Psychological problems

Unipolar depression

The most common type of depression where people suffer from periods of feeling ‘down’

Unipolar

Refers to someone’s mood being pulled in one (uni) direction

Bipolar depression

 When patients have mood swings from very low (sad) to very high

Main symptoms of unipolar depression

• Lowered mood

• Lack of energy despite resting for long

• Lack of motivatione

Mild depression

• 4 symptoms

• Still able to carry out daily activities with some hinderance from symptoms

Moderate depression

• 5-6 symptoms

• Serious problems in daily activities

Severe depression

• 7+ symptoms

• Suicidal thoughts or self-harm to cope with emotions

Identical/Monozygotic twins

Has a 46% likelihood between whether or not genes might influence their risk of developing depression

Monozygotic (A) twins

Identical twins separated at birth and raised in different environments

Fraternal/Dizygotic twins

20% that the other twin will be diagnosed with depression

Parent’s genetic influence on depression

• If the father has depression, the child is 70% more likely to have depression

• This percentage goes higher if the mother also has depression

Stress Diathesis Model

Genetic Predisposition and/or Childhood trauma → vulnerability to mental disorder

Genetic predisposition

Biological tendency to develop a particular behaviour as a result of the genes someone has

Results of Hyde et al. 2016 for genetic explanation

17 different gene variations were linked to developing depression

Strengths of genetic explanation to depression

• If depression can be explained by looking at genes, stigma can be taken away from those that were diagnosed

  • People cannot blame you for being depressed if it's in your genes

• Lots of research evidence available that some people are more prone to depression than others

  • Capsi et al. (2003)

Weaknesses of the genetic explanation of depression

• Genetic theory is very deterministic because it assumes that certain genes would mean you will be more likely to be depressed, and there’s no way to change it

  • This may not be the case as people believe that they have free will to become depressed

• Reductionist approach

  • Too simplistic to assume that it is just an abnormal gene

CBT for depression

• Helps patients change the way they think (cognitive part)

• Helps the patient change the way they act to improve the symptoms (behavioural part)

Stages of CBT (depression)

• First, the patient discusses all their symptoms with the therapist and explain how they feel

• Next, these irrational ways of thinking are challenged by offering advice on how to think more rationally and positively

• Then, the patient will have a series of CBT sessions and will be given homework to do, such as changing the way they think about a situation

Strengths of CBT for depression

• Evidence available to suggest it is effective

  • Beltman et al 2010 found that depressed patients treated with CBT improved more than those who were still waiting for treatment

• May be a longer-lasting treatment than only using antidepressants

• May help patients feel better as they learn how to deal with their own symptoms

Weaknesses of CBT for depression

• Relies on patients wanting to change their behaviour and ability to recognise that their thoughts are irrational

• Ethical issues as the therapist is encouraging the patient to think that their own thoughts are a problem

Cognitive theory of depression

States that behaviour can be explained by looking at how the brain processes information and how we think

Beck’s cognitive triad

• Depression could be explained by 3 negative thought patterns

1. Negative view of the self

2. Negative view of the future

3. Negative view of the world

• This negative triad probably develops from bad experiences in someone’s past

• These people may be vulnerable to magnification

  • Magnification: seeing their problems as far worse than they are in reality

Ellis’s ABC model

• He suggested that there are 3 stages that might cause a person to develop negative thought processes

1. Activating event

2. Beliefs

3. Consequences

Strengths of cognitive theory for depression

• Takes into account the events in a person’s life, accepts that there is often an event that triggers depression and combines nature and nurture factors

• Applied to CBT

Weaknesses of cognitive theory for depression

• Difficult to tell whether irrational thoughts are a cause of depression or a symptom of being depressed

• Some cases of depression can be seen to follow obvious activating events, such as death of a loved one, depression may not be so easily explained by just thought processes

Drug treatments of depression

• Mild depression does not require medication

• Moderate or recurring depression may require antidepressants

Antidepressants

Works by increasing the levels of serotonin in the brain as some symptoms of depression are due to low levels of serotonin

