Psychopathology Depression

Behavioural Characteristics of Depression

Activity levels: reduced levels, making them lethargic, extreme when sufferes cannot get out of bed. Opposite effect is psychomotor agitation, where the body struggles to relax and may pace up and down a room.

Disruption to sleep and eating behaviour: associated with disruptions to sleeping patterns, where sufferers may experience reduced sleep (insomnia), particularly premature waking or a need for increased sleep (hypersomnia). Similarly appetite and eating may increase or decrease, leading to weight gain or loss.

Aggression and self-harm: sufferers are often irritable, in some cases they can become verbally and physically aggressive. This can have a serious knock-on effect on a number of aspects in life. Depression can also lead to aggression against oneself, e.g. suicide attempts.

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Emotional Characteristics of Depression

Lowered mood: is still a defining emotional element. Patients often describe themselves as 'worthless' and 'empty'.

Anger: the experience of negative emotion is not limited to sadness but also frequent experiences of anger, sometimes extreme anger. This can be directed at the self or others.

Lowered self esteem: self esteem is the emotional experience of how much we like ourselves. Sufferers of depression tend to report reduced self esteem, in other words they like themselves less than usual.

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Cognitive Characteristics of Depression

Poor concentration: sufferers may find it difficult to carry out a normal task or make smooth decisions, as they usually would find it easy. Such cognitive processing can make it difficult to carry out everyday tasks.

Attending to and dwelling on the negative: sufferers may feel inclined to pay more attention to negative aspeects of a situation and ignore positives. For example, seeing a glass as half empty rather than half full. They may also be biased when recalling unhappy events rather than happy ones.

Absolutist thinking: most situations are not all good or all bad; when a sufferer is depressed, they tend think in these terms. They sometimes call this 'black and white thinking'. This means when a situation is unfortunate, they tend to see it as an absolute disaster.

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Cognitive Approach Explaining Depression

Beck's cognitive theory: Beck (1967) suggested that a cognitive approach explains why some people are more vunerable to depression than others. He proposed that it is a person's cognition that creates vulnerability. Beck suggested three parts to this cognitive vulnerability.

1: Faulty information processing: when depressed we tend to view things negatively, and ignore the positives. We also tend to blow small problems out of proportion and think in 'black and white' terms. 2: Negative self-schemas: a self-schema is a package of information we have about ourselves. We use our schemas to interpret the world; if we have negative self-schemas we interpret ourselves negatively. 3: Negative triad: a person develops dysfunctional views of themselves because of three types of negative thinking that occur automatically. Regardless of reality and what is happening at the time. These three elements are called the negative triad:

World: e.g. the world is a cold hard place, creating there isnt hope anywhere.

Future: e.g. the economy won't get better, reducing hopefulness and enhancing depression.

The self: e.g. I am a failure, enhancing depressive feelings because they confirm existing emotions of self esteem.

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Evaluation of the Cognitive Approach Explaining De

Supporting evidence: Grazioli and  Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. THey found that those women found to have high cognitive vulnerability were most likely to have post-natal depression. Beck (1999) reviewed  research on this topic and concluded that there was solid support for the cognitive vulnerability, therefore Beck may be right about cognition causing depression.

Practical application: CBT: all cognitive aspects of depression can be challenged in CBT. These include components of the negative triad that are easily identifiable. This means a therapist can challenge them and encourage the patient to test whether they are true. This translates the therapy to be successful.

Doesn't explain all aspects: Beck's theory only explains basic symptoms, however depression is complex. Some depressed patients become angry. Beck cannot easily explain these extreme emotions. Some sufferers even experience hallucinations and bizarre beliefs. Very occasionally, patients suffer Cotard Syndrome, the delusion that they are zombies. Beck cannoy explain these cases.

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Ellis' ABC Model

Ellis (1962) suggested a different cognitive explanation, he proposed that good mental heath is the result of rational thinking. To Ellis conditions like anxiety and depression result from irrational thoughts. Therefore he proposed a model to explain how irrational thoughts affect our behaviour and emotional state.

A: activating event: experiencing negative events trigger irrational beliefs, e.g. failing a test.

B: beliefs: Ellis identified a range of irrational beliefs. (Musterbation: the need to achieve perfection, I-can't-stand-it-it-is: everything is a major disaster, utopianism: life is always meant to be fair)

C: consequences: when an activating event triggers an irrational belief it can cause consequences, this may cause the depression.

