depressions (+ Explanation & Treatment)

Outline depression

All forms of depression are characterized by changes to mood.

Name 4 disorders related to depression

• Major depressive disorder: severe but often short-term depression.

• Persistent depressive disorder: long-term or recurring depression, including sustained major depression and what used to be called dysthymia.

• Disruptive mood dysregulation disorder: childhood temper tantrums.

• Premenstrual dysphoric disorder: disruption to mood prior to and/or during menstruation.

Outline the behavioural characteristics of depression (1/5)

Activity levels: Sufferers have reduced levels of energy (lethargy). Therefore, sufferers tend to withdraw from work, education and social life. In severe cases, sufferers cannot leave their bed.

Outline the behavioural characteristics of depression (2/5)

Psychomotor agitation: Occasionally, sufferers experience psychomotor agitation. Sufferers cannot relax and pace up and down.

Outline the behavioural characteristics of depression (3/5)

Disruption to sleep:

• Insomnia

• Hypersomnia

Outline the behavioural characteristics of depression (4/5)

Eating behaviour: Appetite and eating may increase or decrease also, leading to weight gain or loss.

Outline the behavioural characteristics of depression (5/5)

Aggression and self-harm: Sufferers of depression are often irritable, and in some cases they can become verbally or physically aggressive. This can have serious knock-on effects on a number of aspects of their life.

Depression can also lead to physical aggression directed against the self. This includes self-harm, often in the form of cutting, or suicide attempts.

Outline the emotional characteristics of depression (1/4)

Lowered mood: When we use the word ‘depressed’ in everyday life we are usually describing having a lowered mood, in other words feeling sad. Importantly, there is more to clinical depression than this. Lowered mood is still a defining emotional element of depression, but it is more pronounced than in the daily kind of experience. Patients often describe themselves as ‘worthless’ and ‘empty’.

Outline the emotional characteristics of depression (2/4)

Anger: 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.

Outline the emotional characteristics of depression (3/4)

Low self-esteem: Self-esteem is the emotional experience of how much we like ourselves. Sufferers 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 hating themselves.

Outline the emotional characteristics of depression (4/4)

Loss of interest: Loss of interest and pleasure in usual hobbies and activities is associated with feelings of despair and lack of control.

Outline the cognitive characteristics of depression (1/3)

Poor levels of concentration: The sufferer may find themselves unable to stick with a task as they usually would, or they might find it hard to make decisions. Poor concentration and poor decision making are likely to interfere with the individual’s work.

Outline the cognitive characteristics of depression (2/3)

Attending to and dwelling on the negative: When suffering a depressive episode people are inclined 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.

Outline the cognitive characteristics of depression (3/3)

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 to see it as an absolute disaster.

Outline the cognitive approach to explain depression

The term ‘cognitive’ has come to mean ‘mental processes’. This approach is therefore focused on how our mental processes (e.g. thoughts, perceptions, attention) affect and cause depression.

Outline Beck’s Cognitive Theory of Depression (1967)

Beck suggested that there is a cognitive explanation as to why some people are more vulnerable to depression than others.

Beck suggested there are three parts to this cognitive vulnerability:

• Faulty information processing

• Negative self-schema

• The negative triad

Outline faulty information processing

• Beck believed depressed individuals attend to the negative aspects of a situation and ignore the positives.

• There is a tendency for black and white thinking, where something is all bad or all good.

Outline negative self-schemas

• Schema: a ‘package’ of ideas and information developed through experience.

• They act as a mental framework for interpreting sensory information

• Self-schema: a ‘package’ of information people have about themselves.

• People use schemas to interpret the world, therefore if a person has a negative self-schema they interpret all information about themselves in a negative way.

Outline the negative triad

• Beck suggested that a person develops a dysfunctional view of themselves because of three types of negative thinking, regardless of reality.

• These three elements are called the negative triad.

  • Negative view of the world (it is a hostile place)

  • Negative view of the future (problems will

  • not disappear)

  • Negative view of the self (I am a failure)

Strength - Beck’s Negative Triad - Application in screening and treatment for depression

E.g. Cohen et al (2019) concluded that cognitive vulnerability is associated with developing depression.

Exp: This matters because we can apply this understanding to cognitive behavioural therapy. These therapies work by altering the kind of cognitions that make people vulnerable to depression.

Weakness - Beck’s Negative Triad - Provides a partial explanation

E.g: There is no doubt that depressed people show patterns of cognition, however, the explanation cannot explain how some depressed people feel extreme anger, experience hallucinations and delusions.

Exp: This matters because the cognitive approach can only provide some explanation of depression. Therefore, maybe including other approaches, such as the biological approach may provide a more holistic explanation.

