Psychological Problems: Unipolar Depression and Addiction

Unipolar Depression: Symptoms, Features, Incidence, and Influence

• Definition of Mental Health Problem: A psychological problem characterized by symptoms affecting the mind and behavior, influencing thoughts, feelings, behavior, and relationships.
• Unipolar Depression Definition: A mood disorder causing periods of sadness and lack of motivation, differing from bipolar depression which involves mood swings.

Symptoms of Unipolar Depression

• Classified as 'depressive episodes' under the International Classification of Diseases version 10 (ICD-10), affecting how people feel, specifically causing a very 'low' mood.
• Main Symptoms:
  • Lowering of mood (feeling sad or upset).
  • Lack of energy, even after resting.
  • Lack of motivation to do things.
• ICD-10 Diagnostic Criteria: At least one main symptom present most of the time on most days for at least two weeks, plus another symptom present at some point during that time.
• Other Symptoms:
  • Not enjoying activities previously liked.
  • Poor or increased appetite.
  • Poor sleep (difficulty falling asleep, waking early).
  • Extreme tiredness not relieved by sleep.
  • Acting nervously or feeling slowed down.
  • Feelings of guilt or self-blame.
  • Suicidal thoughts or attempts.
  • Lack of self-esteem.

Features of Unipolar Depression

• According to the World Health Organization, approximately 1 in 15 people suffer from a serious depressive episode each year.
• Unipolar depression affects twice as many females as males and tends to affect women for longer durations.
• Episode Severity:
  • Mild: Four symptoms displayed; patient can usually continue with day-to-day activities.
  • Moderate: Five or six symptoms displayed; patient has serious problems with day-to-day activities.
  • Severe: Seven or more symptoms, plus general feelings of worthlessness; patient may have suicidal thoughts or engage in self-harm.

Incidence of Depression Over Time

• Martin Seligman (1988) reported a tenfold increase in depression diagnoses in the 1980s compared to the 1940s.
• The King's Fund (2008) estimates 1.45 million people in England will be diagnosed with depression by 2026, compared to 1.24 million in 2007.
• Possible Reasons for Increase:
  • Increased awareness of symptoms.
  • Brandon Hidaka (2012) suggests 'modern living' is more stressful with risk factors like sleep deprivation, poor diet, and social isolation.
• Jean Twenge et al. (2010) found young adults in 2007 were significantly more likely to be diagnosed with depression than in 1938, potentially due to the stressful nature of modern life for this age group.
• Liu yi Lin et al. (2016) linked high social media usage to a higher risk of depression in young American participants.

How Depression Affects Individuals and Society

• Individuals:
  • Increases the risk of suicide (10-15% of patients with severe depression may commit suicide).
• Society:
  • Workplace Impact: The Health and Safety Executive (HSE.gov.uk) estimated 9.9 million workdays were lost in 2014-15 due to stress, depression, or anxiety.
  • Economic Impact: Treatment costs for depression in the NHS were estimated at £1.7 billion in 2007, potentially straining NHS services.

Genetic Explanation of Unipolar Depression

• If someone in your family has been diagnosed with unipolar depression, there is a higher risk that you will also be diagnosed with depression. This suggests that unipolar depression might be inherited through genes shared by family members.
• Craig Hyde et al. (2016) found that 17 different gene variations were linked to developing depression.

Twin Studies

• Useful for examining genetic influence; identical (monozygotic) twins share 100% of genes, while fraternal (dizygotic) twins share 50%.
• Peter McGuffin et al. (1996) found that if one monozygotic twin became depressed, there was a 46% chance the other twin would also develop depression. For dizygotic twins, the chance was only 20%.

Genetic Predisposition and Environmental Triggers

• Not all family members of someone with depression will become depressed themselves.
• There needs to be a trigger from the environment in order for the gene to
  become 'active'.
• Some people might have a genetic predisposition to become depressed because they have a gene that increases
  their risk. However, they would only go on to become
  depressed if they are put into a stressful situation that
  triggers the gene's effect on their mood. This combined explanation for depression is often called the diathesis-
  stress model.
• Avshalom Caspi et al. (2003) found evidence that life stress combined with genes might help explain depression.

Strengths and Weaknesses of the Genetic Explanation

• Strengths:
  • Reduces stigma by explaining depression through genetics, fostering social acceptance.
  • Supported by research evidence (e.g., Caspi et al., 2003, found people with a variation of the serotonin transporter gene were more likely to react negatively to stressful life events and develop depression).
• Weaknesses:
  • Deterministic: Assumes that having certain genes likely leads to depression without the ability to change that.
  • Reductionist: Fails to account for environmental factors and life events.

