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Paper 2: Abnormal – Depression (AJW) 2019

Paper 2: OptionsAbnormal PsychologyFor this part of the course you are required to write one essay, in one hour. The essay is marked using the same mark bands as Paper 1 and is therefore scored out of 22. There are three topics in Abnormal Psychology and there is one question guaranteed form each topic. This means that you only need to prepare one of the topics for the exam, so long as you are able to answer all possible essays on that topic. To this end it is advisable to prepare two topics in case you do not like the question for your preferred topic.

We will work towards you answering question 2 which will be about ‘Topic 2: Aetiology of Abnormal Psychology’ as this topic has the least possible essay titles within it. Aetiology means causes or explanations and we are allowed to focus on the causes for a single disorder. We will start by learning a bit about topic 1 ‘Factors affecting diagnosis’, to put the topic in context and help with your critical thinking, before moving onto aetiology. In order to evaluate aetiologies or explanation of depression, we will also be looking at treatments and this means that you could choose to answer question 3 on the paper, if you didn’t like the look of Question 2.

Just like Paper 1, the essay questions for the Options can also focus on Approaches to Research (i.e. methods: experiments, interviews, observations and case studies) and ethical considerations, but these questions will only be set at the topic level as before. The questions can also be linked to the three approaches to understanding human behaviour, (i.e. biological, cognitive and socio-cultural).

This booklet focuses on ‘Major Depressive Disorder’ and uses Problem-Based Learning to help you explore, topics 1-3.


Topic 1: Factors affecting diagnosisLearning outcomes

By the end of the unit you will be able to…

Explain the difficulties that psychologists have in identifying normal as opposed to abnormal behaviours, thoughts and feelings.

Outline two classification systems used for diagnosing disorders Define what is meant by reliability and validity with regard to

diagnosis Explain how reliability and validity are measured in diagnosis Explain why psychologists might find it difficult to make reliable and

valid diagnoses due to clinical biases


Sofia’s storyIt’s February and Sofia has just finished her mocks. She had studied for hours every night after school and never went home in the light. It was dark when she got up and dark when she went to bed. She has just got her results back. Things haven’t gone too well and she is getting really anxious about her final grades. Her parents are really keen for her to get into Bath University and she just feels it’s all a bit too much. Sofia has also been dieting recently; she feels that although her grades might seem outside of her control, at least she can control her weight. She’s cut back on some of her favourites like bread and pasta and has been trying to stick to healthy options like soup and salads.

Complete the table below to help you think more deeply about what Sofia might think about herself, her world and her future, how she might be feeling and what behaviours she is showing at the moment.

Thoughts Feelings BehavioursThinks she has done badly in her mocks (but what does she call bad?)

Thinking about her final exams and grades

Thinking she might let her parents down

Thinking she might not get the grades for Bath (there are other good universities)

Thinks her grades are beyond her control

Believes she can control her weight by not eating pasta and bread.

Feeling anxious (what does this actually feel like?)

Feeling overwhelmed, ‘it’s all too much’

Feeling out of control

Feeling guilty (letting parents down)

Feeling disappointed in herself (in case she doesn’t get the grades for Bath)

Studying long hours every night after school

Never goes home in the light (but how log is long and how hard are her friends working?)

She is dieting and cutting out pasta and bread

Restricting herself from her favourites foods (is she feeling guilty?)

Do you think Sofia’s behaviours, thoughts and feelings are normal or abnormal?

If you find it hard to decide, what additional information would you like to know?

Do Sofia’s age, gender or culture make any difference? Make a list of normal and abnormal thoughts, feelings and

behaviours for a person in Sofia’s situation.

Over the next few weeks, Sofia starts to find it hard to wake up in the mornings. She wakes up every night, worrying about exams and university. She had glandular fever the previous term and missed a lot of school but


doesn’t seem to realise that this may have affected her mock grades as opposed to her own lack of potential. Sofia’s friends are concerned; she is tearful and snappy, can’t make her mind up about the smallest decisions and she has lost weight. She used to walk her dog every day but now leaves it to her parents and she has stopped going to the usual rounds of parties, sleep overs and nights out. She has also been letting homework pile up, which is most unlike her. Her teachers have noticed that she has stopped attending clinics and she cancelled her last two driving lessons. Sofia has stopped taking time to put make-up on and doesn’t seem to care how she looks any more. She has been ignoring texts from her boyfriend as she thinks he is going to dump her as she has been so miserable lately.

Go back to your table and add to Sofia’s thought feelings and behaviours using a different colour pen.

What do you think now? Is Sofia’s behaviour normal or abnormal? What further information might help you to decide?

Read and make notes from pages 32-33.

Could Sofia’s behaviour, thoughts and feelings be considered Deviant in any way, statistically or socially? How could we find out?

