1. Explain what is meant by 'unipolar depression.
'
An affective disorder characterised by persistent low mood or lack of energy and hopelessness. Low
mood is long term. Periods of mania are not experienced.
2. Describe the Beck Depression Inventory.
21 item multiple choices questionnaire.
It is a psychometric self report that measures the severity of depression.
There are three versions of the questionnaire with the most recent from 1996.
The patient reads various statements and answers with how much the statement applies to them on
a 0-3 scale over the past two weeks.
The statements cover issues such as self-dislike, tiredness etc.
The higher the score, the more depressed the person is deemed to be.
e.g.
(0) I do not feel sad.
(1) I feel sad.
(2) I am sad all the time and I can't snap out of it,
(3) I am so sad or unhappy that I can't stand it.
Loathing:
(0) I don't feel disappointed in myself.
(1) I am disappointed in myself.
(2) I am disgusted with myself.
(3) I hate myself.
Results:
1-10: These ups and downs are considered normal.
11-16: Mild mood disturbance.
17-20: Borderline clinical depression.
21-30: Moderate depression.
31-40: Severe depression.
Over 40: Extreme depression.
Version 2-got rid of the statements that had the same scoring.
Version 3-Changed questions on body image, hypochondria and difficulty working and added in
questions on sleep loss and appetite.
BDI also has a kids version. It's more generalizable and applicable since it can be applied to a wider
range of ages.
It has high test-retest reliability. Correlation score of 0.93.
High concurrent validity ratings are given between the BDI and other depression instruments as the
Minnesota Multiphasic Personality Inventory and the Hamilton Depression Scale. 0.77 correlation
rating was calculated when compared with inventory and psychiatric ratings.
3. Describe two drug treatments for depression.
Tricyclics: increasing the brain's supply of norepinephrine and serotonin levels (by inhibiting their
reuptake by the pre-synaptic neurone).
MAOI (Monoamine Oxidase Inhibitor) slowing the natural breakdown of norepinephrine and
serotonin and dopamine (monoamines) by inhibiting the activity of the enzyme Monoamine Oxidase.
SSRI (Selective Serotonin Reuptake Inhibitor): Act on the levels of the neurotransmitter serotonin at
the synapse, preventing its breakdown and reuptake by the pre-synaptic neurone.
4. Explain one similarity and one difference between drug treatments for depression and cognitive
restructuring treatment for depression (Beck, 1979).
Similarities could include:
Both require professional (doctor to prescribe and psychologist to ‘teach’ CBT)
Both have research support for their success.
Both take some time to be effective (usually 4 weeks for SSRI)
Differences could include:
Individual needs to be motivated (and of certain personality type/insight) for cognitive treatment,
whereas individual needs relatively little motivation to take drug.
Drugs have side effects including dizziness, nausea, insomnia, constipation. No side effects with
cognitive treatment.
Patient more actively involved in cognitive restructuring but passive in drug therapy.
5. Explain what is meant by ‘learned helplessness’ (Seligman, 1988).
Learned helplessness is where an individual feels they do not have control over a situation because
they have had negative experiences of that situation in the past.
This gives the individual a sense of helplessness and can then lead to depression.
6. Explain two strengths of the Beck depression inventory.
strengths of assessing depression symptoms using quantitative data, strengths relating to
quantitative data such as can make comparisons between or within patients, do statistical tests,
draw graphs, etc.
three variations of the scale exist which shows the scale has been updated to take into account
changes to the diagnoses of depression
easy and quick to use to assess depression when the therapist/doctor has little time to do the
assessment
can be done by the patient on their own to assess their depression
quick insight into the patients feelings
can compare to previous scores as treatment progresses to see if patient is improving
7. Explain what is meant by ‘bipolar’ disorder.
Two strongly contrasting phases of mood.
Periods of severely elevated mood followed by periods of very low mood lasting for several weeks or
months.
8. Describe cognitive restructuring (Beck, 1979) as a treatment for depression.
This is where the patient participates in a number of therapy sessions over weeks and/or months to
alleviate their symptoms of depression.
As it is believed the depressive symptoms are due to faulty thinking the therapist will help the patient
to identify their faulty thinking and then correct these thinking patterns to more helpful ways of
viewing themselves, the world and the future.
