Depression

Categorised by changes in mood

• Major depressive disorder = severe but often short-term depression
• Persistent depressive disorder = long-term or recurring, including sustained major depression and what used to be called dysthymia.
• Disruptive mood dysregulation disorder = childhood temper tantrums.
• Premenstrual dysphoric disorder = disruption to mood prior/during menstruation.

Acitivity levels -

• reduced levels of energy (lethargic) = withdrawal from work, social life and education. May not be able to get out of bed.
• Psychomotor agitation - opposite effect = struggle to relax, end up pacing up and down.

Disruption to sleep and eating behaviour -

• associated with changes to sleeping behaviour = may experience insomnia, particularly premature waking, or hypersomnia.
• Appetite and eating may increase or decrease, leading to weight gain or loss.

Aggression and self-harm -

• Irritable, can become verbally or physically aggressive = ending relationships or losing a job.
• Physical aggression directed towards the self.

Lowered mood -

• Patients describe themselves as 'worthless' and 'empty'

Anger -

• Directed at the self or others. On occasion, the emotions can lead to aggressive or self-harming behaviour.

Lowered self-esteem -

• Emotional expereince of how much we like ourselves.
• reduced self esteem, some sufferers describe a sense of self-loathing.

Poor concentration -

• Unable to stick with a task, difficult to make decisions. May interfere with their work.

Dwelling on the negative -

• paying more attention to the negative aspects of a situation.
• bias towards recalling unhappy events rather than good ones.

Absolutist thinking -

• Black and white thinking - everything is either good or bad. When a situation is unfortunate they see it as an absolust disaster.

Beck's theory -

Faulty information processing -

• attending to the negative aspects rather than the positive.
• blowing small problems out of proportion.

Negative self schemas -

• interpret all information about themselves in a negative way.

Negative triad -

• Negative view of the world - creates the impression there is no hope anywhere.
• Negative view of the future - reduces hopefulness and enhances depression.
• Negative view of the self - confirms existing emotions of low self-esteem.

Good supporting evidence -

• Grazoli and Terry (2000) assessed 65 pregnant women for cognitive vulnerablilty and depression before and after birth. They found that the women judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression.
• Clark and Beck (1999) reviewed research on te topic and found that there was support for cognitive vulnerability factors.

Practical application in CBT -

• All cognitive aspects of depression can be identified and challenged in CBT, these include components of the negative triad that are easily identifiable.
• translates well into successful therapy.

Doesn't explain all aspects of depression -

• Cannot explain anger, hallucinations or bizarre beliefs.
• Also can't explain cotard syndrome.

ABC model -

Good mental health = rational thinking (ways of thinking that allow people to be happy and free of pain)

Irrational thoughts = interfere with people being happy and free of pain.

A - Activating event -

- Experiencing negative events that trigger an irrational belief.

B - Beliefs -

- The belief that we must alwasy succeed or achieve perfection = musturbation. - The belief that life is always meant to be fair = utopianism.

C - consequences -

- Emotional and behaviourla consequences of an irrational belief.

A partial explanation -

• There is a kind of depression that doesnt have a clear cause and Ellis doesnt explain this.

Practical application in CBT -

• Challenging irrational beliefs can lead to reduction of depression.

Doesnt explain all aspects -

• Doesn't explain anger, hallucinations and delusions.

Extra -

• Cognitive primacy - Cognition doesnt always cause depression . Other theories see emotion as stored as a physical energy, to emerge sometime after the causal event.
• Attachment and depression - Those infants that develop insecure attachments are more vulnerable to depression in adulthood.

Begins with an assessment in which the patient and the therapist work together to clarify the patient's problems, identify goals and put together a plan to achieve them.

Identifying irrational thoughts and changing htem.

Beck's CBT:

• Identify the negative triad. Challange the thoughts. Testing the reality of the negative belief.
• Set homework to record a happy event in a diary ('patient as scientist'). This can be used to challenge negative beliefs.

Ellis's REBT (rational emotive behaviour therapy):

• ABCDE model (D= dispute, E= effect). Identify and dispute irrational thoughts via a vigorous argument.
• Emprical argument = disputing whether there is actual evidence to support the belief. Logical argument = disputing whether the negative thought logically follows the facts.

Behavioural activation - become more active and engage in enjoyable activites.

Effective -

• Large body of supporting evidence. March et al. (2007) compared the effects of CBT with drugs and a combination of the two in 327 adolescents with a main diagnosis of depression.
• after 36 weeks, 81% of CBT group, 81% of drug group and 86% of combined group were significantly improved.

May not work for the most severe cases -

• Patients may not be able to motivate themselves to engage with the hard cognitive work of CBT. May not be able to pay attention to what is happening.
• Possible to treat patients with drugs before CBT.

Success may be due to the patient-therapist relationship -

• The view that simply having someone to talk to is what matters the most.

Some patients want to explore their past -

• Focus of CBT is the present and future. Some patients are aware of the link between their childhood experiences and their current depression and may want to discuss.

Overemphasis on cognition -

• May end up overlooking the patient's living conditions. A patient living in poverty or suffering abuse needs to change their circumstances and CBT can prevent this.