Is she Dysfunctional? How might Sofia do on the WHODAS II? Does Sofia seem Distressed? Is this enough to consider that she might

need a diagnosis? How could we tell? Is Sofia enDangering herself or anyone else? How could we tell? How

might things change in the future? Should we wait and see? Duration is an important factor in deciding whether someone might benefit

form a diagnosis - How long has Sofia been this way? How can we find out? Why might it be difficult to make a decision about whether Sofia’s

behaviour is normal or abnormal? At this point, what ideas do you have about the best route forward for

Sofia? Can you offer any suggestions that might help her other than pursuing a

diagnosis and beginning treatment?

Extension:

You could read Davis (2009) which explains more about the 4 Ds of diagnosis.


Sofia’s friend Lacey has become increasingly concerned about her and has decided to speak to her college tutor, Ms Mui. Mrs Mui reassures her that she has been a good friend by talking about her anxieties and promises that she will have a word with Sofia as soon as possible. After speaking with Sofia, Mrs Mui decides to give Sofia’s mother a call. Sofia’s mum has also been worried about her daughter and decides that it might be wise to take her to see Dr Fielder, their local GP. Luckily for them, Dr Fielder is particularly interested in mental health and wellbeing so Sofia’s mum is feels very positive about the appointment.

Dr Fielder sees hundreds of patients each week, many of whom exhibit symptoms of one or more of over 300 mental disorders listed in the DSM 5, a classification system used by doctors in many countries, but developed in the US. A second classification system, the ICD 10 is also used worldwide to diagnose disorders and there are some key differences between the two manuals.

Over to you…

Read from p. 34-38 and make Cornell notes about the DSM and ICD. Complete the quizizzes about DSM and ICD. Circle the phrases that relate to DSM in one colour and ICD in another:

Is published by the APA, a single nation professional body Can be used by a wide range of

practitioners

Only for use by psychiatrists

Published only in English

Provides a stream of revenue for the organisation who

publish it

Is specific to mental disorders and does not contain guidance on diagnosing physical health

conditions

Is a free and open resource

Is published by the WHO, an agency of the United Nations

Multilingual

Covers all health conditions as well as mental and behavioural

disorders


DSM ICD

Description Critical thinking

Description Critical thinking

What language is it in?

Published only in English

Multilingual

Is it free? Provides a stream of revenue for the organisation who publish it

Is a free and open resource

What does it include?

Is specific to mental disorders and does not contain guidance on diagnosing physical health conditions

Covers all health conditions as well as mental and behavioural disorders

Who publishes it?

Is published by the APA, a single nation professional body

Is published by the WHO, an agency of the United Nations

Who uses it?

Only for use by psychiatrists

Can be used by a wide range of practitioners

Complete the critical thinking cells in this table; you may wish to redraw the table into your book so that you have more space to write out your thoughts.


That evening, Dr Fielder mulls over her day and picks up her copies of the DSM and the ICD from her shelf. She is thinking about Sofia and her mum. She thinks Sofia might have a diagnosable condition but is also reticent to refer her on for further investigation. In pairs, discuss the pros and cons of diagnosis and record them here or in

your book. Get together with another pair and share your ideas further, in order to create

the best lists possible.

Pros Cons

Making a diagnosis

Not making a diagnosis

In pairs, review the example pages from the DSM, (major depressive disorder, generalised anxiety disorder, anorexia nervosa, OCD, acute stress disorder) and decide whether Sofia might meet the criteria for any of these disorders.

Prepare a role play of Sofia, her mother and Dr Fielding at their next appointment as they try to establish whether Sofia has a diagnosable disorder.

Dr Fielding diagnoses major depressive disorder but suggests that Sofia talks to another doctor with more experience. Having spoken with Sofia, the other doctor does not think Sofia has MDD.

Why might the other doctor have reached a different conclusion? Find an example of a structured interview schedule for diagnosing

depression using the internet; how would a tool like this improve the reliability of diagnosis? Try Zung’s scale of depression.

Clinical biases that affect validity of diagnosesIndependent Presentations: Independently or in pairs, create a PowerPoint presentation on one of the following studies about clinical biases in the diagnostic process. Whilst preparing you presentation make Cornell notes on the study and ensure you have covered APFC in sufficient detail that the studies could be sued effectively as part of an essay, i.e. there is enough on the methods and ethics for evaluation.

o Rosenhan (1973)

o Caetano (1974)

o Temerlin (1970)


o Mendel (2011)


Reliability and Validity of diagnosis

Sofia feels anxious after seeing the second doctor. She is studying psychology at college and has learnt that psychiatric diagnosis can be unreliable. Thankfully, Mrs Mui had referred her to the school counsellor and they were to have their first appointment that afternoon. Sofia thought she would talk to her counsellor about her anxieties around diagnosis.