Initially the patient and therapist will identify what the thinking patterns are and the patient will be
helped to come up with alternative thoughts.
The patient then goes away between sessions and practices these alternative thoughts which should
then lead to more helpful behaviours which will lead the patient to feel more hopeful and positive.
9. Explain one strength and one weakness of cognitive restructuring as a treatment for depression.
Likely strengths include:
Effectiveness of treatments – shown to be as effective as SSRIs for treating depression and give a
toolkit for patients to use in the future if the depressive symptoms return.
Treatment does not have any side effects like medication and the patient has learned techniques to
help with depression should they relapse in the future.
Can be inexpensive for the patient as could be offered for free in some countries.
Fairly quick compared to other therapies as around 6–8 sessions. Psychotherapy can take over a
year.
Empowering the patient – their free will is acknowledged and the patient is actively involved in their
treatment.
Likely weaknesses include:
Appropriateness of treatments as some patients will not want to discuss their personal problems with
a therapist. OR some patients may be so severely depressed they cannot engage with the therapy.
Cost of treatment. Therapist’s time must be paid for either by the patient or by the health service.
Therapists can charge £50–100 for a 50 minute session. This could lead to the patient feeling more
depressed if they suffer financial hardship paying for the treatment.
Time consuming. Takes 6–8 sessions but can be offered up to 12. Some therapists will have two
weeks between treatments so it could take almost six months to finish the therapy. For someone
who is very depressed and might engage in self-injurious behaviour waiting for the therapy to get to
the point where it is helpful might be dangerous.
Lots of effort/motivation required from the patient.
Patients may feel uncomfortable discussing their problems and may not be completely honest about
their thoughts and experiences.
10. Outline the cognitive explanation of depression (Beck, 1979).
Depression is due to faulty information processing in which the individual feels responsible for even
the most insignificant events.
For example, someone with depression may blame themselves for choosing the ‘wrong’ day for a
family outing because it rains.
11. Describe the study by Oruc et al. (1997) about a biological explanation for bipolar disorder.
42 participants (aged between 31 and 70; 25 f 17 m) with diagnosis of bipolar disorder from 2
psychiatric institutions in Croatia.
Control group of 40 (no history of mental illness), matched for sex and age.
Information collected from participants and their family members and diagnosis confirmed through
medical records.
DNA testing for polymorphisms in serotonin receptor 2c (5-HTR2c) and the serotonin transporter (5-
HTT) gene.
16/42 (38%) of experimental group had first degree relative with major affective disorder.
But no overall association found between genes and presence of bipolar disorder.
But when participants analysed separately by gender (as serotonin as a neurotransmitter is
understood to be sexually dimorphic), associations found for both polymorphisms in female
participants.
Suggests polymorphisms in these genes could be responsible for increased risk of bipolar disorder
in females
12. Explain two strengths of the study by Oruc et al.
Valid – as control group of 40 is used for comparison
Reliable – Information about incidence of bipolar disorder in family collected by more than one
means, increasing both reliability and validity
Objective – DNA valid as objective data and all results quantitative
Comprehensive – two different gene polymorphisms examined rather than just one to give larger
view of role of serotonin mechanisms
Useful – If increased susceptibility in females then some intervention could be employed early on to
reduce risk of development (but not necessary in males)
Ethical – confidentiality maintained and participants not put under any harm
The Beck depression inventory (BDI) includes 21 items, all of which are assessed on a four-point scale.
One of the items is ‘irritation’, as shown below. 0 I am no more irritated by things than I ever was. 1 I am
slightly more irritated now than usual. 2 I am quite annoyed or irritated a good deal of the time. 3 I feel
irritated all the time.
13. State two items from the BDI, other than ‘irritation’.
Q1 sad, Q2 future discouraged, Q3 feel like failure, Q4 no satisfaction/enjoyment, Q5 guilt, Q6
punished, Q7 disappointed, Q8 feeling worse/blame self, Q9 thoughts of killing self, Q10 crying.
Q12 lost interest, Q13 decision-making, Q14 look worse/unattractive, Q15 working well/push hard,
Q16 sleep, Q17 tiredness (fatigue), Q18 appetite, Q19 lost weight, Q20 health, Q21 lost interest in
sex.
