psychological problems

Unipolar depression

Type of mood disorder causing periods of feeling sad and lacking motivation to complete everyday activities.

Main symptoms

• Lowered mood

• Lack of energy even after long rest periods

• Lack of motivation

Additional symptoms

• Poor sleep

• Difficulties concentrating

• Changes in appetite

• Low self esteem

• Self guilt or blame

• Suicidal thoughts & self harm

Who does it affect?

• 1 in 15 people experience a severe depressive episode each year

• Affects 2x more females than males

• Increasingly common in young adults

Severity

Mild: 4 symptoms (can still function normally)

Moderate: 5-6 symptoms (struggle to function in everyday life)

Severe: 7+ symptoms (suicidal thoughts & self harm)

How to be diagnosed

Must experience the 3 main symptoms as well as other symptoms for at least 2 weeks before being diagnosed.

Incidence over time

• More people are diagnosed as time progresses

• This may be because modern life is more stressfull

• Or more people are aware of mental health problems

How does depression affect individuals

• Causes patients to commit suicide

• Because they need a ‘way out’

• 10-15% of patients with severe depression commit suicide

How does depression affect society

• Missed time from work (depression → low motivation → do not go to work → company has to pay for substitues → economy suffers)

• Cost of treatment (antidepressents are expensive to prescribe & therapists need to be trained → economy suffers)

Twin studies

Research that compares behaviour in groups of twins to see if there are similarities in each pair of twins.

Concordance rate

The extent to which both twins share the same charectaristic.

(identical twins have a high concordance rate)

Monozygotic vs Dizygotic twins

Monozygotic: developed from one fertilised egg that has split into two (100% shared genetics)

Dizygotic: developed from two eggs fertilised during the same pregnancy (50% shared genetics → no more than normal siblings)

Genetic theory

Peter McGuffin et al found that:

• Identical twins → if one twin is depressed → the other one is likely to also be depressed → 62% chance

• Non-identical twins → if one twin is depressed → the other one is less likely to also be depressed → 20% chance

• This tells us that our genes may have a connection to developing psychological problems as monozygotic twins share more DNA than dizygotic twins.

Genetic predisposition

A biological tendency to develop a particular behaviour as a result of the genes someone has.

• Gene can only be ‘switched on’ if triggered by environmental effects.

Diatheses stress model

An explanation for depression that claims more people can have a gene that makes them more likely to develops depression, but only if they face a stressful situation that triggers depressive thoughts.

Strengths of Genetic theory

• If we can prove that depression is caused by genes, stigma is taken away → society becomes more accepting.

• There is lots of research proving the link between genes and depression → Caspi et al’s findings abt the serotonin transporter gene.

Weaknesses of Genetic theory

• It is too deterministic → suggests that you’re genetic makeup means you will get depressed and does not consider the fact that you have free will.

• Reductionist → having a faulty gene may not be the only cause of depression, it could be due to enviromental factors or stressfull life events.

Beck’s Cognitive Triad

Negative views of the self → Negative views of the world → Negative views of the future

Self = I am ugly

World = No one loves me

Future = I will always fail

Explanation

• Suggests that people with depression get trapped in a cycle of negative thoughts.

• It is developed from bad experiences in someone’s past.

• This leads to a negative self schema → cannot see positive aspects of themselves.

• They think the world is a bad place and that the future is negative.

• Due to their cognitive biases, they view things in an abnormal way.

Magnification

A form of cognitive bias that makes people see their problems as far bigger than they already are.

Ellis’s ABC model

• Activating event → something that happens that unsettles the person.

• Beliefs → the thoughts that the person associates with the event can either be rational or irrational.

• Consequence → rational thoughts lead to positive consequences → wheras irrational thoughts lead to negative consequences and a cycle of cognitive biases.

Cognitive theory (Beck & Ellis)

An explanation that focuses on how thought processes may influence behaviour.

Strengths of Cognitive theory

• Takes into account that enviromental factors and the events of a person’s life may contribute to depression.

• It is usefull for therapy → it has been applied to CBT, which is one of the most used forms of therapy. It challenges irrational thoughts and reduces the need for drugs.

Weaknesses of Cognitive theory

• It is difficult to tell if irrational thoughts are a symptom or the cause of depression → most patients are only monitored after being diagnosed, so it is unclear how much their thought processes have changed.

• Some cases may be caused by clear activating events, such as death, but others may be caused by biological factors (postnatal depression) and therefore cannot be explained by cognitive patterns. (reductionist)

Nature

Explanations of behaviour that focus on inate factors (things that we are born with).

