What is Depression 🙇🏻?
Depression 🙇🏻 is a mood disorder characterised by extreme sadness 😓.
To be diagnosed with major depression, the DSM5 states an individual must experience at least 5 from a list of symptoms including; one of depressed mood and/or loss of interest or pleasure in most activities, nearly every day for at least two weeks.
Emotional 😢 Characteristics
- Depressed Mood 🙇🏻 - a key characteristic is the ever present and overwhelming feelings of sadness 😞/ hopelessness. Lowered mood is a defining emotional element of depression but it is more intense and pronounced than in the daily kind of experience people in general can have.
- Loss of Interest and Pleasure 🤐 – depression is often characterised by a lack of enthusiasm associated with a lack of concern or pleasure in daily activities.
- Worthlessness - those suffering from depression often have constant feelings of low self-worth 🤥 and or inappropriate feelings of guilt 👺
Cognitive 🤔 Characteristics
- Reduced Concentration– 🤡 difficulty in paying and maintaining concentration and/or slowed down thinking and difficulty making decisions. Poor concentration and poor decision making are likely to interfere with the individuals work.
- Negative Beliefs about Self 🤥 – those suffering from depression often experience persistent negative beliefs about themselves and their abilities.
- Suicidal 🔪 Thoughts 💭 – depressives can have constant thoughts of death 💀 and/or suicide.
Behavioural 💪🏼 Characteristics
- Change in Activity – typically depressed people have reduced amounts of energy resulting in fatigue 😴, lethargy and high levels of inactivity. In some cases depression can lead to the opposite effect – known as psychomotor agitation - agitated individuals struggle to relax and may end up pacing up and down.
- Change in Eating 🍕 and Sleeping 💤 Patterns – people may experience a change in appetites which may mean they eat more or less than usual, and have significant weight changes (5%) either gaining or losing weight. Insomnia or excessive sleeping are characteristics of depression. The key point is that eating and sleeping behaviours are disrupted by depression.
- Social Impairment – there can be reduced levels of social interaction with friends and relations. 👫
The Cognitive Approach to Explaining Depression 🙇🏻
The cognitive approach generally explains depression 🙇🏻 in terms of faulty and irrational thought 💭 processes and perceptions.
Becks Negative Triad 1️⃣9️⃣6️⃣7️⃣
Aaron Beck believed depression 🙇🏻is caused by negative 👎🏼 thinking 💭 , especially about oneself and that negative 👎🏼 thinking 💭 comes before the development of depression 😞.
Negative 👎🏼 cognitive triad – Beck believed that depression 😞 has three components called the cognitive triad; which is a negative 👎🏼 view of the self 🤥, the world 🌎 and the future 📤 . Beck believed that these negative 👎🏼 views interfere with normal cognitive processing, such as memory and problem-solving. Each one feeds into the other. For example:
- The self 🤥 – where individuals see themselves as being helpless, worthless and inadequate, e.g. ‘I am unattractive 🤥, what is there to like in me?’
- The world 🌎(life experiences) – where obstacles are perceived within ones environment that cannot be dealt with, e.g. ‘I can understand why people do not like me, even my boyfriend 💔👫left me.’
- The future 📤 – where personal worthlessness is seen as blocking any improvements, e.g. ‘I am always going to be on my own and nothing will change it’
• Negative 👎🏼 self schemas
Beck believes that depressed 🙇🏻people develop negative 👎🏼 schemas about themselves, which makes them think in this negative 👎🏼 way.
Negative 👎🏼schemas develop in childhood 👧🏻and adolescence 👩🏼 as a result of rejection 🔞 by parents or friends in the form of criticism and exclusion, or perhaps by the loss of a close family member ⚰️.
Such negative 👎🏼 events mould the person’s concept of themselves as unwanted or unloved 💔.
This then filters into adulthood 👩🏼 providing a negative 👎🏼 framework 🖼 to view life in a pessimistic fashion. Negative 👎🏼 schemas lead to systematic cognitive biases in thinking.
• Cognitive 🤔 biases
People with negative 👎🏼 schemas become prone to making errors ❌ in their thinking 💭 . They tend to focus selectively on certain aspects of a situation and ignore equally relevant information known as cognitive biases.
One example is over generalisation where people with depression make a sweeping conclusion on the basis of a single event (e.g. he did not smile at me so he must hate me).
Ellis ABC Model 1️⃣9️⃣5️⃣7️⃣ - IRRATIONAL THINKING
Albert Ellis believed that depressives 🙇🏻 mistakenly blame external events for their unhappiness however it is their interpretation of these events that is to blame for their distress. He proposed that the key 🔑 to depression lay in irrational beliefs. According to this model, depression is produced by the irrational thoughts triggered by unpleasant events. In his ABC model:
A refers to an ACTIVATING EVENT:
something happens in the environment around you E.g. failing exam 📝❌
B is the BELIEF which is held about the event which may be rational or irrational
Belief about why this happened
E.g. ‘I am too stupid to pass exams’
C is the CONSEQUENCE– rational beliefs lead to healthy emotions whereas irrational beliefs lead to unhealthy emotions.