By now you will have read p 35 and 37 about the reliability and validity od the DSM and ICD. Now read p84 and 85 about depression.

Complete the table below to evaluate the reliability and validity of diagnosis.

DSM ICDReliability

Good

Poor

Validity Good

Poor


Sofia’s classmate Chunhua has come to study at her college from China. They are in the same Maths group. They don’t talk much but Sofia has noticed that Chunhua is often rubbing her shoulder. When she asks if she is okay Chunhua says she has had the pain for weeks on end. Sofia suggests that they talk to her tutor Mrs Mui as Chunhua has never been to the doctor in the UK and is a bit nervous. Mrs Mui thinks the pain might be due Chunhua working long hours on her computer in the evenings.

Over to you…

Re-Read Betram’s study of acculturation in Chinese international students

Explain why Mrs Mui might be wrong and make suggestions about how a credible diagnosis could be reached for Chunhua. Refer to the ‘Cultural Formulation Interview’ in your answer, (see DSM-5).

What suggestions could you make for Chunhua in order to provide her with a greater sense of social support both from home (China) and to help her to build a social network in the UK, including people who identify as Chinese and/or British.

How do you think social support would protect Chunhua from developing (further) depressive symptoms?


Topic 2: Aetiology of Abnormal PsychologyLearning outcomes


Outline symptoms and features of major depressive disorder Describe and evaluate biological, cognitive and socio-cultural

explanations of depression Define what is meant by prevalence Discuss biological (e.g. hormones and epigenetics), cognitive (e.g.

stress) and socio-cultural, (e.g. gender, class and culture) factors affecting the prevalence of depression

Describe and evaluate research methods used to investigate the aetiology of abnormal psychology, e.g. experiments, case studies, observations, interviews

Describe and evaluate ethical considerations relevant to the aetiology of abnormal psychology.

Sofia and Chunhua decide that they would like to raise awareness of major depressive disorder and the different forms that it can take as they realise that many young people in their college might be affected. They are particularly interested in ensuring that their campaign reaches people from ethnic minority groups in the college, who may be experiencing more somatic than affective/cognitive symptoms. Over to you…

Revisit Zung’s self-rated depression scale and complete John’s worksheet to divide the statements into the ‘ABCS’; affective, behavioural, cognitive and somatic symptoms; note how this scale may not pick up depression in people from non-Western cultures.

Create an awareness raising leaflet or 2 minute video about major depressive disorder. You should …

o bust myths relating to this disordero clearly state the symptoms, being mindful of cultural

differenceso state the prevalence of this disorder making reference to age

(as its targeted at college students) and cultural differences (bearing in mind that Sofia and Chuanhua are IB students in a culturally diverse college).


Biological explanations of major depressive disorder

Evolutionary explanation: Social Competition HypothesisYou need to know one evolutionary explanation of human behaviour for Paper 1 Biological approach. We will use Price’s Social Competition Hypothesis. If this comes up as an essay I would advise against writing it up as I have not provided much evaluation here , however we will look at one study as this is important for an SAQ and can be recycled in Paper 2 if you find yourself writing about biological causes of depression.Supporting study: Raleigh and Maguire:Aim: To investigate the relationship between position in the social hierarchy and serotonin.Procedure:

Adult vervet monkeys that had been living in captivity for at least 5 months were observed in their ‘indoor/outdoor’ enclosures, where they lived in groups of three males and three females plus their offspring

Monkeys were categorised as dominant or subordinate (IV) based on observations of six key behaviours including threaten, contact and display, all of which had been shown to have high levels of inter-rater reliability between 0.86 and 0.94.

DV: Blood samples were taken periodically to measure serotonin concentrations, using ketamine to sedate the animals prior to collection

In four of the ten social groups, there was a naturally arising change in the dominance hierarchy, whereby a previously subordinate monkey became dominant and the dominant monkey became subordinate.

Findings: serotonin increased by about 60% for those monkeys which became

dominant and decrease by about 40% in monkeys which became submissive

Conclusions: Depressive symptoms, caused by low levels of serotonin, may result from a loss of social position; lack of serotonin is the effect of loss of social status, therefore social-environmental factors are potentially important triggers for depression and how we think about such losses could affect our wellbeing.

Questions:

1. Think of 5 social situations where humans lose social status that could result in depression?

2. List 3 symptoms of depression that might be linked to loss of social status.


3. Name one hormone which is released during times of chronic stress which could be linked to reduced serotonin.

4. Give one strength and one weakness of this study.Neurochemical explanation

1. Create an interactive diagram for the doctor’s office wall to illustrate synaptic transmission; include vesicles, serotonin, post-synaptic receptor sites, serotonin reuptake transporters, MAO, tryptophan.

