9.2- Major Depression

Case 9 - Case Formulation Using the Integrative Model: (pp. 128-131)

Key Answer: C. A biological vulnerability or predisposition to develop depression

Explanation:
In the diathesis-stress model, “diathesis” refers to a biological vulnerability—a genetic or neurobiological predisposition that increases a person’s risk for developing depression when combined with stressful life events (the “stress” component).
Note: DSM-5 Code for Major Depressive Disorder, Single Episode, Moderate — 296.22.

According to the integrative model, which of the following best describes the “diathesis” component in mood disorders such as major depression?

A. The experience of significant life stressors
B. A learned tendency toward helplessness
C. A biological vulnerability or predisposition to develop depression
D. The absence of social support

Key Answer: B. Identical twins show higher concordance rates for depression than fraternal twins

Explanation:
Twin studies (e.g., McGuffin et al., 2003) demonstrate that identical (monozygotic) twins are significantly more likely to share a mood disorder than fraternal (dizygotic) twins, showing the role of heredity in mood disorders.

Which finding provides the strongest evidence for a genetic contribution to major depressive disorder?

A. People with depression often have low serotonin levels
B. Identical twins show higher concordance rates for depression than fraternal twins
C. Individuals with depression report more stressful life events
D. Depression occurs more frequently in industrialized nations

Key Answer: C. Activating stress hormones that affect neurotransmitter systems

Explanation:
Stressful life events activate stress hormones (e.g., cortisol) that affect serotonin and norepinephrine systems. Chronic stress can cause structural brain changes and disrupt emotion regulation, contributing to major depression.

Stressful life events are thought to contribute to the onset of major depression primarily through which mechanism?

A. Increasing dopamine receptor sensitivity
B. Decreasing serotonin transporter production
C. Activating stress hormones that affect neurotransmitter systems
D. Suppressing immune system activity

Key Answer: B. Internal, stable, and global

Explanation:
A pessimistic attributional style involves interpreting negative events as internal (“it’s my fault”), stable (“it will always be this way”), and global (“it affects everything in my life”). This pattern is linked to depression (Abramson, Seligman, & Teasdale, 1978).

Which attributional pattern is most strongly associated with depression according to the learned helplessness theory?

A. External, unstable, and specific
B. Internal, stable, and global
C. Internal, unstable, and specific
D. External, stable, and global

Key Answer: B. Self, world, and future

Explanation:
Beck’s cognitive triad describes the negative thought patterns of depressed individuals: negative views of the self, the world, and the future, contributing to hopelessness and low mood.

According to Beck’s cognitive theory, which three areas form the “cognitive triad” characteristic of depression?

A. Self, others, and society
B. Self, world, and future
C. Past, present, and future
D. Emotions, behaviors, and thoughts

Key Answer: B

Explanation:
A schema is a stable, deeply held cognitive structure or belief system. In depression, negative schemas distort how individuals interpret experiences, leading to automatic negative thoughts.

According to Beck, which of the following best defines a schema in depression?

A. A temporary mood fluctuation
B. A stable, enduring belief system that biases information processing
C. A learned coping mechanism for dealing with stress
D. A form of unconscious repression

Key Answer: C. Strongly and bidirectionally related

Explanation: Studies show a bidirectional relationship — marital dissatisfaction can lead to depression, and depression can erode marital quality. Both factors mutually reinforce each other (e.g., Beach et al., 1990; Whisman, 2007).

Research has found that marital dissatisfaction and depression are:

A. Unrelated once biological factors are controlled
B. Causally linked in only one direction
C. Strongly and bidirectionally related
D. Significant only in younger couples

Key Answer: B. Lack of social support increases vulnerability to depression after stress

Explanation:
Adequate social support buffers the effects of stress and reduces the risk of developing depression. Conversely, low support increases vulnerability and slows recovery (Brown & Harris, 1978; Monroe et al., 2009).

Which statement about social support and depression is most accurate?

A. Social support has no measurable effect on depression outcomes
B. Lack of social support increases vulnerability to depression after stress
C. Excessive social support can prolong depressive episodes
D. Social support is only important for anxiety, not depression

Key Answer: C. Increased risk of relapse in depression

Explanation:
“High expressed emotion” (frequent criticism, hostility, and overinvolvement) in family environments predicts higher relapse rates in individuals recovering from major depression (Hooley & Teasdale, 1989).

High levels of “expressed emotion” in families are associated with:

A. Faster recovery from depression
B. Greater resilience to stress
C. Increased risk of relapse in depression
D. No measurable impact on depression outcomes

Key Answer: B. Improving interpersonal relationships and resolving role conflicts

Explanation: IPT is a structured, evidence-based therapy that targets interpersonal relationships and social functioning, helping clients resolve conflicts and improve support systems to reduce depressive symptoms.
Note: DSM-5 Code for Major Depressive Disorder, Single Episode, Moderate — 296.22.

Interpersonal Psychotherapy (IPT) primarily focuses on:

A. Changing automatic thoughts
B. Improving interpersonal relationships and resolving role conflicts
C. Reducing biological vulnerability through medication
D. Teaching relaxation and exposure techniques