14. Explain the theory on which the BDI is based.
Beck (1979) believes that people react differently to aversive stimuli because of the thought patterns
that they have built up throughout their lives.
Schemas (core beliefs) are formed in early life, and include self-blame schema and ineptness
schema. A person has negative automatic thoughts (NATs).
The negative cognitive triad, comprises unrealistically negative views about the self, the world and
the future.
15. Suggest how the reliability of the BDI could be assessed.
Reliability: test-retest (way of judging reliability by administering the same test to the same person on
two different occasions and comparing the result).
Reliability: split half (splitting a test in two halves and administering each half to the same person.
The two scores should match). Marks: 1 mark basic answer (e.g. identification of term)
16. Suggest how the validity of the BDI could be assessed.
Validity: concurrent validity – compared with an alternative measure.
Face validity – it looks like it measures depression.
Other types of validity, but not ecological validity.
17. Discuss the strengths and weaknesses of using self-report questionnaires to measure depression.
You should include a conclusion in your answer.
Strengths:
Asking people directly means that participants are given the opportunity to express their feelings and
explain their behaviour rather than the researcher trying to work out reasons for their behaviour from
other methods.
Relatively large numbers of participants can be done relatively easily. Questionnaires are easy to
replicate.
Data can be qualitative, but may also be quantitative depending on type of question.
Quantitative data (as used in this inventory) can be scored and compared to all other people
completing the questionnaire.
Weaknesses:
Some participants may provide socially desirable responses; not give truthful answers; respond to
demand characteristics.
Closed/fixed choice questions may force people into choosing answers that do not reflect their true
opinion and therefore may lower the validity.
Researchers have to be careful about use of leading questions; it could affect the validity of the data
collected.
18. Describe explanations of depression.
Genetic and neurochemical (Oruc et al., 1997):
Depression has a genetic basis. Oruc et al. found the participants in their study with bipolar disorder
– sixteen of the participants had at least one first degree relative who had a major affective disorder.
In addition, polymorphisms in the genes of the participants could be responsible for the increased
risk of developing bipolar disorder (just with the females in the sample). Also credit neurochemical
explanation (low levels of serotonin).
Cognitive (Beck, 1979)
Depression due to faulty processing of information. Created the cognitive triad (negative views about
the world, negative views about oneself and negative views about the future) which all influence
each other and can lead the depressed individual to spiral into lowering moods.
Learned helplessness/attributional style (Seligman, 1988)
Learned helplessness is where the depressed person has learned they are helpless in the
unpleasant situation they are currently living in and they no longer try to make their life/mood better.
19. Evaluate explanations of depression, including a discussion of practical applications.
Named issue – practical applications (with reference to explanations) – these approaches are useful
as therapy has been created to improve the lives of patients with depression based on the approach
(e.g. CBT, drug therapy). If the explanation is valid, then the application will be effective. However, if
the explanation is not valid/reductionist the treatment which is based on the explanation may not
work, may not fully work or may not work for everyone. For example, SSRIs do not work for
everyone. Some feel much better, whereas others feel worse. This could be because the
biochemical explanation is limited and therefore medication on its own will never be 100% effective
without treating the other causes of depression.
A range of other issues could be used for evaluation here. These include: • Generalisability • Nature
versus nurture debate with reference to the explanations • Comparisons of different explanations •
Reductionist nature of the explanations • Deterministic nature of the explanations • Evaluation of the
evidence to support the explanations.
20. Describe characteristics and measures of bipolar and related disorders.
Definitions and characteristics of abnormal affect:
Abnormal effect disorders are classified as ‘mood disorders’ in DSM-V. This is in contrast to brief
feelings of sadness/joy. Here, emotions are beyond the usual ups and downs experienced by all and
are amplified or enhanced, characterised by persistent negative or positive mood. Emotions may
include despair, emptiness, anger or euphoria. The extreme and persistent nature of these moods is
distinct from everyday experience. Disorders of abnormal affect significantly impair the individual’s
ability to function normally.
