L10: Mental health II Flashcards
(11 cards)
COGNITIVE-BEHAVIOURAL MODEL
Depression stems from problematic behaviours & dysfunctional ways of thinking
Depression is associated with significant changes in the number of rewards and punishments (Lewinsohn et al., 1990, 1984). Depressed individuals report fewer positive rewards than non-depressed individuals, and when rewards increase, mood improves (Stein et al., 2020; Santos et al., 2019). There is particular importance in the role of social rewards (Tan, Shallis, & Barkus, 2020; Werner-Seidler et al., 2017). According to the Cognitive Model by Aaron Beck, there are several key components contributing to depression. First are maladaptive attitudes, such as “My worth is tied to every task I perform.” Second is the cognitive triad, in which depressed individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways. Third are errors in thinking, such as drawing negative conclusions based on little evidence. Fourth are automatic thoughts, which are often difficult to spot. Types of automatic thoughts include: all-or-nothing thinking (viewing situations in only two categories, black-or-white), catastrophizing or fortune-telling (predicting negative outcomes without considering alternatives), disqualifying the positive (insisting positive experiences don’t count), emotional reasoning (believing something is true because you feel it strongly), labelling (applying global, fixed labels such as “I’m a failure”), magnification/minimization (magnifying negatives and/or minimizing positives), mental filter (focusing only on one negative detail), mind reading (believing you know what others are thinking), overgeneralization (making broad negative conclusions), personalization (assuming others’ behaviours are your fault), and “should” and “must” statements (rigid expectations and self-criticism when not met).
learned helplessness
Learned Helplessness (Seligman, 1975)
Depression involves feelings of helplessness.
Attribution–Helplessness Theory (Updated version)
Depression linked to how individuals explain negative events.
cbt
Cognitive Behavioural Therapy (CBT) – 4 Phases
Phase 1: Increasing Activities and Elevating Mood
Behavioural activation: encourage activity.
Clients plan hourly activities for the coming week.
Phase 2: Challenging Automatic Thoughts
Recognize and record automatic thoughts.
Bring lists to session and test their reality.
Phase 3: Identifying Negative Thinking and Biases
Identify illogical thinking patterns.
Example: “They broke up with me because I’m unattractive.”
Phase 4: Changing Core Attitudes
Challenge and test maladaptive attitudes through discussion.
Effectiveness
CBT is more effective than placebo/no treatment.
(Gautam et al., 2020; Zakhour et al., 2020)
Booster sessions help prevent relapse.
(de Jonge et al., 2019)
gender and depression
Gender and Depression
Women are twice as likely as men to be diagnosed with unipolar depression.
Observed in: France, Sweden, Lebanon, New Zealand, USA
Explanations:
Theory Explanation
Artifact theory Clinicians underdiagnose men.
Hormone explanation Hormonal changes may trigger depression (puberty, pregnancy, menopause).
Life stress theory Women experience more stress.
Body dissatisfaction theory Unrealistic beauty standards.
Lack-of-control theory Women feel less control (based on learned helplessness).
Rumination theory Women ruminate more when sad, increasing depression risk.
worry and anxiety
Worry is defined as “a chain of thoughts or images, negatively affect-laden and relatively uncontrollable” (Borkovec et al., 1983), and when it becomes excessive, pervasive, and uncontrollable, it is referred to as pathological worry, which is closely linked to rumination (Segerstrom et al., 2000). Early stress theories by Cannon (1915) and Hans Selye (1936, 1950) highlighted the body’s stress response, particularly involving the HPA axis and cortisol release (Godoy et al., 2018; McEwen & Akil, 2020). Anxiety differs from fear in that fear is a reaction to immediate threat, while anxiety involves the anticipation of future threat and is often described as “objectless” or “about tomorrow” (Davis et al., 2010). Despite its distressing nature, anxiety can serve an adaptive, evolutionary function by promoting survival through heightened vigilance (Price, 2003). Anxiety disorders are highly prevalent, affecting around 19% of adults annually and about 31% at some point in life (NIMH, 2020b), though only 42% receive treatment (Alonso et al., 2018). These disorders include Generalized Anxiety Disorder (GAD), which involves persistent worry across various domains; specific phobias; agoraphobia; social anxiety disorder; and panic disorder, characterized by sudden attacks of intense fear. Most individuals with one anxiety disorder also experience another, indicating high comorbidity (Cuncic, 2020a; Roy-Byrne, 2019). The DSM-5 defines GAD as excessive anxiety occurring most days for at least six months, being difficult to control, and accompanied by symptoms like restlessness, fatigue, concentration issues, irritability, muscle tension, and sleep problems. Sociocultural factors such as poverty, dangerous environments, and disease outbreaks also contribute to anxiety. Cognitive theories, particularly Ellis’s (1962) concept of maladaptive assumptions, emphasize how unrealistic beliefs like needing universal approval or fearing incompetence can heighten anxiety. From a biological perspective, anxiety begins with the perception of a threat, which is processed by the sensory system and then activates the brain’s fear circuits, leading to a fear response. One key model is the Fear Centre Model, which emphasizes the amygdala as the central hub for fear processing. However, the more recent Two-System Model proposes that threat information is processed through two distinct pathways: the defensive survival circuit, which triggers automatic defensive responses, and the cognitive circuit, which gives rise to the conscious experience of fear or fearful feelings. This distinction helps explain why people can have fear responses without necessarily feeling fear, highlighting the complex interplay between instinctive reactions and higher-level cognition.