Consequences of Belief.
E.g. Leave college and become depressed 🙇🏻
It is not the activating event that causes the consequence; the consequence is caused by the beliefs about the activating event. Having irrational beliefs leads to unhealthy negative reactions and emotions, which in turn can lead to depression🙇🏻. Individuals who become depressed 🙇🏻 interpret unpleasant events in excessively negative or threatening ways at point B.
What are the evaluation points for the Cognitive Explanation of Depression 🙇🏻
1) Supporting research ✅
2) Cause or effect ⛔️
3) Practical application ✅
4) A more holistic approach is needed ⛔️
Outline the evaluation point
1) Supporting research ✅
Becks Negative Triad
Point:
There is a wealth of research 🔬 to support Beck’s cognitive explanation.
Evidence:
Koster et al’s study used student 👨🏼🎓 volunteers who took part in an attention task and were presented with positive ➕, negative➖ and neutral words.
Explain:
They found 🔍 that depressed 🙇🏻 participants spent longer attending to the negative words than the non-depressed group.
Re-cap:
The result supports ✅ the aspect of cognitive biases and that people with depression 🙇🏻attend to negative ➖ aspects of their life rather than the positive.
Elaborate:
However, the study was carried out in artificial conditions and used a procedure quite different from people’s everyday experiences of negative thinking; therefore, lacking ecological validity. Also, the study was conducted using college 👨🏼🎓 students, which makes it difficult to apply the findings to actual clinically depressed 🙇🏻 patients.
Ellis ABC model
Point:
The view that depression 🙇🏻 is linked to irrational thinking is supported by research.
Example:
Hammen and Krantz (76) found that depressed🙇🏻 participants made more errors ❌in logic when asked to interpret written material than non-depressed participants.
Re-cap:
Additionally, empirical support for Ellis therapy based on the ABC model contributes to the acceptance that irrational beliefs lead to depression 🙇🏻(Benjamin 2011).
Outline the evaluation point
2) Cause or effect ⛔️
Point:
It is difficult to determine the extent to which negative cognitive pattern’s cause depression 🙇🏻.
Explain:
Numerous studies have shown that depressed 🙇🏻people do show more negative 👎🏼 thinking than controls.
Example:
For example, Evans used a questionnaire of pregnant 🤰🏻 women and found that women with a high negative 👎🏼 schema were subsequently 60% more likely to become depressed than those with a low negative schema.
Elaborate:
However, as yet there is not enough convincing evidence that such thinking comes before a depressive episode.
Re-cap:
It seems likely that negative 👎🏼 thinking is a consequence of depression and that it might well serve to maintain the disorder rather than explain its origins.
Outline the evaluation point
3) Practical application ✅
Point:
Both Ellis’ ABC model and Beck’s cognitive explanation of depression 🙇🏻 has been very influential and has stimulated a huge amount of research 🔬 into the disorder over the last few decades.
Explain:
They have contributed greatly to our understanding of depression and to the rise of cognitive behavioural therapies, which have been very helpful in alleviating the symptoms of depression 🙇🏻.
Example:
Beck reviewed the effectiveness of CBT and found it highly effective in treating depression 🙇🏻especially unipolar depressive🙇🏻 disorder.
Elaborate:
Lipsky’s research 🔬 found that by challenging a person’s irrational negative 👎🏼 beliefs, depression 🙇🏻can be reduced.
Re-cap:
This evidence concerning the effectiveness of both Ellis’ and Beck’s forms of CBT can be taken as support for the theory it’s based on.
Outline the evaluation point
4) A more holistic approach is needed ⛔️
Point:
It has been argued that the cognitive distortions of depressed 🙇🏻people are not a cause but a symptom of the depression therefore other explanations are needed to fully understand the disorder and where faulty thoughts originated from.
Example:
Psychodynamic 👧🏻👦🏼(childhood events) explanations could play role in helping to understand how early experiences have influenced the development of the irrational and faulty thinking characteristic of depression.
Explain:
Additionally current research 🔬 supports ✅ the role of low levels of serotonin in depressed people and the success of drug therapies 💊 for treating depression offer further strength to a biological explanation.
Elaborate:
Taking electic approach, including social, biological and psychological theories, would be a better way of explaining such a complex disorder.
Re-cap:
To fully understand depression more holistic approach is therefore needed.
The Cognitive Approach to Treating Depression
The therapy aims target 🎯 to identify 🔍 and alter negative and irrational beliefs and expectations (cognitive element) and to alter dysfunctional behaviours that may be contributing to the depression (behavioural element). It is assumed as part of CBT that successfully challenging the patient’s irrational thoughts is of crucial importance if recovery from depression🙇🏻 is to occur.
- CBT begins with an assessment 📝 in which the client and the cognitive behavioural therapist work together to identify the negative 👎🏼 or irrational thoughts 💭 that will benefit from challenge. They jointly identify goals for the therapy and put together a plan 🗺 to achieve them.
