Depression

Characteristics of Depression

• behavioural

• emotional

• cognitive

Behavioural Characteristics

• shift in activity levels (increase/restlessness or decrease/withdrawal)

• affected sleep (increase or decrease/insomnia)

• affected appetite (increase or loss in appetite)

• aggression and self-harm (culminating in suicidal behaviour)

Emotional Characteristics

• sadness (consistent low mood with hopelessness)

• anger (outburst and unpredictable mood swings)

• loss of interest (once brought joy, increase sadness)

• low self-esteem (self-loathing, increase sadness and hopelessness)

Cognitive Characteristics

• negative world view (everything turns bad, no hope)

• irrational thoughts (not reflect reality, mirror negative mindset)

• poor concentration (disturbed, unable to focus on specific task)

• inability to make decisions (paralysed with indecision)

• catastrophising (end of the world mindset, smallest setback is tragedy)

Explanations for Depression

• Beck’s cognitive theory (negative triad)

• Ellis’ cognitive theory (ABC model)

Beck’s Negative Triad

• negative schema

• faulty thinking/information processing

• negative triad

How does Beck explain Depression

• internal mental processes determine behaviour

• e.g. thoughts, information, perception

• depression is a result of faulty or irrational though processing and negative schema

Negative Schema

• acquired during childhood

• caused by factors (criticism, peer rejection, parental rejection)

• lead to interpret events and self negatively

• leads to faulty thinking

Faulty Information Processing

• prone to misinterpreting information

• leads to low mood

• e.g. overgeneralisation - single event is never ending pattern (breakup = no one loves me)

• e.g. catastrophing - exaggerate as disaster

• e.g. personalisation - blame self no matter (blame self for breakup, normally both parties)

• e.g. mental filter - only note negative things, ignore positive

Negative Triad

• pessimistic and irrational view

• occur automatically regardless of reality

• lead to/cycle of depression

• future - i will never be good enough

• self - i’m worthless

• world - everyone hates me

Real-Life Application strength of Beck’s Cognitive Theory

• CBT used to identify, challenge and change irrational thoughts

• depression symptoms recede

• demonstrates external validity to help in real settings

• helps suffering of depression

Research Support strength of Beck’s Cognitive Theory

• some pregnant women who show vulnerability for depression

• more likely to suffer post-natal depression than without diathesis

• cognitive approach used to identify vulnerability

• trigger interventions to delay or prevent progress of depression

What not Why criticism of Beck’s Cognitive Theory

• highlights hat characterises irrational thinking

• not why such thoughts occur or where they come from

• lacks explanatory power

Biological criticism of Beck’s Cognitive Theory

• not consider influence of biological factors

• genetics and neurotransmitters play key role in development

• not full holistic approach to explaining depression

• viewed as cognitive only

What does Ellis’ ABC Model claim

• irrational thoughts interfere with happiness

• good mental health result of lack of irrational thinking

• any thoughts which obstruct happiness are irrational

• ABC model explains how irrational thoughts affect mood and behaviour

Ellis’ ABC Model

a - activating event

b - beliefs

c - consequences

A = Activating Event

• any occurrence which someone perceives negative

• e.g. losing one job

B = Beliefs

• irrational thoughts associated with event and why happened

• e.g. losing one job turns into lost job because i’m useless

• musterbation (e.g. i must never fail)

C = Consequences

• A+B leads to C

• rational beliefs lead to healthy consequences

• e.g. lost job, no big deal, better look for another

• unhealthy consequences always lead to depression

Control strength of ABC Model

• assigns responsibility for individual to manage thoughts

• allow some degree of control to manage consequences of Activating event and Beliefs

• idiographic approach theory

• no two experiences of depression are identical

Real-Life Application strength of ABC Model

• Ellis developed REBT (form of CBT)

• successful in treating depression

• changing irrational thought patterns

• therapy has good application

Research Against criticism of ABC Model

• ‘sadder but wiser’ effect in depressed people

• gave more accurate estimates of disaster likelihood than non-depressed

• irrational thoughts are not irrational

• unbiased, realistic, clear-eyed appraisal of event or situation

No Event criticism of ABC Model

• accounts for reactive depression where response to activating event

• not endogenous depression where develops without accompanying Activating event

• limit external validity

What is the treatment for Depression

cognitive behavioural therapy

What does CBT include

• cognitive restructuring (negative thoughts into positive)

• guided discovery (challenge negative thoughts and irrational belief)

• keep journal (recording thoughts, feelings, actions between sessions)

• activity scheduling (acting on decisions, not procrastinating)

• relaxation techniques (muscle relaxation, deep breathing, visualisation)

• role-playing (different scenarios patient finds difficult)

Aim of CBT

client can be independent using strategies practiced over course of CBT treatment (5-20 30-60min sessions)

How does CBT relate to Beck’s Theory

• thought catching - identify automatic, negative thoughts about self, world, future

• “patient as scientist” - make hypothesis then investigate evidence of irrational belief

How does CBT relate to Ellis’ REBT

• extended to ABCDE

• D = dispute

• E = effect

• “vigorous argument” disputes belief - involves disputing techniques

• empirical argument = is there real evidence to support irrational belief

• logical argument = does negative thought follow logically from facts

• pragmatic argument = does this way of thinking benefit the individual

How does CBT relate to both

• emphasis on current events/thinking not past events

• aims to change negative, irrational beliefs

• “reality testing” - thought diary providing evidence to challenge irrational thoughts

• cognitive restructuring - whats irrational? where’s the evidence? how can we change to positivity?

• behavioural activation - decrease avoidance and isolation to not worsen depression

  • engage in actives shown to improve mood/previously enjoyed

Success strength of Cognitive Approach

• CBT most popular therapy for depression treatment

• CBT as successful as drug therapy

• good real life application

• effective in reducing symptoms of depression

• BUT influenced by client-therapist relationship

Individual strength of Cognitive Approach

• CBT allows patient to develop at own pace

• therapist tailors sessions to suit individual

• CBT embraces free will in approach

Individual Difference criticism of Cognitive Approach

• emphasis on here and now

• not appropriate if need to revisit past event

• limits usefulness

• not effective for all individuals in treatment

Expression criticism of Cognitive Approach

• talking therapy

• doesn’t work for people who don’t like to express themselves freely

• or lack verbal or intellectual skills

• therapy lacks idiographic dimension, ignoring experiences of some individuals