introducing and explaining depression Flashcards
DSM-V
All forms of depression and depressive disorders are characterised by changes to mood. The latest version of the DSM recognises the following categories of depression and depressive disorders:
• Major depressive disorder - severe but often short-term depression.
• Persistent depressive disorder - long-term or recurring depression, 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 to and/or during menstruation.
behavioural characteristics of depression
Activity levels
Typically people with depression have reduced levels of energy, making them lethargic.
This has a knock-on effect, with people tending to withdraw from work, education and social life. In extreme cases this can be so severe that the person cannot get out of bed.
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 a room.
Disruption to sleep and eating behaviour
Depression is associated with changes to sleeping behaviour. A person may experience reduced sleep (insomnia), particularly premature waking, or an increased need for sleep (hypersomnia). Similarly, appetite and eating may increase or decrease, leading to weight gain or loss. The key point is that such behaviours are disrupted by depression.
Aggression and self-harm
People with depression are often irritable, and in some cases they can become verbally or physically aggressive. This can have serious knock-on effects on a number of aspects of their life. For example, someone experiencing depression might display verbal aggression by ending a relationship or quitting a job.
Depression can also lead to physical aggression directed against the self. This includes self-harm, often in the form of cutting, or suicide attempts.
emotional characteristics of depression
Lowered mood
When we use the word depressed’ in everyday life we are usually describing having a is more to clinical depression than this.
lowered mood, in other words feeling sad. As you can see from the rest of this spread there Lowered mood is still a defining emotional element of depression but it is more pronounced than in the daily kind of experience of feeling lethargic and sad. People with depression often describe themselves as ‘worthless’ and ‘empty.
Anger
Although people with depression tend to experience more negative emotions and fewer positive ones during episodes of depression, this experience of negative emotion is not limited to sadness. People with depression also frequently experience anger, sometimes extreme anger. This can be directed at the self or others. On occasion such emotions lead to aggressive or self-harming behaviour - which is why this characteristic appears under behavioural characteristics as well.
Lowered self-esteem
Self-esteem is the emotional experience of how much we like ourselves. People with depression tend to report reduced self-esteem, in other words they like themselves less than usual. This can be quite extreme, with some people with depression describing a sense of self-loathing, i.e. hating themselves.
cognitive characteristics of depression
Poor concentration
Depression is associated with poor levels of concentration. The person may find themselves unable to stick with a task as they usually would, or they might find it hard to make decisions that they would normally find straightforward. Poor concentration and poor decision-making are likely to interfere with the individual’s work.
Attending to and dwelling on the negative
When experiencing a depressive episode people are inclined to pay more attention to negative aspects of a situation and ignore the positives. In other words they tend to see a glass as half-empty rather than half-full.
People with depression also have a bias towards recalling unhappy events rather than happy ones - the opposite bias that most people have when not depressed
Absolutist thinking
Most situations are not all-good or all-bad, but when a person is depressed they tend to think in these terms. This is sometimes called ‘black-and-white thinking. This means that when a situation is unfortunate they tend to see it as an absolute disaster.
Becks cognitive theory of depression
*Some people’s cognitions make them more vulnerable to depression
*Three parts to this cognitive vulnerability
-Faulty Information processing
* Negative self-schema
*The negative triad
faulty information processing
This is when depressed people attend to the negative aspects of a situation and ignore positives. For example, if I was depressed and won E1 million on the Lottery, I might focus on the fact that the previous week someone had won £10 million, rather than focus on the positive of all I could do with £1 million. Depressed people may tend towards black and white thinking’ where something is either all bad or all good.
negative self schema
A schema is a ‘package’ of ideas and information developed through experience. They act as a mental framework for the interpretation of sensory information. A self-schema is the package of information people have about themselves. People use schema to interpret the world, so if a person has a negative self-schema they interpret all information about themselves in a negative way.
negative triad
Beck suggested that a person develops a dysfunctional view of themselves because of three types of negative thinking that occur automatically, regardless of the reality of what is happening at the time. These three elements are called the negative triad. When a person is depressed, negative thoughts about the world, the future and oneself are uppermost.
a) Negative view of the world - an example would be ‘the world is a cold hard place. This creates the impression that there is no hope anywhere.
b) Negative view of the future - an example would be there isn’t much chance that the economy will really get better. Such thoughts reduce any hopefulness and enhance depression.
c) Negative view of the self - for example, thinking I am a failure. Such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem.