Nurture

Explanations of behaviour that focus on environmental factors.

Cognitive behavioural therapy

A type of therapy for mental health disorders that aims to change thought processes in order to reduce symptoms.

Aims of CBT

• Help the patient change the way that they think.

• Help the patient change the way that they act to improve symptoms that they are having.

Stages of CBT

1. Identify negative thoughts → patient describes symptoms and what causes them.

2. Challenge irrational thoughts → the therapist tells the patient to consider the validity of the feelings and to challenge thoughts that are not rational.

3. Homework → patient is given ‘homework’ where they are told to identify irrational thoughts in stressfull situations and challenge them to create more rational thoughts.

Strengths of CBT

• Evidence to prove that it is effective → Beltam et al found that CBT patients where improving much more than patients who were waiting or not recieving any treatment.

• Long lasting treatment → patients learn how to challenge thoughts and control symptoms and can do so whenever needed.

• Healthier than drug therapy → drugs temporarily improve symptoms but can unpleasant side effects and may stop working over time.

Weaknesses of CBT

• CBT relies on patients wanting to change and being able to recognise their thoughts as irrational (depression → causes lack of motivation → patient does not do CBT homework)

• Ethical issues → therapist is telling patient that there is something wrong with their natural thought process and that they should change the way that they think.

How does drug therapy work?

• If CBT was not effective for a patient, they may be prescribed drugs to reduce their symptoms.

• They work by raising the levels of neurotransmitters in the brain that are associated with a good mood. These are noradrenaline and serotonin.

• The drugs help to lengthen the effects of these brain chemicals or increase the amount produced.

• They also block the reuptake of the chemicals.

Neurotransmitters

Chemicals found within the nervous system that pass messages from one neuron to another across a synapse.

Nonadrenaline

A type of neurotransmitter that is involved in mood and is released in times of stress.

Reuptake

The process by which neurons reabsorb neurotransmitters that they release.

Selective serotonin reuptake inhibitors (SSRIs)

• Work by blocking the reuptake of serotonin so it is available for longer.

• Allows more opportunity for other neurons to absorb it, which increase serotonin levels in the brain and improve mood.

Serotonin and nonadrenaline reuptake inhibitors (SNRIs)

• Work in the same way as SSRIs but block the reuptake of both serotonin and nonadrenaline.

• This enhances the effect of serotonin and nonadrenaline and makes them available for longer periods of time, which improves mood.

Monoamine oxidase inhibitors (MAOIs)

• Work by preventing monoamine oxidase from doing its job properly which is to break down serotonin and nonadrenaline after they have been released from the neuron.

• This means the neurotransmitters are present for longer and improves mood.

Tricyclics (TCAs)

• Oldest drug available (1950s)

• Work by preventing the reabsorbtion of serotonin and nonadrenaline into the neuron which boosts their effect.

Strengths of Drug therapy

• Drugs reduce the symptoms of depression which allows patients to access other forms of therapy such as CBT (they gain motivation)

• Studies show that 50-65% of patients said they noticed an improvement in their symptoms whilst on antidepressants, wheras only 20% of patients given a placebo said they felt an improvement in their symptoms, proving that they are effective.

Weaknesses of Drug therapy

• Unpleasant side effects (naseous, dizzy, poor sleep, diabetes) → quality of life is actually worse.

• Drugs (MAOIs) cannot be mixed with certain foods (citrus) causing patients to go on controlled diets.

• Drugs may reduce the patients symptoms but they do not cure depression, meaning users are likely to relapse.

• The effects may wear off over long periods of time, causing the drugs to not work.

Addiction

A mental health problem that means people need a particular thing (substance or activity) to go about their daily routine.

Withdrawal

A set of unpleasant physical or psychological symptoms someone gets when they are trying to quit or cannot satisfy their addiction.

Physical withdrawal symptoms

• Shaking

• Sweating

• Throwing up

• Lack of appetite

• Headaches

• Insomnia

• Irritability

Detoxification

When an addict tries to stop taking the drug that they are addicted to.

Symptoms of dependence disorder

• A feeling that the person must take the substance.

• Stopping or reducing the substance is very difficult.

• Ignoring evidence that the use of the substance is harmful to them.

• Replacing normal/fun activities with time spent doing the susbstance.

• Tolerance to the substance → need to take more over time to feel the same effects.

• Experience physical withdrawal symptoms.

Symptoms of behavioural addiction

• They need to do the activity regularly to feel normal.