2. Role play the doctor using the diagram to show Sophia how synaptic transmission works and some of treasons why she might be suffering from depression. Also use your diagram to explain how SSRIs and MAOIs help alleviate depressive symptoms. You could film this on your ipad and upload to classroom.

3. Label the image of the limbic system; you may also want t refer to this in your role play.

Fill in the gaps:The monoamine hypotheses were proposed in the 19………………..s by ………………………… who argued that depression is caused by abnormally ……………. levels the monoamines noradrenaline, serotonin and ………………………...

These neurochemicals were deemed sensible possibilities due to the high density of receptor sites in the …………………………….., ……………………………… and …………………………………… (the limbic system), which is involved in many functions that link to depressive symptoms such as regulating …………………………, sleep and appetite and storing new memories. The limbic system also has connections to many other brain regions including the …………………………. cortex, which is involved in decision-making.

Early versions of this hypothesis focused on the role of …………………………………., suggesting that ……………………… levels, were associated with low mood and this was known as the ………………………………. hypothesis. Later revisions highlighted the importance of …………………………………., which regulates noradrenaline. This became known as the ……………………………….. amine hypothesis, as low levels of serotonin permit noradrenaline levels to fall, leading to depressive symptoms.

There are many reasons why a person may have low levels of serotonin, including low levels of ……………………………………. (an essential amino acid necessary for serotonin production), elevated levels of …………………………………………, the enzyme which breaks down serotonin the synaptic cleft and abnormalities of the serotonin transporters, which allow for serotonin ……………………………… on the …………..-synaptic cell, but one possibility that has received recent attention is the role of ……………………………………., whereby the brain compensates for low levels of serotonin by increasing the sensitivity, and over time the number, of post-synaptic serotonin receptors.


Finally, Dinan (1994) proposes that high levels of ……………………………, caused by stress, may be a cause of depression. It is argued that high levels of this hormone can inhibit serotonin production and cause upregulation due to disruption of the h…………………………..-p………………………..-a…………………………….. axis.

Supporting Studies

1.Moreno et al. (1999) and Moreno and Delgado (2000)

Aim: To investigate the role of tryptophan depletion as a cause of depressive symptoms.

Procedure: 12 experimental participants, medication-free but currently in

remission from MDD; control group: 12 age and gender-matched controls, no personal or family history of mental disorder.

All participants ingested 102g chocolate flavoured amino acid drink designed to deplete tryptophan.

Effects were compared with a 25 g quarter-strength drink Used a double blind, randomised mixed design. Measures of depression (the DV) were taken before ingestion and 5,

7, and 28 hours after ingestion using the Hamilton Depression Scale (HAM-D)

Depressive symptoms were monitored regularly over the next 12 months

Findings: All participants experienced changes in mood 24 hours after

ingestion Minimal changes for the healthy controls but much more

pronounced for the experimental group A dip of 5 points or more on the HAM-D during the depletion period

accurately predicted future depressive episodes in the following year.

Conclusion: Permissive amine hypothesis is supported as low levels of serotonin,

triggered by tryptohan depletion, were associated with the onset of depressive symptoms but only in people who had already experienced depression.

Even a very short-lived reduction in serotonin can have long lasting impact, leaving people with a history of depression more vulnerable to depression in the future.

Questions: 1. Why might the outcome of tryptophan depletion have been less

pronounced for the control group2. Give one strength and one weakness of this study.

2: Caspi et al (2003)

Amanda Wood (AJW), 21/02/19,

Delgado’s study is Relevant and thoroughly explained Research selected is effectively used to develop an argument


Aim: To investigate the effects of a polymorphism in the gene which codes for the serotonin transporter, specifically how does having a short allele or long alleles affect chances of developing depression. Procedure: 847 New Zealanders aged 26, divided into three groups according to their genotype for the 5HTT gene:

1. 17% two short alleles 2. 51% one short and one long allele 3. 31% two long alleles Hypothesised that in the face of stressful life events, group 1 would

be more likely to suffer from depressive symptoms, followed by group 2 and finally group 3.

Life history calendars were used to record the number of stressful life events participants had experienced in the last 5 years

Findings: No association between genotype and number of life events Aged 26, 17% of participants were found to meet the criteria for

MDD using the DSM IV and 3% had attempted suicide or had suicidal thoughts

Stressful life events were predictive of future depressive episodes only in the group carrying at least one short allele but not in those with two long alleles and this was true for participants who had not experienced depression prior to the age of 21

If the person had not suffered any life events, it was irrelevant whether they were carrying a short allele or not as the percentage of people with MDD was the same (around 10%)

In the group who had suffered four or more life events in the previous 5 years, 33% of those with a short allele became depressed compared with only 17% in the long allele group.