Ellis’s ABC model
Another American psychiatrist, Albert Ellis (1962) suggested a different cognitive explanation of depression. He proposed that good mental health is the result of rational thinking, defined as thinking in ways that allow people to be happy and free from pain.
To Ellis, conditions like anxiety and depression (poor mental health) result from irrational thoughts. Ellis defined irrational thoughts, not as illogical or unrealistic thoughts, but as any thoughts that interfere with us being happy and free from pain.
Ellis used the ABC model to explain how irrational thoughts affect our behaviour and emotional state.
A Activating event
Ellis focused on situations in which irrational thoughts are triggered by external events.
According to Ellis we get depressed when we experience negative events and these trigger irrational beliefs. Events like failing an important test or ending a relationship might trigger irrational beliefs.
B Beliefs
Ellis identified a range of irrational beliefs. He called the belief that we must always succeed or achieve perfection ‘musturbation’. I-can’t-stand-it-itis’ is the belief that it is a major disaster whenever something does not go smoothly. Utopianism is the belief that life is always meant to be fair.
C Consequences
When an activating event triggers irrational beliefs there are emotional and behavioural consequences. For example, if a person believes that they must always succeed and then fails at something this can trigger depression.
The activating event is the failure, and the irrational belief (e.g. “I must always succeed”) already existed before the event. The event triggers that belief, and that leads to the emotional response (like depression).
s-becks-research support
One strength generally of Beck’s cognitive model of depression is the existence of supporting research.
‘Cognitive vulnerability’ refers to ways of thinking that may predispose a person to becoming depressed, for example faulty information processing, negative self-schema and the cognitive triad. In a review David Clark and Aaron Beck (1999) concluded that not only were these cognitive vulnerabilities more common in depressed people but they preceded(came before) the depression. This was confirmed in a more recent prospective(looking to future)study by Joseph Cohen et al. (2019). They tracked the development of 473 adolescents, regularly measuring cognitive vulnerability.
It was found that showing cognitive vulnerability predicted later depression.
This shows that there is an association between cognitive vulnerability and depression.
strength-practical applications
A further strength of Beck’s cognitive model of depression is its applications in screening and treatment for depression.
Cohen et al. (see above) concluded that assessing cognitive vulnerability allows psychologists to screen young people, identifying those most at risk of developing depression in the future and monitoring them. Understanding cognitive vulnerability can also be applied in cognitive behaviour therapy (CBT - see next spread). These therapies work by altering the kind of cognitions that make people vulnerable to depression, making them more resilient to negative life events.
This means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice.
s-ellis-real world application
One strength of Elli’s ABC model is its real-world application in the psychological treatment of depression.
Ellis’s approach to cognitive therapy is called rational emotive behaviour therapy or REBT for short. The idea of REBT is that by vigorously arguing with a depressed person the therapist can alter the irrational beliefs that are making them unhappy. There is some evidence to support the idea that REBT can both change negative beliefs and relieve the symptoms of depression (David et al. 2018).
This means that REBT has real-world value.
l-ellis-reactive and endogenous depression
One limitation of Ellis’s ABC model of depression is that it only explains reactive depression and not endogenous depression.
There seems to be no doubt that depression is often triggered by life events - what Ellis would call activating events: Such cases are sometimes called reactive depression. How we respond to negative life events also seems to be at least partly the result of our beliefs. However, many cases of depression are not traceable to life events and it is not obvious what leads the person to become depressed at a particular time. This type of depression is sometimes called endogenous depression. Elli’s ABC model is less useful for explaining endogenous depression.
This means that Elli’s model can only explain some cases of depression and is therefore only a partial explanation.