• Reducing/stopping is very difficult.

• They ignore evidence that the activity is harmful to them.

• They spend more time doing the activity than things that they used to enjoy.

• Tolerance to the activity → have to do the activity more often, or do something more ‘risky’ to get the same ‘buzz’

How to be diagnosed

The patient must display 3 of the symptoms at the same time for 1 month or for repeated occasions throughout the year.

Who does it affect?

• 2 million people are suffering from addiction in the UK.

• More men are addicts than women.

• But women are more likely to overdose on substances.

• In 2014-2015, 141,646 people where being treated for a substance misuse problem (NHS)

• 6% of the world’s population have an internet addiction.

Incidence over time

• Addictions are becoming more common in society.

• The definition of addiction has changed overtime. Nowadays, it includes things such as internet overuse but previously it was only to do with substance misuse.

• Things that used to be conisdered ‘medicine’ are now considered adictive drugs. Someone who uses opiates frequently is now considered a drug addict.

• Lots of addictive substances are being easier accesible and cheaper.

• 27% of people in 2008 said they had used an illegal substance. 31% said they had in 2013.

How does addiction affect individuals

• They spend less time with friends and family

• They may stop going to work and school

• They spend money that they do not have (instead of on things that they need)

• They stop taking care of themselves → quality of life diminishes

How does addiction affect society

• People do not attend work because they are preoccupied by their addiction → company has to pay for substitute → puts strain on the economy.

• Every year the cost of susbtance abuse for the NHS is 488 million pounds (including rehab programmes and treatments for health problems)

• Criminality increases → Every year drug related crimes cost 13.9 billion pounds.

Genetic explanation for addiction

• There is evidence that people become addicts due to genes that they carry. So it is suggested that addiction can run in families.

• This would explain why not all people who try addictive substances or activities become addicts.

Carmelli’s twin findings (1992)

• Carmelli et al found that if one monozygotic twin was a smoker, there was a higher chance than in dizygotic twins that their co-twin was also a smoker.

• This suggests that there is a connection between genetics and addictive tendencies, as monozygotic twins share more genes than dizygotic twins.

Goodwin’s adoptition studies (1973)

• Goodwin et al found that adopted children with 1 biological parent who was an alchohol addict was likely to become an alchoholic themselves.

• This suggests that the child may have inherited a gene that makes them predisposed to alchohol addiction.

Cadoret’s adoption studies (1983)

• Cadoret el al found that children with a biological link to alchoholic where more likely to have problems with alchohol themselves (supports Goodwin’s theory)

• However, he is also found that if there was alchohol misuse in the adoptive family, the adoptee had greater risk of developing an addiction as well.

• This suggests that environmental factors can also have an impact on becoming an addict.

Strengths of Genetic theory

• There is a lot of scientific evidence to support the studies (such as Martinez et al’s research on the dopamine receptors of opiate addicts and non-addicts)

• It explains why some people do not become addicted.

Weaknesses of Genetic theory

• It is too reductionist → it does not take environmental factors into account (the twins used in Carmelli’s study where raised in the same environment which could influence their behaviours)

• Cadoret investigated enviroment as well and proved that it does play a role.

• The exact gene that influences addiction has not been discovered yet, and genes that ‘could’ be linked to addiction have been linked to other things (such as autism), making it hard to distinguish which genes are actually significant.

Learning theory of addiction

An explanation for addiction that believes behaviour is learned through associations and experiences.

Classical conditioning

• Behaviour is learnt through association.

• When two things happen at the same time, our brain immediatley connects them and we associate one thing with the other.

• If a substance/activity is associated with pleasure → the addict will do it when they want to feel good, because they associate it with a positive outcome.

• eg - an alchohol addict will drink at a party because they associate drinking with having fun.

Operant conditioning

Behaviour is learnt through the consequences of our actions.

Reinforcement

An outcome from behaviour that increases the chance of the behaviour being repeated or avoided in the future. The outcome may be gaining something positive or having something negative being removed.

Positive reinforcement

When we do the behaviour and the result is positive (a reward) we are likely to repeat it.

eg - alchoholic drinks wine and feels relaxed, so they do it again.

Negative reinforcement

When we do a behaviour to avoid a negative result.

eg - a drug addict does the drug to avoid withdrawal symptoms.

Social learning theory

Suggests that behaviour is a result of learning others, especially those who we look up to and consider role models, and modelling our behaviours on theirs.

Social learning steps

• Attention - the observeser must pay attention to the role model’s behaviour.