Cognitive Theory as an Explanation of Depression

• Cognitive theory explains behavior by examining how the brain processes information and how we think.

Beck's Cognitive Triad

• Aaron Beck proposed depression could be explained by three negative thought patterns related to oneself, the future, and the world.
  • Negative view of self: I am worthless/unimportant/useless/a waste of time.
  • Negative view of the world: Everyone is against me.
  • Negative view of the future: I am never going to amount to anything.
• These patterns are cognitive biases that make things viewed negatively, and the person sees themselves in a negative way, thinks the world is generally a bad place and thinks the future is bleak.
• This negative triad develops from bad experiences, leading to negative self-schemas and cognitive biases like magnification (seeing problems are far worse than they are in reality).

Ellis's ABC Model

• Albert Ellis suggested three stages that might cause a person to develop negative thought processes, which can then lead to them becoming depressed:
  • A - Activating event: Something happens to a person that makes them feel unsettled, such as a bad exam result, losing their job or bereavement.
  • B - Beliefs: The thoughts the person associates with the event, such as why it happened, which can either be rational (and healthy) or irrational (and unhealthy).
  • C - Consequences: If the person has a rational thought about the event - they failed an exam (the event) because they didn't do enough work (rational belief if this is true) -then they will have positive emotional consequences (they won't be depressed). However, if the person has an irrational thought about the event - they failed an exam (the event) because they went to a birthday party the week before (irrational if the rest of the time they worked hard) - then they will have negative emotional consequences (they might be depressed).

Strengths and Weaknesses of the Cognitive Theory

• Strengths:
  • Considers life events that trigger depression, combining nature and nurture factors.
  • Applied to therapy; Cognitive Behavioral Therapy (CBT) challenges irrational thoughts to reduce depression without antidepressants.
• Weaknesses:
  • It's difficult to tell whether irrational thoughts are a cause of depression or a symptom of being depressed.
  • Some depression cases may not be easily explained by thought processes, such as post-natal depression.

Cognitive Behavioral Therapy (CBT) as a Treatment for Depression

• CBT's main aims:
  • Help the patient change the way they think (cognitive part of the therapy).
  • Help the patient to change the way they act to improve the symptoms they are having (behavioral part of the therapy).
• CBT is based on the understanding that the way we think affects how we feel, and how we feel influences how we behave.
• First stage involves discussing symptoms and feelings with a therapist.
• The next stage of CBT involves challenging these irrational ways of thinking. When a patient can recognise thoughts that are irrational or negative they should try to replace them with more rational and positive ways of thinking.
• Patients may have 'homework' (e.g., journaling) between sessions.
• NHS evidence suggests that when patients with depression are given CBT alongside their previous treatment (often antidepressants) there is a more significant improvement in their symptoms.

Strengths and Weaknesses of Using CBT to Treat Depression

• Strengths:
  • There is evidence to suggest it is effective. For example, Matthijs Beltman et al. (2010) found that depressed patients treated with CBT improved more than those who were still waiting for treatment or not receiving any treatment.
  • It may be a longer-lasting treatment for depression than only using antidepressants.
  • It may help depressed patients feel better because they learn how to deal with their own symptoms.
• Weaknesses:
  • CBT relies on patients wanting to change their behavior and being able to recognize when their thoughts are irrational. A symptom of depression is lack of motivation, so the patient might not be able to do all the CBT sessions and homework. This would make the therapy ineffective. For this reason, some patients may be offered drug therapy first to alleviate their symptoms and help them prepare for therapy.
  • Some people argue that the therapist is encouraging the patient to think that their own thought processes are a problem and that they should think in a different way. This could change the way they interact with others or make some people feel that the way they think and behave is in some way wrong.

Drug Therapy as a Treatment for Depression

• Drug therapy is offered for moderate to severe depression or when psychological therapies are ineffective.
• Antidepressants raise levels of neurotransmitters like serotonin and noradrenaline.

Types of Antidepressants

• Selective serotonin reuptake inhibitors (SSRIs) block the reuptake of serotonin, increasing its availability.
• Serotonin and noradrenaline reuptake inhibitors (SNRIs) block the reuptake of both serotonin and noradrenaline.
• Monoamine oxidase inhibitors (MAOIs) prevent the enzyme monoamine oxidase from breaking down serotonin and noradrenaline.
• Tricyclics (TCAs) boost the effect of serotonin and noradrenaline by preventing their reabsorption.