Conclusions: Genotype in combination with social-environmental life events may be particularly important in predicting depression.

Questions:

1. People with both short and long alleles got depressed at same rate when they had experienced no life events; why might this be? How do these findings help in understanding the findings of Moreno and Delgado’s study?

2. This study has not been replicated for example, e.g. Risch et al (2009) meta-analysis of attempted replications. What does this tell us about Caspi’s findings?

3. Furthermore life events were self-reported and this type of data may lack validity as people who are more prone to depression may be better at remembering negative life evetns than people who are not prone to depression and thus report low or no such events due to forgetting.

Critical thinking: Evidence which supports the role of alternative causes of depression


1. Maguire and Raleigh: see above.

2. Stickland et al (2002)

Aim:Procedure:

Naturalistic community-based study women with children under 16 were assessed using

questionnaires and interviews for depression and vulnerability to depression

four salivary cortisol samples taken at 9am and 11pm on two consecutive days and blood samples were taken to assess serotonergic activity

Findings: Counter to expectation depression was not associated with high levels of cortisol and serotonergic activity was in fact increased in the depressed group in comparison with the non-depressed group. Conclusions: This study refutes the permissive amine hypothesis and demonstrates that the biochemistry of depression is far from clear.

Limitations: No way of measuring serotonin levels directly in the brain;

studies such as Raleigh and Maguire and Strickland which use blood samples only provide indirect measures.

When writing an essay on this topic you can also get marks for critical thinking by looking at practical applications of the monoamine depletion hypotheses, e.g. antidepressant medications (see below).

Think! What factors might affect the image that you perceive in these ambiguous figures?

Give 3 key process involved in information processing

S

O

I


Cognitive explanations of major depressive disorder

Cognitive psychologists suggest that behaviour and experiences are determined by the way in which the individual processes incoming information. They argue that somatic, affective and behavioural symptoms of depression are caused by the way in which the individual selects and organises information from their social world and from the inferences that are made based on this information.

They suggest that depression results from a systematic negative bias in thinking processes, which make people more vulnerable to depression under certain circumstances.

Cognitive distortions: Look at the optical illusions pictured here; if you can accept that the mind sometimes focuses on certain aspects of a simple visual scene and creates a distorted impression, then it is not a great leap to see how individual minds construct their own depictions of reality regarding more complex social situations, selecting to attend only to certain information, seeing certain information as more important and allowing it to influence our thinking and decisions more greatly for example.

Aaron Beck (1967): The Cognitive Triad

Retrieved 2.4.10 from http://www.mercybh.org/poc/view_doc.php?

type=doc&id=13006&cn=5

Cognitive theorists suggest that depression results from maladaptive, faulty, or irrational cognitions taking the form of distorted thoughts and judgments. Depressive cognitions can be learned socially (observationally) as is the case when children in a dysfunctional family watch their parents fail to successfully cope with stressful experiences or traumatic events. Or, depressive cognitions can result from a lack of experiences that would facilitate the development of adaptive coping skills.

According to cognitive theory, depressed people think differently than non-depressed people, and it is this difference in thinking that causes them to

http://www.mercybh.org/poc/view_doc.php?type=doc&id=13006&cn=5

http://www.mercybh.org/poc/view_doc.php?type=doc&id=13006&cn=5

Quick check!

1. Give three words which describe the cognitions of people who may be at greater risk of depression.

2. Give two possible reasons why a person may have developed this cognitive style?

3. What is the cause of the depression for the cognitive psychologist?

4. Give three areas which may be viewed in a pessimistic way, possibly leading to depressive symptoms.

5. What does this pessimistic style of thinking tend to lead to?

6. Sketch a graph to illustrate the relationship between amount and severity of depressive symptoms and negative thoughts


become depressed. For example, depressed people tend to view themselves, their environment, and the future in a negative, pessimistic light. As a result, depressed people tend to misinterpret facts in negative ways and blame themselves for any misfortune that occurs. This negative thinking and judgment style functions as a negative bias; it makes it easy for depressed people to see situations as being much worse than they really are, and increases the risk that such people will develop depressive symptoms in response to stressful situations.

According to Dr. Aaron Beck, negative thoughts, generated by dysfunctional beliefs are typically the primary cause of depressive symptoms. A direct relationship occurs between the amount and severity of someone's negative thoughts and the severity of their depressive symptoms. In other words, the more negative thoughts you experience, the more depressed you will become.


Beck also asserts that there are three main dysfunctional belief themes (or "schemas") that dominate depressed people's thinking: 1) I am defective or inadequate, 2) All of my experiences result in defeats or failures, and 3) The future is hopeless. Together, these three themes are described as the Negative Cognitive Triad. When these beliefs are present in someone's cognition, depression is very likely to occur (if it has not already occurred).