• Remember - the observer recals how they did the behaviour.

• Reproduce - the observer must acquire the skills necessary before they can do the behaviour themselves → then they recreate it.

• Motivation - the observer needs to have a reason to copy the behaviour → it is because they want to be like the role model → and gain a reward or avoid a punishment.

• eg - child who grows up with smoking parents may pretend to ‘smoke’ things like pencils, and when they have the opportunity to try real cigarettes, they feel more inclined to do so bc their parents did it.

Strengths of Learning theory

• Suggests that if we can learn behaviours, we can also ‘unlearn’ them.

• Explains why addicts relapse.

Weaknesses of Learning theory

• It ignores the role of genetics → some people have a predisposition bc they carry the DDR2 gene (reductionist)

• Conditioning theories do not explain why lots of people try addictive substances/activities but do not get addicted (reductionist)

CBT for Addiction Stages

Works similarly to CBT for depression

1. Functional analysis

2. Skills training

Functional analysis

• The first stage of CBT to treat addiction where triggers their ideas.

• The therapist analyses addict’s behaviour and figures out what makes them turn to their addictions.

• Therapist and patient talk about what emotions they feel and who they are with before doing the substance/activity.

• Therapist helps patient treat their addiction by pointing out which places and people or feelings trigger their behaviours. The patient then tries to avoid them.

Skills training

• The second stage of CBT to treat addiction whereby addicts learn ways to control the patterns of behaviour that lead to their addiction.

• Therapist teaches skills that can help the addict treat the addiction → assertiveness training, reduce cravings, improve motivation.

• Patients are told to keep a diary to document important events within the process (such as when they are tempted)

• CBT can then be combined with other therapies (drug) to improve motivation.

Strengths of CBT

• It gives the patient control over their behaviour → CBT provides skills that they can use to become better, which can be very rewarding.

• It is supported by scientific evidence such as Young’s study → patients said CBT helped with symptoms within the first few weeks and after 6 months of learning skills

• This tells us that CBT is helpful in the long and short term.

Weaknesses of CBT

• The addict must be motivated to change their behaviour → Main symptoms of addiction are finding it difficult to stop & ignoring evidence that the substance is harmful → means continuing with treatment may be difficult.

• Statistics show that even if addicts learn the skills needed through CBT, they do not always put them into practice and then they relapse.

Drug therapy as treatment for addiction

• When addicts become reliant on a substance = they experience withdrawal symptoms when trying to detoxify.

• They occur because as the substance leaves the system, their body does not feel ‘normal’ → their body craves the substance again.

• Drugs can help to reduce withdrawal symptoms and allow the addict to feel more in control of themselves.

• They can also reduce cravings → methodone is a synthetic opiod → it has the same effect on opiod receptors as heroin but it is much safer → so it is administered in small doses to treat opiod addiction.

• Addicts may also suffer from depression → antidepressants are administered to reduce the effects of these problems as they could cause a relapse.

Nicotine replacement

• Used to treat cigarette addiction.

• Comes in the form of chewing gum and patches.

• Reduces cravings by releasing small amounts of nicotine.

Naltrexone

• Used to treat opiod addiction and behavioural addictions → gambling.

• Work by blocking endorphin receptors in the brain.

Methodone

• Used to treat opiod addiction.

• Works in the same way as heroin (synthetic opiod) but it is much less dangerous.

Strengths of Drug therapy (addiction)

• Scientific evidence to support it → Suck Won Kim et al (2001) → 75% who were nalrexone to treat their symptoms saw a rapid improvement wheras only 20% felt an improvement when given a placebo.

• Helps addicts access long-term forms of therapy and beat their addiction such as CBT as they help deal with short-term withdrawal symptoms.

Weaknesses of Drug therapy (addiction)

• Addiction is a different experience for every patient, and therefore there is no guarantee they will be effective for everyone. Studies show that there was no improvement in relapse rate for alchoholics on naltrexone and addicts taking a placebo → suggests that they did not work for all patients.

• Giving patients drugs for their withdrawal symptoms is like giving them a new substance to be addicted to → then they will experience withdrawals from the treatment drug.

• Treatment drugs, like substances, can start to lose effectiveness as the patient develops tolerance, causing withdrawals and the need for a new drug or an alternate form of therapy.

Caspi et al (2003) Aim

• To see why stressfull life experiences lead to depression in some and not others.

• To investigate the role of a gene involved with serotonin to see if it contributed to depression.