Outline Ellis’ (1962) ABC Model

• Ellis proposed that good mental health is the result of rational thinking.

• Ellis suggested that conditions like anxiety and depression (poor mental health) result from irrational thoughts.

• Ellis defined irrational thoughts as thoughts that interfere with us being happy or free from pain.

Define activating event

Ellis suggests that we become depressed when we experience negative events and these trigger irrational beliefs.

Name and describe two irrational thoughts

• Musturbation: We must always succeed or achieve perfection.

• I-can’t-stand-it-itis: The belief that it is a major disaster whenever something does not go smoothly.

Define consequence

When an activating event triggers irrational beliefs there are emotional and behavioural consequences.

For example, if a person believes that they must always succeed and then fail at something this can trigger depression.

Strength - Ellis’ ABC model - Real-world application in the psychological treatment of depression

E.g: Ellis’s approach to cognitive therapy is called rational emotive behavioural therapy (REBT). There is some support that REBT can both change negative beliefs and relieve symptoms of depression (David et al 2018).

Exp: This matters because REBT has real-world value to treating depressed individuals.

Weakness - Ellis’ ABC model - Ethical issues

E.g. The ABC model is controversial because it locates responsibility for depression purely with the depressed person. Therefore, this is effectively blaming the depressed person.

Exp: This matters because it would be unfair to blame the client for their mental illness.

Outline cognitive therapy

• Cognitive therapy originally focused on the view that the way we feel is dependent on the way with think about events.

• Cognitive therapy evolved into cognitive behavioural therapy (CBT), as the need to develop coping strategies (changes in behaviour) was required.

Outline Beck’s CBT

• Cognitive behavioural therapy is the application of Beck’s cognitive theory of depression.

• The idea is to identify automatic thoughts about the world, the self and the future – this is the negative triad.

• Once identified these thoughts must be challenged. This is the central component of the therapy.

• As well as challenging these thoughts directly, cognitive therapy aims to help patients test the reality of their negative beliefs.

Outline the history of Ellis’ REBT

• Ellis developed the first form of CBT, called rational therapy.

  • This was because he saw psychological problems as a result of irrational thoughts.

• Ellis then renamed his therapy, rational emotive therapy (RET).

  • This is because the therapy focused on resolving emotional problems.

• Finally, Ellis renamed his process rational emotional behavioural therapy (REBT).

  • This is because he recognised the importance of behaviour in resolving problems.

What did DEF stand for when Ellis expanded his model?

D – Disputing irrational thoughts

E – Effects of disputing and Effective attitude to life

F – Feeling (emotions) that are produced

Outline Ellis’ REBT

• REBT focuses on challenging the irrational thoughts and replacing them with rational beliefs.

• Effective disputing of beliefs allows a client to move from

  catastrophising to more rational interpretations of events.

• This in turn makes clients feel better and become more self accepting.

Outline homework within CBT

Clients are often given homework between sessions. They might be set homework such as to record when they enjoyed an event or when people were nice to them.

This is sometimes referred to as the ‘patient as scientist’, investigating the reality of their negative beliefs in the way a scientist would.

Outline behavioural activation within CBT

• CBT focuses on encouraging clients to become involved with activities that they may have previously enjoyed.

• The idea of being active leads to rewards that are an antidote to depression.

Outline unconditional positive regard

• Ellis (1994) came to recognising the value in convincing the client of their value as a human being.

• If the client feels worthless, then they’re less likely to consider changing their beliefs and behaviour.

• If the therapist provides respect and appreciation regardless of what the client does or says (i.e. unconditional positive regard) this will allow a change in beliefs and attitudes.

Weakness - Cognitive treatments for depression - Other effective treatments

E.g: Drug therapies (such as SSRIs) require less effort on the part of the client, but can also be used in conjunction with methods such as CBT. Cuijpers et al. (2013 ) found that CBT was especially effective if it was used in conjunction with drug therapy.

Exp: This matters because it suggests that CBT may be more effective when used alongside other treatments, such as drug therapies.

Weakness - CBT - Individual differences affect its effectiveness

E.g. CBT appears to be less successful for people who have high levels of irrational beliefs, and are resistant to change. CBT also appears to be less effective when high levels of stress are present.

Exp: This matters because it shows that CBT is not always effective for all clients. Individual differences between clients can lead to less successful sessions.

Weakness - Cognitive therapy to treat depression - All methods of treatment for mental disorders may be equally effective

E.g. Luborsky et al. reviewed over 100 studies that compared different therapies, and found only small differences. The argument is that all therapies feature very common factors like being able to talk to a sympathetic person, or having an opportunity to express one’s thoughts.

Exp: This matters because it shows that commonalities between different types of therapy might explain the lack of difference in the effectiveness of different therapies.