Psychodymanic explanation (Freud)
Depression occurs when the normal grieving process does not diminish with time. The individual cannot accept the loss and merges their personality with that of the loved one.
- This is called 'introjection' and the individual projects all the feelings they had for the loved one onto themselves, this can include anger and sadness.
When depression occurs without the death of a loved one, Freud suggested a symbolic loss, this can include losing a job or breaking up with a partner. These are interpreted in the same way as the death of a loved one.
Depression can also occur as a result of the individual's early relationship with parents. Hosilte feelings towards parents are redirected towards the individual in the form of self-hatred or self-accusation. These feelings may arise as a result of a lack of love and care, support and safety, or child abuse.
- In general terms, the repression of trauma from early childhood emerges in the form of depression as an adult.
Psychodymanic explanation (Bowlby)
Separation from/loss of the mother in early childhood could result in severe depression in adulthood.
Examined the effect of separating infant rhesus monkeys from their mothers. The mother and child monkeys displayed behaviours similar to the symptoms of depression found in humans. However, as humans were not used, the validity of this test has been questioned.
Reviewed 14 studies and found inconclusive evidence, 7 supported Bowlby's hypothesis and 7 did not support it.
Martin et al (2004)
Depressed patients often report 'affectionless control' in reference to their parent's parenting style.
Evaluation of the psychodynamic explanation
It is diffiicult to test Freud's ideas as they rely on the subconscious and 'symbolic loss' which is impossible to investigate.
- There is evidence that those with depression show more anger than those without depression, but findings are inconclusive. Not only this, but studies have been unable to show this anger is directed inwards as Freud suggested.
There is evidence that the loss of a parent in early childhood can lead to depression in later life. However, loss of a parent also effects the environment the child is in, eg. it could lead to social or economic hardships that create vulnerabilities to depression.
- Harris (2001), family discord and lack of adequete care predispose people to depression, even in families where there is no physical separation.
In many studies, only some children/monkeys reacted to loss with depresssive symptoms making this theory reductionist.
- Bonanno (2004), less than 10% of those who experience major losses in early life go on to develop depression.
These treatments introduced by Freud aim to help the individual better cope with the emotional conflicts that are causing the disturbances.
The therapy is to uncover unconscious conflicts and anxieties that have their origins in the past.
After bringing them to the surface, the client is encouraged to work through them through examining and dealing with them in the safety of the consulting room.
It is thought that confusing/traumatic experiences as a child are better understood with the benefit of adult knowledge.
The techniques include:
- free association
- word association
- dream analysis
- projective tests
Evaluation of psychodynamic therapies
It is normally conducted over a number of years, which makes it expensive.
More modern, brief psychodynamic therapies exist where the focus is on current, rather than past, events. These can produce quick improvements in functioning and are more affordable.
Psychoanalysis may not be suitable for depression, as people with depression are often too passive, withdrawn and fatigued to take part in such demanding therapy sessions.
- The effects of the disorder mean people can too easily become disheartened and drop out of therapy before it has any effect.
Psychodynamic therapies can cause emotional harm. It can result in bringing up memories that the client finds emotionally distresing to deal with, but must be dealt with in order to recover from their current problem.
The therapist could abuse their power over the client, even though there is a code of practice that they are supposed to follow.
Evaluation of psychodynamic therapies (2)
He questioned whether psychodynamic therapies actually worked.
He reviewed two outcome studies with waiting list controls and found 66% of the control group (on the waiting list) improved spontaneously, while only 44% of the psychoanalysis patients improved.
- Bergin (1971), one of the patients in the Eysenck's control group was hospitalised and others were being treated by their GP. Eysenck did not control extraneous variables.
- Bergin found that 83% of those undergoing pyschoanalysis improved, and only 30% of the control group improved spontaneously.
Cognitive explanation (Beck)
There are 3 main components of depression known as the 'cognitive triad':
- Negative views of the self, eg. worthlessness and helplessness
- Negative views of the world, eg. the world is full of obstacles
- Nagative views of the future, eg. the future will be just as bad
As the 3 components interact, they interfere with normal cognitive functioning.
This can lead to impairments in:
- problem solving abilities
The individual becomes completely obsessed with their negative thoughts.The thoughts arise spontaneously and are not the resilt of consious intention.
The cognitive triad is maintained by the interaction of negative schemas and cognitive distortions.
Negative self-schemas are a set of self-blaming and pessimistic beliefs developed by a depressive prone individual about themselves.
These schemas may develop in childhood as a result of trauma and/or negative treatments. Whenever the person encounters a situation that resembles the early negative/traumatic experience, the negative schema is triggered.
Examples that could contribute to the negative schema are:
- death of a sibling/parent
- parental rejection, criticism, overprotection, neglect or abuse
- being bullied at school/peer rejection
Gotlib and Macleod (1997)
Negative schemas are deep-seated belief systems that develop early in life as the result of a series of negative events.
People with negative distortions are prone to making logical errors in their thinking and they tend to focus selectively on certain aspects of a situation while ignoring equally relevant information. Beck referred to these logical errors as 'cognitive disruptions'. They include the following:
- Arbitrary interference - drawing conclusions on the basis of irrelevant/insuffient evidence, eg. you are worthless because the open air concert you were going to see has been rained off.