Serotonin

Neurotransmitter that regulates mood, social behaviour, appetite, digestion, sleep and memory

Noradrenaline

Neurotransmitter needed for alertness, energy and attention to life

Monoamine oxidase

Enzyme that breaks down serotonin and noradrenaline in the synapse after they have been released by neurons

Stages of antidepressants

• After 2-3 weeks after the antidepressant, patients will feel much better

• The full effect is seen after a 2-6 week period

  • Stopping between the period will put the patient at risk of developing depression again and it may be more severe

SSRI: selective serotonin reuptake inhibitors

• Blocks the reuptake of serotonin when they are released from a neuron, so serotonin is available for longer

  • Reuptake: process where neurons reabsorb neurotransmitters that they released

SNRI: serotonin and noradrenaline reuptake inhibitors

Same as SSRI but blocks the reuputake of noradrenaline too

Monoamine oxidase inhibitors

• Prevents enzyme from carrying out its function properly

• Monoamine oxidase breaks down serotonin and noradrenaline after they are released 

Tricyclic antidepressants

• Oldest antidepressants, created in 1950

• They work by boosting the effect of serotonin and noradrenaline in the brain by preventing reabsorption of these neurotransmitters into the neuron

• However the symptoms of taking this is very severe e.g severe nausea, headaches etc

Relapse

Return of symptoms after treatment has been given

Placebo

An inactive substance used instead of an active substance, the patient is unaware that it is fake when given the placebo

Addiction

A persistent and intense urge to engage in behaviour or drug that makes the addict feel good, despite the negative effects

Incidence of addiction

• Addiction now includes addiction to video games and internet addiction

• In the past, addiction was only concerned with substance misuse

• Statistics show that the number of addictions in society are rising while many sources of addiction are becoming cheaper

Influence of addiction on individuals

• Negatively impacting relationships (ignoring family, skipping work)

• Spend extra money on their addiction instead of functional things like food or housing

• Physical and mental health issues (not enough money to take care of themselves)

Influence of addiction on society

• Impact on workplace: taking time away from work

• Cost of healthcare services to support addictions

• Addicted people turn into criminals as their behaviour gets worse

• Costs of investigating crimes increases

Internet addiction

As of now, ICD-10 does not recognise “internet addiction” as a mental health problem, it is seen as a behavioural addiction

Learning theory as an explanation for addiction

Explanation that believes behaviour is learned through experiences

Classical conditioning

• Behaviour is learned through associations, when two or more things happen at around the same time and our mind links them together

• In the future if one of these things happen, we believe the other will automatically be triggered

• This may explain why people become addicted, as they may believe a substance or activity is associated with positive feelings in some ways, so the next time they want to feel good, they will repeat this action as they have associated it with the positive outcome

Operant conditioning for addiction

• Behaviours are repeated when they lead to positive consequences

• Positive consequences is a form of reinforcement that strengthens behaviour and makes it more likely to be repeated

• People with addictive behaviour may continue even if told that it is not good for them, if it makes them feel good, it reinforces the behaviour and makes them want to do it again

Social learning theory for addiction

• Behaviour is learned as a result of observing other people, especially role models

• For addiction, people may look up to people who do addictive behaviour, and when given the opportunity to try it out, they may be more inclined to try it

Strengths of learning theory for addiction

• Assuming addictions are based off learning can mean they can be unlearned

• Explains why previous addicts relapse 

Weaknesses of learning theory for addiction

• Ignores role of biological factors

  • However operant conditioning does consider that taking drugs is often done to get the positive feeling in your brain

• Does not explain why lots of people try these behaviours, but only a few do get addicted

Capsi et al. 2003

The study to investigate why stressful life events lead to depression in some people but not others and if depression was more likely for those with a certain variation of the 5-HTT gene

5-HTT gene

Linked to the amount of serotonin available in the brain

Results of Capsi et al

Those with at least 1 short version of the 5-HTT gene and had experienced stressful life events were more likely to develop depression

Strengths of Capsi et al

• Large sample of 847 participants

  • Makes generalising easier

• Information is useful to doctors as it suggests that someone with depression may have different causes for their symptoms

  • They can check the genes

  • However this may not be possible due to time and cost restraints

Weaknesses of Capsi et al.