Strengths and Weaknesses of Drug Therapy

• Strengths:
  • Can improve symptoms enough to facilitate access to other psychological therapies.
  • The Royal College of Psychiatrists reports that 50 to 65 per cent of patients with moderate to severe symptoms of depression show improvements when given antidepressants. This is compared to only 25 to 30 per cent of patients with similar symptoms who were given a placebo (a 'fake pill').
• Weaknesses:
  • Can have unpleasant side effects (MAOIs require specific diets; general side effects include drowsiness, nausea, dizziness, and disturbed sleep).
  • Does not address the underlying cause of depression; relapse is common after treatment cessation.

Addiction: Symptoms, Features, Incidence, and Influence

• Addiction Definition: A psychological problem where people feel they need to 'have' or 'do' something regularly to avoid negative feelings.
• Addiction can be to substances such as alcohol or tobacco (cigarettes).
• The International Classification of Diseases
  version 10 (ICD-10), where addiction is known as
  a 'dependence disorder', focuses on drugs (both legal and illegal drugs can
  be addictive).
• Some people can also have addictions to activities, including gambling, shopping or being on the internet.
• Withdrawal symptoms occur if the addiction cannot be satisfied.

Symptoms of Addiction

• ICD-10 refers to addiction as a dependence disorder because the body 'depends' on the substance in order to feel normal.
• To be diagnosed as an addict, at least three of the symptoms in Figure 3.5 needs to be present at the same time for 1 month in total, or for repeated occasions over a year.
  • A feeling that the person needs to take the substance
  • Stopping or reducing the
    use of the substance
    is very difficult
  • Physical withdrawal symptoms
  • They ignore arguments that the
    activity is unhealthy or damaging
  • They spend more time doing
    the activity than other things
    they used to enjoy

Features of Addiction

• Figures from Public Health England state that in
  2014-15 there were 141,646 adults being treated for
  problems with substance misuse.
• The NHS have estimated that about 2 million people in the UK
  are suffering from some kind of addiction, suggesting it
  is not a rare problem.
• According to a recent study, approximately 6 per cent of the world's population have problematic internet use, which could be
  categorised as an addiction (Cheng and Yee-lam Li,
  2014).

Incidence of Addiction Over Time

• Statistics suggest that the number of addictions in society is rising.

How Addiction Affects Individuals and Society

• Individuals:
  • A person with the addiction may
    ignore their family and the things they regularly did, such as going to work or
    school.
  • They may also spend money they would normally have used for other
    things, such as food or accommodation, on their addiction.
• Society:
  • A further impact on society is the cost of health care services provided
    to support those with addictions.
  • Figures presented by the NHS claim that drug-related crimes cost UK society £13.9 billion a year in total.

Genetic Explanation of Addiction

• Addictions can run in families.
• Dorit Carmelli et al. (1992) found that in identical twins, if one of them was a smoker there was a higher chance of the other one smoking than if the twins were not identical
• Donald Goodwin et al. (1973) found that adopted children who had at least one biological parent with alcohol addiction were highly likely to show signs of alcohol addiction themselves.
• One gene, the DDR2 gene, has been shown to be
  related to developing addiction.
• Diana Martinez et al. (2004) found that a group of heavy users of cocaine were more likely to have a particular version of a dopamine receptor
  gene.

Strengths and Weaknesses of the Genetic Explanation

• Strengths:
  • Twin studies and adoption studies act as a control for possible factors that could explain addiction.
  • the genetic explanation would explain why only some people are prone to becoming addicts.
• Weaknesses:
  • There is evidence that family members might share genes that would explain why addiction runs in families, but the results could also be explained by other shared factors.
  • Research has not been able to find a single gene that explains where addiction comes from.

Learning Theory as an Explanation of Addiction

• Learning theories for addiction believe that the behavior of addicts have
  been learned through some kind of experience they have had.
• Classical conditioning
• Operant conditioning
• Social learning theory

Classical Conditioning

• Classical conditioning states that behaviour is learned through associations, so when two or more things happen at around the same time our mind 'links' them together.

Operant Conditioning

• Operant conditioning claims that behaviours are repeated when they lead to positive consequences.

Social Learning Theory

• Social learning theory claims that behaviour is learned as a result of observing other people, especially those we consider to be role models, and modelling our behaviour on theirs.

Strengths and Weaknesses of Learning Theory

• Strengths:
  • Assumes addictions are learned and can be unlearned, supporting treatability.
  • Explains relapse through associations (classical conditioning); stressors trigger urges in former smokers.
• Weaknesses:
  • Ignores biological factors, though operant conditioning recognizes reinforcement from drug effects on brain chemistry.
  • Doesn't explain why most who try addictive substances don't become addicted; social learning theory helps by considering role model influence.
• Many substances that are addictive act in the brain by
  either directly, or indirectly,
  increasing the amount of the
  neurotransmitter dopamine
  being transmitted in a certain
  pathway.