Depression results from making internal/dispositional attributions (the self), seeing failure as permanent as opposed to temporary (the future) and generalising failures to other areas of life as opposed to seeing them as specific to the situation in which they occurred (the world). (Depressed= internal, global and stable; Non-depressed: external, specific and unstable).

An example of the negative cognitive triad themes will help illustrate how the process of becoming depressed works. Imagine that you have just been laid off from your work. If you are not in the grip of the negative cognitive triad, you might think that this event, while unfortunate, has more to do with the economic position of your employer than your own work performance. It might not occur to you at all to doubt yourself, or to think

The schematic organisation of the clinically depressed individual is dominated by an overwhelming negativity. A negative cognitive trait is evident in the depressed person’s view of the self, the world and the future... As a result of these negative, maladaptive schemas, the depressed person views

himself as inadequate, deprived and worthless, the world as presenting insurmountable obstacles and the future as utterly bleak and hopeless.


that this event means that you are washed up and might as well throw yourself down a well. If your thinking process was dominated by the negative cognitive triad, however, you would very likely conclude that your layoff was due to a personal failure; that you will always lose any job you might manage to get; and that your situation is hopeless. On the basis of these judgments, you will begin to feel depressed. In contrast, if you were not influenced by negative triad beliefs, you would not question your self-worth too much, and might respond to the lay off by dusting off your resume and initiating a job search.

Faulty information processing

Beck suggests that people with depression are also prone to distorting and misinterpreting information from the world. They are inclined to make overly negative and self-defeating interpretations that lead to low mood and passivity. Beyond the negative content of the dysfunctional thoughts, these beliefs can also warp and shape what someone pays attention to. Beck asserted that depressed people pay selective attention to aspects of their environments that confirm what they already know and do so even when evidence to the contrary is right in front of their noses. This failure to pay attention properly is known as faulty information processing.

Personalising

Seeing everything in terms of success or failure

Taking responsibility and blame for all unpleasant things that happen.

Black & White thinking

Drawing sweeping conclusions based on a single incident.

Think!

1. Using the information above and the diagram here, explain how other people’s representations of the world may not correspond to the internal representations of the word constructed by a person with depression

2. Going back to the example above of the girl who split up with her boyfriend and failed the stats test, assuming she was suffering with the pessimistic style of thinking described by Beck, give examples of information that she may have selectively attended to or selectively ignored which could help to maintain her negative view

Applying Beck’s terminology

Below is an excerpt from an interview with a depressed patient. Read the excerpt and do the following:

Identify features of this patient’s thinking that illustrate the depressed cognitive triad Choose two of the information processing biases explained above, and identify statements from the

interview that illustrate the biases. Choose two more of the information processing biases, and invent some statements of your own that


Particular failures of information processing are very characteristic of the depressed

mind. For example, depressed people will tend to demonstrate selective attention to information, which matches their negative expectations, and selective inattention to information that contradicts those expectations. Faced with a mostly positive performance review, depressed people will manage to find and focus in on the one negative comment that keeps the review from being perfect. They tend to magnify the importance and meaning placed on negative events, and minimize the importance and meaning of positive events. All of these manoeuvres, which happen quite unconsciously, function to help maintain a depressed person's core negative schemas in the face of contradictory evidence, and allow them to remain feeling hopeless about the future even when the evidence suggests that things will get better.

Silent assumptions

Beck believes that the inner life of depressed people is dominated by a set of assumptions that shape conscious cognitions. These assumptions derive ultimately from the messages we receive from parents, friends, teachers and other significant people (intentional or not; we infer them from the way these people talk and behave toward us). The silent assumptions play an important role in making people vulnerable to depression. Examples of silent assumptions: ‘I must get people’s approval’, ‘I must do things perfectly’, ‘I must always be valued by others’, ‘The world must be fair and just’. These types of belief are not particularly unusual. What makes depression-prone people different is the extent to which they subscribe to them.

Applying Beck’s terminology

Below is an excerpt from an interview with a depressed patient. Read the excerpt and do the following:

Identify features of this patient’s thinking that illustrate the depressed cognitive triad Choose two of the information processing biases explained above, and identify statements from the

interview that illustrate the biases. Choose two more of the information processing biases, and invent some statements of your own that


Over to you, discuss the following scenarios, one per pair and complete the table.

It’s Sofia’s birthday and she has been given a surprise invitation to meet her friends at lunchtime to celebrate. She is disappointed because her best friend didn’t turn up and has given no reason or apology.