• Researchers thought there was a chance that some were naturally more likely to put themselves in stressful situations

  • The short version may be a natural factor that makes people more likely to suffer from situations

  • Therefore genes and life events may not be the cause, but instead the person is just in too many stressful events

• Evidence from questionnaires are self-report data which may not be reliable

  • Some may exaggerate their symptoms and some may not make a big deal of it

CBT for addiction

• A talking therapy that manages problems by changing the way you think and behave

• Most commonly used to treat anxiety and depression, but can help with other mental/physical health problems

• Aims to change your thinking based on current events rather than looking into the past

Functional analysis of CBT (addiction)

• Involves looking at the addict’s behaviour and working out what makes them turn to their addiction

• They look at what emotions cause the need for addiction

• People can learn what places, people and feelings to avoid in order to stop getting addicted

Skills training of CBT (addiction)

• After completing functional analysis, patients move to this stage

• They will learn skills to avoid engaging in their addiction

• In between sessions patients will keep a diary of important events to record their progress, they can note their feelings and thoughts

• CBT can be combined with other therapies to deal with physical effects of recovery from addiction

Strengths of CBT for addiction

• Aims to give patient control over their addictions

• Supported by research evidence (Young’s study)

  • Showed that it is effective for treating people with internet addiction both in short and long term 

Weaknesses of CBT for addiciton

• Addict must be motivated in the first place to change their behaviour

  •  Problem: some symptoms of addiction include having difficulty changing their behaviour

  • This means they might refuse to go to therapy or see that their addiction is harmful

• Some research suggested that CBT will not always reduce the problem behaviour

Young (2007) Cognitive Behaviour Therapy with Internet Addicts

The study to investigate the effect of using CBT to treat a group of patients with internet addiction and how problem behaviours improved over time both during CBT and after

Young 2007 results

• Slightly more males (58%) than females were included in the study

• 61% of the participants were at university level

• There was some differences of what apps participants were addicted to

• 96% of participants’ biggest problem caused by their addiction was the time taken up by using apps

Strengths of Young 2007

• CBT might be useful for treating internet addiction

  • Encourages people to access treatment as some people may be embarrassed to see a therapist or have little time to go to therapy

• Using the same questions and rating scales makes data reliable

  • Participants were all recording their own behaviours in the same way

Weaknesses of Young 2007

• Clients filled in questionnaires with their own feelings, which may not be accurate

  • People may have lied when they are aware that they should be getting better

• Different types of internet addiction were identified and it is unclear if all types received the same effects from treatment

Nature/Nurture debate

What has the biggest effect on a person?

Nature

• The biological factors that influences a person’s behaviour

• Affected by genes and they happen before birth

• People will be physically different because of the different genes everyone has

• Some psychologists also think that behavioural characteristics are affected by our genes

  • E.g Being a criminal means that building relationships and developing mental health issues could all be explained by what genes we have

Nurture

• The environmental factors that may influence a person’s behaviour, occurs after birth

  • E.g watching family members may have an impact on a person’s behaviour

• People who look at nurture’s influence tend to think that we are born with nothing (called a blank slate) and our experiences in life are written into us

• The process of writing into our “blank slate” is through experiences and their influence on our behaviour

Nature evidence

Caspi et al. (2003)

- Found that having specific versions of a gene can affect how likely someone will develop depression after a stressful life event

- Allows us to consider that patients may find it hard changing negative behaviours

- Hyde et al. (2016)

- Monozygotic twins had 46% likelihood between whether or not genes might influence your risk of developing depression

Evidence for Nurture

- Cognitive explanation of depression and learning theory

- Both explanations assume that the psychological problems occur from things that happened in a person’s environment

- CBT (Cognitive behavioral therapy)

- Suggests that the way of thinking directly affects the development of depression, and ways of thinking are developed from the environment and peers, suggesting that it is nurture

- Young (2007)