- Selective abstraction - focusing on a single aspect of a situation, eg. you are reponsible for losing a football match even though you are only one player.
- Overgeneralisation - making sweeping conclusions from one event, eg. you get a D in an exam when you normally get As, therefore you're stupid.
- Magnification and minimisation - exaggerating or underplaying the significant event, eg. scraping a bit off your car means you're a terrrible driver or being praised for a excellent term's work is trivial.
- Personalisation - attributing negative feelings of others to yourself, eg. your teacher looks angry when she enters the room, so she must be angry with you.
Different personality types will determine the type of event that can trigger depressive episodes.
Sociotropic personality types base their self-esteem entirely on the approval and regard of others.
- A snub from a colleage or neighbour could be enough to trigger a depressive episode.
Autonomous personality types would react badly to a situation where their sense of acheivement or independence had been challenged.
- This could involved losing a game of tennis or having a decision overuled at work.
Evaluation of the cognitive explanation
It is difficult to show cause and effect. Very few longitudinal studies show cognitive vulnerability as a predictor of depression.
- Segal and Ingram (1994), no different between a variety of cognitive vulnerability measures in depressed people and non-depressed people. This suggests negative thinking is an effect of depression, rather than a cause.
- Most studies into cognitive theory are correlational and cannot show cause and effect.
There is lots of research into cognitive explanations of depression, which has greatly contributed to understanding of the disorder.
Hundreds of studies have investigated whether depressed people think more negatively than non-depressed people, and most evidence supports this.
- Evans et al (2005), depressed people have a tendency to maladaptive attitudes and beliefs, and the more of these they hold, the more depressed they are.
Cognitive behavioural therapy (CBT)
Formed on the basis that cognitions interact and influence emotions and behaviours.
1. The therapist encourages the client to become aware of beliefs and expectations that contribute to anxiety and/or depression.
- This involves direct questions, "tell me what you think about..." and diagrams can be used to explain thought processes such as the ABC model.
2. The client and therapist work to replace irrational, negative thoughts with more adaptive thinking.
- Goals can then be set so the client can start to think more rationally and realistically. This is usually done in graded stages of difficulty so the client can build on their own success.
3. The client and therapist test the client's beliefs through reality based experiements, either through roleplay or as homework assignments.
- The idea is that the client will recognise the consequences of their negative, maladaptive thinking and use adaptive thinking instead.
Rational-emotive behavioural therapy
Developed by Ellis (1962) and is based on the ABC model (activating event, belief, consequences)
ABC model states that if an event (A) is reacted to with irrational thoughts (B) it will lead to undesirable emotions/behaviours (C). If an event (A) is reacted to with rational thoughts (B), it will lead to desirable emotions/behaviours (C).
Ellis claimed that REBT helps people 'cure' themselves in an elegant way so they become less disturbed and anxious, and maintain this state over a long period over time.
REBT should be incorperated into a person's way of life in order to overcome procrastination and eradicate self-defeating thoughts.
Haaga and Davison (1989), REBT is effective for anger, depression and anti-social behaviour. It is difficult to evaluate the effectiveness of REBT, as it is difficult to define and measure 'irrational thoughts'.
Engels et al (1993), examined quantative data from 28 controlled studies, whcih showed REBT to be more effective than a placebo and no therapy.
Beck's cognitive therapy
Used mainly for people with depression and trains clients to moniter situations where they make negative assumptions. The client is encouraged to challenge these distorted thoughts and take part in activities that show them their thoughts are irrational. This includes four stages and is normally delivered over 20 weeks.
- Stage 1
- Draw up a schedule of activities
- Become more active and confident
- Stage 2
- Recognise automatic, negative thoughts and reccord them
- Test the reality of thoughts with the therapist
- Stage 3
- Therapist helps the client recognise underlying illogical thinking
- Stage 4
- Therapist helps client change maladaptive attitudes, testing them in real life
- Client is encouraged to take part in pleasurable activities
Evaluation of CBT
Senra and Polaino (1998), one difficulty of assessing the effectiveness of depression therapy comes from the measurement scale used to moniter the effects of treatments. They assessed 52 patients suffering from major depressive disorder with Beck's Depression Inventory, the Hamilton Rating Scale and Zung's Self-Rating Depression Scale and found different measures of improvement, depending on which scale was used.
CBTs are structured, with clear goals and outcomes. They are becoming the most widely employed therpy by clinical psychologists in the NHS. They are short-term and economic.
They appeal to clients who find insight therapies (eg. psychoanalysis) too threatening. But CBT can be criticised for not dealing with underlying issues. They empower the client by giving them self-help strategies. Some clients can become too dependant.
Hollon et al (1992) found CBT to be as effective as drugs for treating depression.
Fava et al (1998) used 40 participants who had experienced at least 3 bouts of depression. They were either given drugs then CBT (G1) or drugs then clinical management (G2). During a 2 week follow up, only 25% of G1 had relapsed, while 80% of G2 had. This shows the advantage of combining treatments, although only a small sample has been used so it has low ecological validity.