It’s grade review at Sofia’s school and her tutor, Mrs Mui is going through her subject grades. Most are very good but her psychology mark is a bit lower than the others and Mrs Mui passes tells Sofia that her teacher has that she has missed a couple of deadlines this half term.

Sofia has been seeing a boy in her Maths class for a couple of weeks; they usually exchange texts daily but he has not texted her today and this is a bit unusual.


According to Beck’s theory what thought might Sofia have relating to each scenario, what emotions might these thoughts lead to and how might she react as a consequence.

If you were Sofia’s friend how might you try to change Sofia’s mind in each situation, complete the more rational/positive explanations in the end column and again think about how this might change the way Sofia feels and behaves as a consequence.

Irrational/negative Rational/positive

Situation 1: Birthday

Thoughts

Emotions

Behaviours

Situation 2: Grade review

Thoughts

Emotions

Behaviours

Situation 3: Relationship

Thoughts

Emotions

Behaviours

Evaluating cognitive explanations of depression

Supporting studiesRuiz-caballero and Gonzilez (1994)

Aim: To determine whether depressed Pps show a negative bias in terms of their explicit and implicit memory compared with non-depressed Pps.

Procedure:

32 women and 20 men divided into two groups of 26 based on Becks Depression Inventory scores. o Depressed (score of > 12) had a mean of 16.19 and non-

depressed (< 5) = 2.65). BDI was completed at end of memory part of study.

Pps saw two lists of 27 adjectives, 9 positive, 9 negative and 9 neutral matched for length (average 8 letters) and frequency of occurrence in Spanish.


Tested in groups of 6 to 10 and told “Your task is to study a list of words that will be presented to you.”

There were two groups: incidental learning (told they were doing a task about linguistic perceptual speed) and intentional learning

The incidental learning group were shown the 27 words randomly order in three columns and asked to count the vowels, then cross out letter in another set of words as a filler task - Pps were given 5minutes

In the intentional learning condition the Pps were told “Your task is to study a list of words that will be presented to you.”

Next Pps completed a word-stem completion test: list of the first 3 letters of the 54 of the words (27 were word-stems from the list studied in the study session and the other 27 word-stems were from the other list), typed in random order on three sheets of paper. Pps were told to complete the 54 word-stems with the first word that came to mind that began with those 3 letters. They were asked, not to use proper nouns or foreign words.

After this Pps performed an unrelated filler task to occupy them for another 5 minutes before the final free recall task where they had to write down “all the words they could remember from the learning task”. No time limit was set for this task.

Once this was done the BDI was administered.

Findings: The researchers found there was a three-way mood x priming x word type interaction, p < 0.05 meaning depressed Pps completed and recalled more words that were negative than positive.

Conclusions: This supports the idea that depressed people do retrieve information that is negative more than information that is positive showing that there is a difference in information processing for people who are depressed compared with people who are non-depressed.


The Temple-Wisconsin Cognitive Vulnerability to Depression (CVD) project.

Alloy et al (1999)Aim: to test the cognitive vulnerability and other etiological hypotheses of hopelessness and Beck's theories of depression for both depressive symptoms and clinically significant depressive episodes.

Procedure:

5378 university freshmen who were non-depressed (and no other mental health problems) were followed..

every 6 weeks for 2 years every 4 months for an additional 3 years

with self-report and structured interview assessments of stressful life events, cognitions, and symptoms and diagnosable episodes of psychopathology

instruments included.. the Cognitive Style Questionnaire to assess how people think

about positive and negative life events Dysfunctional Attitudes Scale

These scales measured cognitive vulnerabilities associated with Beck theory e.g. negative triad, and Alloy and Abramson’s hopelessness theory; coping stryles and social support

freshmen divided into `generic' high or low cognitive risk for depression

o those in the highest quartile (most negative) at phase 1 (stable, global, internal) = high-risk (HR) n=173

o those in the lowest quartile (most positive) = low-risk (LR) (unstable, specific, external) n=176

o across the two sites (Temple and Wisconsin) there was a good mix of white Caucasian and black Afro-American Pps from different socio-economic backgrounds.

At each follow up screening Pps were reassessed for life events, thinking styles and symptoms of hopeless depression (HD)

All assessment were conducetd by ‘blind’ researchers, i..e they didn’t know if the Pp was HR or LR.

Data about lifetime history of neglect and abuse experiences, parents' feedback styles and parenting behaviours were also collected

Pps parents also completed measures of their own cognitive styles (CSQ, DAS), symptoms, parenting, feedback styles and were directly interviewed

Findings:


HR group showed greater lifetime prevalence than the LR group of major depressive disorder (39% vs. 17%), minor depressive disorder (22% vs. 12%), HD (40% vs. 12%)

o i.e. double the rate of lifetime major depression than the LR group and triple the rate of HD.

o these HR/LR differences were specific to depressive disorders; no statistically significant differences in rates of anxiety, addictive or other Axis I disorders

In those with prior history of depression HR were more likely than LR to have another episode of depression.

