Depression (Shapiro Ch. 14)

Question 1

What does emotion encompass in depression?

Answer 1

Depression includes both the presence of negative feelings and the absence of positive feelings, with sadness common in teens and irritability common in younger children.

Question 2

What physiological characteristics does depression have?

Answer 2

Depression can involve either lethargy or agitation, insomnia or excessive sleeping, and overeating or loss of appetite.

Question 3

What cognitive characteristics does depression have?

Answer 3

Depressive cognition is marked by negative distortions of the self, world, and future, and by causal attributions that result in low self-esteem and hopelessness

Question 4

What behavioral characteristics does depression have?

Answer 4

Depressive behavior is usually marked by low energy, apathy, and withdrawal, although agitated behavior may also occur

Question 5

What neurobiological characteristics does depression have?

Answer 5

*Depression is associated with low levels of serotonin activity at the synapses of neurons that regulate mood, activity, motivation, and response to reward due to inefficient transport and abnormal functioning of serotonin receptors.
*Selective serotonin reuptake inhibitors (SSRIs) block the reuptake of serotonin at synapses, resulting in its accumulation and more frequent firing of adjacent neurons
*Depression is associated with reduced size and functioning of the hippocampus, which regulates the hypothalamic pituitary-adrenal axis. This results in chronic elevation of cortisol, a stress hormone.
*Depression is associated with low levels of left prefrontal cortex activity. Both infants of depressed mothers and depressed adolescents show low activity in this “reward circuitry”

Question 6

What behavioral characteristics does depression have?

Answer 6

*Depressed behavior is usually characterized by a low overall rate of activity, although there are bursts of agitation or mania in some forms.
*The operant perspective provides a simple explanation: Depressed people receive a low rate of positive reinforcement, which suppresses their behavior in a general way. *Several factors contribute to the low rates of positive reinforcement and activity characteristic of depression: Low energy (partly resulting from sleep disturbance), Avoidance of challenging activities, Pessimism and hopelessness about activities, Weak social skills, including depressed mood itself, which lead to rejection

Question 7

What cognitive characteristics does depression have?

Answer 7

*Depressed people interpret events in pessimistic and self-critical ways.
*They underestimate their competence.
*In lab experiments, they selectively attend to negative stimuli and have better memory for negative than positive content, while nondepressed people show the opposite pattern.
*Depressed people focus more on negative elements of situations while focusing less on encouraging elements, compared to nondepressed people, who exhibit the opposite pattern.
*Depressed mood causes depressed cognition, as well as the other way around

Question 8

How do people with depression view successes and failures?

Answer 8

Failures: attributed to internal reasons
Success: attributed to external reasons

Question 9

How do people with depression attribute events?

Answer 9

NONdepressed people make attributions to small, specific causes (e.g., being weak in algebra), whereas depressed individuals make attributions to large, global causes (e.g., being unintelligent).

Question 10

How might depression present in children?

Answer 10

It can oftentimes present as irritability

Question 11

How may some youth (esp. boys) prefer to describe their depression?

Answer 11

bored, down, blue, bummed out

Question 12

How might behavioral activation (CBT) be used with a client that is dealing with depression?

Answer 12

This CBT technique directly addresses the low activity level characteristic of depression.

Pleasant event scheduling: means identifying activities the client finds enjoyable (no matter how small or ordinary) and purposefully scheduling them for her.

Question 13

How can therapists test depressive beliefs with evidence?

Answer 13

*Counselors can support the development of adaptive cognition by: Identifying “facts” that are actually beliefs (e.g., “I’m a loser”), asking about and expanding on exceptions and doubts about the complete truth of the belief, citing evidence inconsistent with the depressogenic belief, suggesting alternative explanations of facts from which the client draws depressing implications

Question 14

How can reattribution be used with clients dealing with depression?

Answer 14

changing attributions for negative events from global, stable factors to specific, unstable factors (i.e., “That test went badly, but others haven’t, and the next ones might not)

Question 15

Characterological self-blame

Answer 15

(attribution to a personal trait) is always dysfunctional.

Question 16

Behavioral self-blame

Answer 16

(attribution to a mistake) is often adaptive, because it implies potential control over recurrence in the future (J

Question 17

When should psychodynamic therapy be used with clients that are depressed?

Answer 17

when the client’s self-derogation seems to have an unconscious source. This possibility is suggested when: Clients recognize that their self-criticisms are irrational but cannot stop. Clients think of new self-criticisms as fast as the counselor refutes old ones

Question 18

How can work on object relations help a client with depression?

Answer 18

Sometimes the client’s sense of personal badness developed as an internalization of derogating messages or mistreatment by parents. The needed life lesson is simple but often hard to believe: Other people, including adult caregivers, can be wrong

Therapists can provide experiences of being accurately seen, known, and valued in a nurturing relationship, and this can change the client’s self-concept and sense of what is possible in relationships. The most important times to provide corrective emotional experiences are when the client’s pessimistic expectations emerge acutely. Then, therapists can disconfirm these fears by treating the client in unexpected and positive ways.