Cognitive Behavioral Therapy as a Treatment for Addiction

• CBT aims to help people understand the triggers for their
  addictive behaviours and then learn how to control
  and manage these behaviours.

• Functional analysis: looking closely at the addict's behavior and working out what makes them turn to their addiction.

• Skills training

• Strengths:

  • It gives the patient control to stop their own addictive behavior.
  • Kimberly Young's (2007) study found that CBT was effective for treating people with internet
    addiction both in the short term and up to 6 months after treatment
    ended.

• Weaknesses:

  • CBT is that the addict has to be motivated to change their behaviour.
  • Jon Morgenstern and Richard Longabaugh (2000) found that alcoholics often showed the ability to cope
    with their addiction after CBT, but did not always put these skills into
    practice and actually stop drinking.

Drug Therapy as a Treatment for Addiction

• Treatment options can be a complex decision.
  Treatment will depend on the type of
  addiction they have and the severity of symptoms.
• Drug Treatments:
  • Patients with drug addictions can often benefit from taking a form
    of medication to help them cope with the effects of detoxification.
  • Drugs can be given to patients to reduce these symptoms of withdrawal and
    reduce the chance of the patient relapsing and using the substance again.
  • Medication can be given to control these symptoms. such as methadone, naltrexone, Nicotine-replacement therapy
    These help to reduce cravings felt by patients.
  • Doctors are now prescribing naltrexone, a drug normally
    prescribed to treat those with severe alcohol addiction, to some patients with severe gambling addiction.

Strengths and Weaknesses of Drug Therapy

• Strengths:
  • There is research evidence supporting the effectiveness of drug therapies to treat
    addictions. For example, Suck Won Kim et al. (2001)
    presented evidence that 75 per cent of the gambling
    addicts they studied who were treated with naltrexone
    showed a significant improvement in their symptoms.
  • They may help the patient access other types of
    therapy that could help them control their addiction
    in the long-term, by dealing with some of the
    problematic short-term symptoms associated with
    stopping their addiction.
• Weaknesses:
  • There was no significant difference in relapse rates
    over a 12 month period between alcoholic patients
    taking naltrexone and those taking a placebo drug.
    This suggests that naltrexone is not an effective
    treatment for all alcohol addiction patients, as their
    group showed no advantage compared to people
    taking a placebo.

Caspi et al. (2003) Influence of Life Stress on Depression

• Background:
  • Stressful events can cause depression, but not everyone who experiences stressful life events becomes depressed.
• Aim:
  • To investigate why stressful life events seem to lead to depression in some people and not others.
• Procedure:
  • 847 participants completed a questionnaire that measured the life events that occurred between
    their 21st and 26th birthdays.
  • Another questionnaire assessed whether they had
    any symptoms of depression in the year before
    their 26th birthday, which gave the researchers
    quantitative data in the form of a 'depression score.
• Results:
  • Participants with the short version of the gene more likely to develop suicidal thoughts after stressful events
• Conclusion:
  • Evidence suggests an interaction between life events and genetic influences in causing depression.
• Strengths:
  • Large sample size (847 participants).
  • Information from this study could be useful for doctors as it tells them
    that someone with depression could have different
    causes for their symptoms.
• Weaknesses:
  • The researchers thought there was a chance that some people were
    naturally more likely to put themselves in situations where stressful life events might happen.
  • The evidence from the questionnaires is self-report data, which might not be reliable.

Young (2007) Cognitive Behavior Therapy with Internet Addicts

• Aim:
  • To investigate the effect of using CBT to treat a group of
    patients diagnosed with internet addiction and to see
    how problem behaviours improved over time both during
    the therapy and after therapy sessions had ended.
• Procedure:
  • group of 114 participants were recruited from the
    Center for Online Addiction, a website dedicated to
    treating people with internet addiction in the USA.
  • Participants filled in a questionnaire during the 3rd,
    8th and 12th online therapy session, and again 6
    months after the treatment sessions had finished.
• Conclusion:
  • The results of this study seem to suggest that CBT can
    be an effective treatment for internet addiction because
    clients reported an increase in their ability to control
    problem behaviours.

Issues and Debates: Nature vs. Nurture

• Nature refers to biological factors (e.g., genes).

• Nurture refers to environmental factors.

• Nature and Nurture in Mental Health:

  • There are explanations of mental health problems
    that claim genes have a strong influence, supporting
    the nature side of the debate.
  • There are also explanations for psychological
    problems that support the nurture side of the debate,
    such as the cognitive explanation of depression and
    learning theory as an explanation of addiction.