Affectionless and controlling parenting and emotional abuse was correlated with cognitive vulnerability but physical and sexual abuse was not.

HR group were more likely to have depressive mothers than LR group (35 % v 18%. The findings was not so clear cut re fathers (18% v 12%).

Conclusions: These findings suggest that depressogenic cognitive styles may confer risk for full-blown, clinically significant depressive disorders and for HD, and that the risk may be specific to depression.

Strengths: They carefully ensured that prior history of depression did not contaminate their HR group, meaning it was a truly prospective study.

Questions: Can you think of any weaknesses relating to the research methods in this study?


Implication/hypotheses

Evidence Further commentary

People who are depressed should demonstrate noticeably different ways of thinking, including for example a negative view of self/low self esteem

Ruiz-Caballero and Gonzilez (1994)

This is only evidence for Beck’s theory if it is possible to demonstrate that the negative bias and/or faulty thinking preceded the onset of symptoms, i.e. it was a cause of depression rather than effect of depression.

Link to other approaches: Low levels of certain biochemicals could induce inability to concentrate, extract causal relationships, distortion, selective attention to inappropriate material etc.

Negative thinking strategies should precede the onset of symptoms, if negative thinking is cause of depression rather than an effect

Alloy et al. (1999)Studies suggests that negative thinking is a consequence of depression not a cause since people who have experienced depression but are not currently depressed do not show negative schemas or faulty thinking; but maybe when they are not depressed they are better at hiding their maladaptive thinking from other people; they recognise that it is irrational and so don't report it?

Lewinsohn (2001) longitudinal prospective study; assessed students tendency towards negative thinking at the start of their course; found that those with greatest negativity were most likely to become depressed in the 12 month duration of the study.

Refuted by Lewinsohn (1981) where those that became depressed were no more likely to subscribe to irrational beliefs, Have lowered expectancies for successful outcomes, have higher expectancies for unsuccessful outcomes, Attribute success to external causes or failure to internal causes; it was concluded that people who are vulnerable to depression are not characterised by stable patterns of negative cognitions.

As with the bio explanation of depression essay, you can use points about cognitive behavioural therapy see below, as the practical applications are strengths of the theory.


Some extra points you could include in your essay:

Individual differences

Recognises that faulty thinking strategies and negative schemas can result from differing childhood experiences, e.g. sociotropic personality: snub from family/friend might be a trigger; person craves social acceptance from others; autonomous personality: overruled by an authority figure; personal craves control

Gender differences

Notman and Nadelson (1995) suggest the theory can account for why women are 40% more likely to suffer from depression than men; they are socialised to play down their strengths, one could say they are taught to use a depressive attributional style.

Cultural differences

Can account for why depression is not so apparent in some collectivist cultures where the norm is to play down individual success and exhibit something more akin to Beck’s idea of a depressive attributional style; i.e. this way of thinking is adaptive and normal as opposed to maladaptive and abnormal. Western, individualist cultures reinforce the use of self serving bias, which heightens self esteem through celebrating and taking ownership of individual successes, thus when someone does not think in this way it is seen as abnormal.

Real world applications

Has inspired research which has led to development of effective therapies (CBT) which are easily administered and can even be offered by remote counselling over the internet! Excellent practical option for overstretched NHS with ever increasing prevalence of depression

Alternative factors which may cause depression

ignores the fact that real external factors could be causing depression; not just a person's perception of events; this seems to cast blame on sufferer for 'blowing things out of proportion'; Brown and Harris found that social factors such as lack of paid employment, two or more children under 5, early loss of mother and lack of close confiding relationship (best friend) were all correlated with depression.

It is possible that negative thinking causes biochemical changes in the brain which leads to the symptoms of depression

It is possible the negative thinking acts as a cognitive ‘diathesis’ (vulnerability factors predisposing depression) but that it is still requires an environmental life event to trigger an episode, (Brown and Harris 1978). This idea has been developed by Hankin and Abramson (2001) who have considered events such as sexual abuse or childhood separation/deprivation as triggers for negative biases in thinking.


Topic 3: Treatment of disordersLearning outcomes


Describe one or more biological and psychological treatments for MDD

Outline the APFC of two more studies in to the effectiveness of biological and psychological treatments

Evaluate biological and psychological treatments with reference to research evidence, practical and ethical implications and alternative treatments

Discuss the relationship between culture and treatment Outline two or more studies into culture and treatment

paper 2: abnormal – depression (ajw) · web viewpaper 2: abnormal – depression (ajw) 2019....

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