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Evaluation of Ellis' ABC Model

Partial explanation: depression does occur from actiating events, however psychologists call this reactive depression and see it as different from the kind of depression that arises from an obvious cause. This means that Ellis' explanation only appplies to certain types of depression (the types that arise from a cause), therefore only a partial explanation.

Practical application in CBT: like Beck's explanation, Ellis' has lead to successful therapy. The idea of challenging irrational negative thoughts, a person can reduce their depression. This is supported by Lipsky et al (1980). This in turn supports the same belief that irrational beliefs play a role in depression.

Doesn't explain all aspects: although Ellis' explains why some people are more vulnerable to depression than others, as a result of their cognitions, his approach has very much the same limitations as Beck's. It doesn't easily explain the anger associated with depression or the fact that some suffer hallucinations or delusions.

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CBT (Cognitive Behavioural Therapy)

Most commonly used psychology treatment for depression and other mental health problems. Starts off with an assessment of the patient and working together with the therapist to clarify the patients problems. They identify goals and plans in ways to achieve them. One of the central tasks is to identify were there may be negative or irrational thoughts. Some use techniques based on Beck's cognitive therapy, others use Ellis' emotive behaviour and most draw on both.

Beck's cognitive therapy: It is the application of Beck's cognitive theory of depression. The idea behind it is to find automatic thoughts about the world, self and future. This is the negative triad. Once identified it must be challenged. This is the central component of the therapy. As well as challenging the thoughts to aim is to allow the patients to test the reality of them. This is when 'patient as scientist' is in place, when the patient is set homework to record when something good happens to them. Investigating the reality of their negative beliefs in the way of a scientists would, for future sessions if patients say that there is no one nice to them then this can be used as evidence.

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Evaluation of CBT (Cognitive Behavioural Therapy)

Effectiveness: there is a large body of evidence to support CBT for depression. March et al (2007) compared CBT against antidepressants and a combination of both in 327 adolescents with a main depression. 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT and antidepressant group improved. Thus CBT emerged as just as effective and helpful alongside medication. This suggests there is a good case for making CBT the first choice of treatment.

CBT may not work in severe cases: depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT. Where this is the case it is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated. This is a limitation of CBT because it means CBT cannot be used as the sole treatment of all cases of depression.

Therapist-patient relationship: Rosenzweig (1936) suggested that the difference between CBT and systematic desensitization might actually be small. It may be the quality of the a therapist-patient relationship that determines success rather than any particuar technique that is used. Many comparative reviews find very small differences, which support the view that simply having an opportunity to talk to someone who will listen could be what matters most.

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DSM-5 Categories of Depression

The DSM (diagnostic statistical manual) recognises the following categories of depression and depressive disorders.

Major Depressive Disorder: severe but often short term depression.

Persistant Depressive Disorder: long term or recurring depression, incuding sustained major depression.

Disruptive Mood Dyregulation Disorder: childhood temper tantrums.

Premenstrual Dysphoric Disorder: disruption to mood prior to and/or during menstruation.

** A diagnosis of major depressive disorder requires the presence of at least 5 symptoms and must include either sadness or loss of interest in normal activities

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Musturbatory Thinking

Ellis defined different irrationa beliefs. He called the belief that we "must" succeed or achieve perfection as "musturbation".

Ellis identified the three most important irrational beliefs:

I must be approved or accepted by people I find most important.

I must do well, or very well, or I am worthless.

The world must give me happiness, or I will die.

Other irrational assumptions include "others must treat me fairly and give me what I need" and "people must live up to my expectations or it is terrible!"

An individual who fails an exam becomes depressed not because they fail but because they hold an irrational belief regarding the failure e.g. "I must always do well so failing the exam means I am stupid".

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Alternative Expanations Explaining Depression

The biological approach: Depression could be inherited genetically. Wender et al (1986) found that adopted children who develop depression were more likely to have a depressive biological parent, even though adopted children are raised in different environments, impying biological factors are more important than cognitive ones.

Neurotransmitters may also cause depressive symptoms, e.g. low levels of serotonin have been linked to depression, which can be supported by the effectivenes of SSRIs to treat the disorder.

The behavioural approach: Depression may be learned. Lewinsohn (1974) proposed that negative life events may incur a decline in positive reinforcements and even lead o learned helplessness, where individuals learn through experience that they seemingly can't bring about positive life outcomes. Depression could even result from social learning, through the observation and limitation of others.

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