new-wave CBT approaches
New-wave CBT approaches focus on challenging maladaptive assumptions and targeting worry more directly (Haseth et al., 2019; Stefan et al., 2019). One such approach is mindfulness-based CBT, which encourages individuals to observe and accept their worries rather than trying to eliminate them (Hayes, 2019).
treatment:
Treatment:
SSRIs = long-term
Benzodiazepines = short-term (side effects!)
Examples:
Alprazolam (Xanax)
Lorazepam (Ativan)
Diazepam (Valium)
Mechanism: GABA (inhibitory neurotransmitter)
Antipsychotics (non-specific emotional blunting)
(LeDoux & Pine, 2016)
phobias
Specific Phobias
9% prevalence in the U.S.
Women outnumber men 2 to 1
Only 32% seek treatment (McCabe, 2018)
DSM-5 Criteria:
Persistent, excessive, unreasonable fear
Triggered by specific object/situation (e.g., flying, heights)
Exposure provokes immediate anxiety
Person recognizes the fear is unreasonable
Avoidance or intense distress interferes with normal life
Fliuyau et al. (2022) A meta-analysis of 64 randomized controlled trials involving 6,128 participants found that SSRIs significantly reduced depressive symptoms across various substance use disorders (opioid, alcohol, cocaine, cannabis, and nicotine), with the strongest effects seen in social anxiety symptoms for alcohol use disorder and generalized anxiety symptoms across multiple substances. SSRIs also supported abstinence and reduced cravings and substance use, particularly for alcohol and cocaine. Fluoxetine showed the greatest antidepressant effect. No moderating effects were found for attrition rate, SSRI dosage, or treatment length. Overall, the findings support SSRIs as effective treatments for co-occurring substance use, depression, and anxiety.
Michael G Gottschalk 1, Katharina Domschke 2,*
Evaluating GAD’s molecular cross-disorder position, a general community twin study on the genetic and environmental structure of anxiety spectrum disorders suggested two independent genetic factors for GAD, one more associated with panic disorder (PD), agoraphobia, and social anxiety disorder, and one factor with higher loading for specific phobias. Together, these account for 23% of the genetic variance in liability to GAD, the rest being represented by unique environmental factors.5
things i lit didnt see
How are fears learned?
Modelling (Bandura & Rosenthal, 1966):
A process of learning in which a person observes and then imitates others.
Also, a therapy approach based on the same principle
Predisposition to develop certain fears (McCabe, 2018b; McNally, 2016)
Predispositions transmitted genetically through an evolutionary process (McNally, 2016; Ohman & Mineka, 2003)
Systematic desensitization
patients learn to relax while gradually facing the objects or situations they fear
Flooding
Repeated exposure to the feared object
Modelling
the therapist who confronts the feared object or situation while the fearful person observes
~70% of phobic patients show significant improvement after receiving exposure treatment (Davis, Ollendick, & Öst, 2019; McCabe & Swinson, 2019).
The key to greater success appears to be actual contact with the feared object or situation.
Use of VR
Dysfunctional beliefs
Holding unrealistically high social standards and so believing that they must perform perfectly in social situations.
Believing they are unattractive social beings.
Believing they are socially unskilled and inadequate.
Believing they are always in danger of behaving incompetently in social situations.
Believing that inept behaviors in social situations will inevitably lead to terrible consequences.
Believing they have no control over the feelings of anxiety that emerge in social situations.
Anticipating that social disasters will occur, overestimate how poorly things go in their social interactions, and dread most social situations (Hofmann, 2019; Gavric et al., 2017).
Mediation
CBT
Social skills training