- CBT then involves working to change the negative and irrational thoughts. During this phase the therapist uses questioning ❓designed to challenge maladaptive thoughts. The client may be taught skills such as relaxation 😌 techniques e.g. guided imagery and positive self statements with a view to over the time these challenges will result in a person’s cognition changing.
The therapy is Intended to be relatively brief consisting of 20 sessions over 16 weeks.
It is an active, directive therapy which focuses on current problems and current dysfunctional thinking. Some CBT therapists use techniques purely from Becks and some from Ellis. Most draw on both when treating depression.
What are the strategies used within CBT for people with depression?
Strategies used within CBT for people with depression include:
- Thought 💭 catching 🙌🏼
- Cognitive 🤔 Reconstructing 📏📐
- Behavioural 🏃🏻♀️activation
- Homework 📚(patient 👩🏼 as scientist👩🏼🔬)
What is meant by THOUGHT 💭 CATCHING 🙌🏼?
Identifying 🔍 negative 👎🏼 thoughts.
Individuals are taught to see the link between their thoughts and how they feel.
They might, as part of their homework 📚assignments, be asked to record 🎥 any emotion-arousing events and also the automatic negative 👎🏼 thoughts that are associated with these events (cognitive element).
What is meant by COGNITIVE 🤔RECONSTRUCTING📏📐?
Clients 👩🏼💼are asked to challenge these dysfunctional thoughts and replace them with more constructive ones.
This cognitive reconstructing can lead to individual to have more positive 😊thoughts and can alleviate the depressive symptoms (cognitive element).
What is meant by BEHAVIOURAL 🏃🏻♀️ ACTIVATION (behavioural element)?
A characteristic of many depressed people is that they no longer participate in activities that they previously enjoyed.
During CBT and REBT, the client 👩🏼💼and therapist 👩🏻🏫 identify 🔍 potentially pleasurable activities and to overcome any obstacles in carrying them out.
They are given graded homework 📚 assignments which allow them to experiment with the chosen activity, and the engage in progressively more rewarding activities.
What is meant by HOMEWORK 📚 (patient as scientist) ?
Patients 👩🏼💼 are often set homework 📚 tasks encouraging them to test reality of their irrational beliefs to help put new rational beliefs into practise.
What are the evaluation points of CBT in terms of its EFFECTIVENESS
1) Support for the effectiveness of CBT ✅
2) Competence Of Therapist 👩🏻🏫(not very good @ it) ⛔️
Outline the evaluation point
1) Support for the effectiveness of CBT ✅ in terms of CBT’s EFFECTIVENESS
Point:
There have been numerous studies that have shown CBT is defective in reducing symptoms of moderate and severe depression and in preventing relapse - especially for those who only have depression 🙇🏻.
Example:
March 2️⃣0️⃣0️⃣7️⃣compared effects of CBT, with anti-depressant drugs 💊 and a combination of 2 in 327 adolescents with a main diagnosis of depression.
After 36 weeks 81% of the CBT group and 81% of antidepressant group and 86% of the combined group were significantly improved.
Elaborate:
The high % in CBT group suggests that CBT is very effective in eating 🍔 depression 🙇🏻.
Re-cap:
However, also suggests that it may be even more effective when used as a combined treatment alongside medication.
Outline the evaluation point
2) Competence Of Therapist 👩🏻🏫(not very good @ it)
Competence - knowledge, skills and attitudes and their integration that allow individuality perform.
Point:
Issue with assessing the effectiveness of CBT is the competence of the therapist 👩🏻🏫.
Explain:
Appears to explain a significant amount of variation in CBT outcomes
Example:
Kuyken 2️⃣0️⃣0️⃣9️⃣supports this claim, concluding that as much as 15% is variance in outcome may be attributed to therapist competence.
Elaborate:
They found that therapists 👩🏻🏫 who were assessed as most competent had better patient outcomes regardless of the complexity of the case.
Re-cap:
Appears that to some extent, effectiveness of CBT depends upon the training and skills of the therapist 👩🏻🏫.
What are the evaluation points of CBT in terms of its APPROPRIATENESS
1) Factors affecting the choice of treatment ✅
2) Responses To CBT ⛔️
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Conformity (Majority Influence)31
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Exam Focus: Types Of Attachment - The Strange Situation10
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Obsessive Compulsive Disorder (OCD)6
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The Biological Approach To Explaining Obsessive Compulsive Disorder16
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The biological approach to TREATING obsessive compulsive disorder9
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Social Learning Theory24
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Psychodynamic Approach23
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Biological Approach17
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Exam Focus: Writing Frame - Explanation of Attachment11
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Psychopathology0
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Definitions of Abnormailty22
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Psychopathology Phobias5
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Behavioural Approach to EXPLAINING phobias9
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Behavioural Approach to TREATING phobias23
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Depression26
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The Behaviourist Approach20
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Attachment5