Sample

• This was a longditudinal study because the participants where already part of a study that monitored them since 3 yrs (Dunendin multidisciplinary study)

• 847 caucasian non-maori participants where selected from the original cohort of 1037 people. They where then divided into 3 groups.

• Group 1 → 147 people → 2 copies of the short 5-HTT allele.

• Group 2 → 435 people → 1 copy of the short & 1 copy of the long 5-HTT allele (heterozygous)

• Group 3 → 265 people → 2 copies of the long 5-HTT allele.

Procedure

• Stressfull life events where recorded in a calendar between 21st and 26th birthdays.

• The categories included housing, employment, financial, health and relationship stressors.

• For each group at age 25-26, depressive symptoms where assesed using the diagnostic interview schedule.

• An informant (someone who new the participant well) was asked to fill out a questionarre about the depressive symptoms of each participant.

• This gave researchers plenty of quantative data that they could turn into a ‘depressive score’.

Data

Measure 1

Stressfull life events →

• None = 30%

• One = 25%

• Two = 20%

• Three = 11%

• Four or more = 15%

Measure 2

• Depressive episode experienced in the past year: 17%

• Past year suicide attempt: 3%

Results

• Participants with at least one short version of the 5-HTT and who had been through stressfull life events showed a significant increase of depressive symptoms from the time of experiencing a stressfull life event → age of 26.

• Participants with at least one short version of the 5-HTT gene where more likely to be diagnosed with depression.

• Participants with two short versions of the 5-HTT were most likely to have severe depressive symptoms after experiencing stressfull life events.

• They also experienced higher rates of suicidal thoughts or suicide attempts if they had 3+ stressfull life events.

Conclusions

• There is a connection between the type of gene a person carries and the likelihood of developing depression.

• It supports both nature and nuture → it connects depression with biology but also considers the fact that people must experience a stressfull life event in order for it to be ‘switched on’.

Strengths of Caspi et al

• 847 participants → large sample → increases generisability and makes it more scientfically accurate than a small sample.

• Can explain why some people get depressed after experiencing a stressfull life event and others do not.

Weaknesses of Caspi et al

• Some people may be experiencing more stressfull life events than others, simple because of the fact that each individual person’s life is different. This means the amount of depressive symptoms may not just be due to the participant’s genes.

• Deppressive symptoms may be affected by trauma/childhood mistreatment.

• Partcipants may be biased whilst doing their interviews, either under or overexaggerating their symptoms, making the data less valid.

Young et al (2007) Aims

To see how effective CBT would be for those suffering from internet addiction.

Sample

• 114 participants where recruited from the Centre of Online Addiction in Pennsylvania.

• 42% were women, 58% were men.

• 84% were Caucasian

• Mean age for F: 38

• Mean age for M: 46

• 61% had a bachelors degree.

• All participants were tested using an internet addiction screener.

• They had no existing psychological problems.

Procedure

• All participants were given online CBT sessions.

• Participants were given a questionnaire at the 3rd, 8th and 12th online session. They were then given another one after 6 months.

• There were 12 questions why used a 5 point likert scale → analysing motivation, time management, relationship function, sexual function, engagement in offline activities & absitence from problematic applications.

Results

Problematic applications were

• Women → Sexual chatrooms, general chatrooms, online shopping, gambling (minority)

• Men → Pornography, sexual chatrooms, gambling

Problems associated with internet use

• Time (96%) relationship (85%) sexual (75%) work (71%) financial (42%) physical (29%) academic (15%)

Overtime, clients said that they found the conseulling environment very comfortable and that the relationship with the therapist improved over time.

As sessions went on, clients goals where entered into a table as well as their improvement ranking after each session.

• They were motivation, time management, sexual function, engagement in offline activities, abstinence from problematic applications.

Most clients showed continous improvement by session 3 and effective symptom management by 8 and 12 with overall skills maintenence and symptom improvement by 6 months.

Conclusion

• CBT is an effective treatment for compulsive internet use.

• It gives long term benefits and prevents relapse (6 month feedback)

Strengths of Young et al

• Online CBT was given → tells us that addicts who are not comfortable/cannot access going to in person therapy can still try to improve their lives by doing online sessions.

• The questionarres used the same questions and likert scale after 3,8,12 weeks and 6 months, meaning the data was reliable. Each person was assesing themselves in the same way, meaning the data was consistent and standardised.

Weaknesses of Young et al

• Participants where told to fill out their own questionarres → biases could affect the data.

• Several types of addiction where identified but it is unclear whether CBT was effective for each kind.