Thursday 1st February 2024

Depression
Depression – a mood disorder that causes people to feel unhappy and discontent.
DSM – V
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.
- Disruptive Mood Dysregulation Disorder – Childhood temper tantrums.
- Premenstrual Dysphoric Disorder – disruption to mood prior to and/or during
menstruation.
Characteristics

 Behavioural characteristics:
o Activity Levels – lethargy or psychomotor agitation.
o Eating and sleeping disruption – more or less.
o Aggression and self-harm – verbal and physical.
o Withdrawal from activities one enjoyed – anhedonia.
 Emotional characteristics:
o Lowered mood – worthlessness and emptiness.
o Anger – directed at self and others.
o Lowered self – esteem – liking yourself less.
 Cognitive characteristics:
o Poor concentration – focussing or making decisions.
o Attending to/dwelling on negatives – positives ignored.
o Absolutist thinking – all or nothing; absolute disaster.

Cognitive approach to explaining depression.

Cognitive vulnerability to depression comes from:
1. Faulty information processing: When depressed we attend to the negative aspects of
a situation and ignore positives. For example, someone was depressed and won £1
million in the lottery you may focus on the fact that the previous week someone won
£10 million rather than focus on the positive of all they could do with £1 million. We
also tend to blow small problems out of proportion and think in ‘black and white’
terms.
2. Negative self-schemas: 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 we have about ourselves.
We use schemas to interpret the world, so if we have a negative self-schema, we
interpret all information about ourselves in a negative way.
3. The negative triad: A person develops a dysfunctional view of themselves because of
three types of negatiuve thinking that occurs automatically, regardless of the reality of
what is happening at the time. These three elements are called the negative triad.
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Depression
When we are depressed, negative thoughts about the world, the future and oneself
comes to us.
a. Negative view of the world – e.g., ‘the world is a cold, hard place’. This
creates the impression that there is no hope anywhere.
b. Negative view of the future- e.g., ‘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 (oneself) – e.g., ‘I am a failure’. Such thoughts
enhance any existing depressive feelings because they can confirm the existing
emotions of low self-esteem.
Ellis’s ABC model
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 of 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 of pain. Ellis used the ABC model to explain how irrational thoughts affect our
behaviour and emotional state.
A – Activation event
Whereas Beck's emphasis was on automatic thoughts, 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 you believe you must always succeed and then fail at
something this can trigger depression.

EVALUATION:
BECK’S COGNITIVE THEORY
It has good supporting evidence:
A range of evidence supports the idea that depression is associated with faulty information
processing, negative self-schemas and the cognitive triad of negative automatic thinking. For
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Depression
example, Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability
and depression before and after birth. They found that those women judged to have been high
in cognitive vulnerability were more likely to suffer post-natal depression.
- Clark and Beck (1999) reviewed research on this topic and concluded that there was
solid support for all these cognitive vulnerability factors. Critically, these cognitions
can be seen before depression develops, suggesting that Beck may be right about
cognition causing depression, at least in some cases.

It has a practical application in CBT:

A further strength of Beck's cognitive explanation is that it forms the basis of a cognitive
behaviour therapy (CBT). All cognitive aspects of depression can be identified and
challenged in CBT. These include the 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 is a strength of the explanation because it translates well into a
successful therapy.

ELLIS’S ABC MODEL

A partial explanation
There is no doubt that some cases of depression follow activating events. Psychologists call
this reactive depression and see it as different from the kind of depression that arises without
an obvious cause. This means that Ellis’s explanation only applies to some kinds of
depression and is therefore only a partial explanation for depression.

It has a practical application in CBT.

A strength of Ellis’ explanation is that, like Beck’s explanation, it has led to a successful
therapy. The idea that, by challenging irrational negative beliefs, a person can reduce their
depression is supported by research evidence. This in turn supports the basic theory because
it suggests that the irrational beliefs had some role in the depression.

Treatments of Depression
Cognitive Treatments:
Individuals can overcome mental disorders by learning to use more appropriate cognitions.
If people think in more positive wyes and reinforce these thoughts, they can be helped to feel
better (cognitive restructuring).

Becks Cognitive Behaviour Therapy:

- Identifies and challenges beliefs in negative triad – ‘thought catching’.
- Patient can test the reality if these beliefs as part of their homework by recording
positive events – ‘patients as scientists’.
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Depression
- The client might also be asked question about events that go against negative schema,
or to do things that prove them wrong.
- These can be used in the future as evidence against faulty thinking.
- Patients are also set hypothesis testing goals with behavioural coping skills.
- Over time, this changes irrational ideas to more rational beliefs – cognitive restricting.
Rational Emotive Behaviour Therapy (REBT)
- REBT extends the ABC model and includes ‘D’ and ‘E’:
o D – Dispute – challenging automatic negative thoughts within a vigorous
argument (such as empirical and logical arguments) looking at underlying
absolutist demands (all or nothing).
o E – Effect – breaks the link between negative events and depressive
symptoms.
- It’s not events that upset us, but the beliefs we have about the event.
EVALUATION
It is effective
- There is a large body of evidence to support the effectiveness of CBT for depression.
For example, a study by March et al. (2007) compared the effects of CBT with
antidepressant drugs and a combination of the two in 327 adolescents with a main
diagnosis of depression. After 36 weeks 81% of the CBT group, 81% of the
antidepressants group and 86% of the CBT plus antidepressants group were
significantly improved. Thus CBT emerged as just as effective as medication and
helpful alongside medication.
- This suggests there is a good case for making CBT the first choice of treatment in
public health care systems like the National Health Service.
CBT may not work for the most severe cases
- In some cases depression can be so severe that patients cannot motivate themselves to
engage with the hard cognitive work of CBT. They may not even be able to pay
attention to what is happening in a session. Where this is the case it is possible to treat
patients with antidepressant medication and commence CBT when they are more alert
and motivated.
- Although it is possible to work around this by using medication, this is a limitation of
CBT because it means CBT cannot be used as the sole treatment for all cases of
depression.
Success may be due to the therapist-patient relationship
- Rosenzweig (1936) suggested that the differences between different methods of
psychotherapy, such as between CBT and systematic desensitisation, might actually
be quite small. All psychotherapies share one essential ingredient - the therapist-
patient relationship. It may be the quality of this relationship that determines success
rather than any particular technique that is used.
- Many comparative reviews (e.g. Luborsky et al. 2002) find very small differences,
which supports the view that simply having an opportunity to talk to someone who
will listen could be what matters most.
Some patients really want to explore their past
- One of the basic principles of CBT is that the focus in therapy is on the present and
future, not the patient's past. This is in contrast to some other forms of psychological
therapy. Some patients are aware of the link between their childhood experiences and
current depression and want to talk about their experiences. They can find this
'present focus' very frustrating.