Types: depression (unipolar) and depression and mania (bipolar)
Unipolar depression, also known as major depressive disorder, or a depressive episode, includes
having a depressed mood for an extended period of time. This includes a lack of pleasure in most
activities, weight changes, changes in sleep patterns (sleeping too much (hypersomnia) or difficulty
in sleeping (insomnia), psychomotor agitation, fatigue, feelings of worthlessness and reduction in
ability to concentrate.
Bipolar disorder used to be known as manic depression. It is characterised by episodes of mania
that cannot be accounted for in a physical way. Mania may include feelings of euphoria, rage or
irritability. Behaviours associated with mania include racing thoughts or being easily distracted, over-
confidence, speaking quickly, and engaging in risky behaviours (gambling or promiscuity, for
example). Mania is one ‘pole’ of bipolarity. The other pole would be features of unipolar depression
(although this is not essential for diagnosis). There must also be some change in polarity for a
diagnosis of bipolar disorder to be made.
Measures: Beck depression inventory:
This is a psychometric test used by professionals to measure level of depression. It contains 21
items and is used in questionnaire form. Each item includes at least 4 statements, the person taking
the test must choose the one that best fits how they have been feeling during the past week or two
weeks, depending on the version being used. Examples of items include: Satisfaction 0 I get as
much satisfaction out of things as I used to 1 I don’t enjoy things the way I used to 2 I don’t get real
satisfaction out of anything anymore 3 I am dissatisfied and bored with everything Unhappiness 0 I
do not feel unhappy 1 I feel unhappy 2 I am unhappy 3 I am so unhappy that I can’t stand it. The
total score is used to indicate the severity of the depression with a score of 10 as minimum for
diagnosing mild depression, 19–29 for moderate depression, and a score of 30+ to indicate severe
depression. Scoring does differ between the different versions. The Beck Depression Inventory has
been revised twice since its initial introduction.
21. Evaluate characteristics and measures of bipolar and related disorders, including a discussion of
validity.
Named issue – validity – bipolar and related disorders include a variety of different symptoms and no
one key symptom is needed for diagnosis. DSM-V and ICD-10 do not ask for the same criteria or
longevity of symptoms. Two individuals with very different symptoms could both be diagnosed with
major depressive disorder. The reliance on self-report measures of depressed individuals (by
definition) may be invalid within potential exaggeration or minimalization of symptoms. Co-morbidity
could also call validity into question in terms of symptom overlap with, say, schizophrenia. However,
the Beck depression inventory has been used in one form or another for over 50 years and appears
to capture the essence of depression so is thought to have high validity.
Reliability • Usefulness • Reductionist • Co-morbidity • Gender bias
22. James has a mood (affective) disorder and has started to receive rational emotive behaviour therapy
(REBT). At the first session, James tells the therapist that he has been having problems at work. He
feels that he has nothing to contribute in his team. He also thinks that his manager does not like him
and this is causing him distress. Explain how REBT can help James with his distress.
During therapy James will be helped to identify the limiting beliefs he has about work that are
causing his distress. The therapist will help James to identify alternative thoughts by challenging/
disputing the limiting beliefs. For example, if James says his manager did not listen to his new ideas
at recent meeting because his manager doesn’t like him, the therapist will suggest his manager may
have been listening but just did not respond to James. James can learn to exchange the limiting
thought for this new more rational thought and feel less distress as he no longer thinks his manager
does not like him – the effect.
This follows the ABCDE model – activating agent, beliefs, consequences, dispute and effect. For full
marks there needs to be implicit reference to the D and E part of the ABCDE model and how this will
help James with his feelings about work.
23. Asha is a student at school who has been diagnosed with bipolar disorder. Explain how two
characteristics of this disorder might affect Asha at school.
Characteristics of the disorder include:
High mood phase symptoms – euphoria, increased activity/energy, racing/fast thoughts,
impulsiveness. Low mood phase symptoms – depressed mood, low energy/oversleeping, lack of
interest in normal activities. Other symptoms might include – weight change, sleep changes,
exhaustion.
Example: One of the characteristics of this disorder is a manic mood phase where the person has
racing/fast thoughts. Due to fast thoughts she will find it really difficult to concentrate during her
lessons and do her homework. Another characteristic of this disorder is lack of interest in normal
activities during the low mood phase. This could cause Asha to withdraw from social activities at
school and feel more depressed due to lack of social engagement. Asha will experience two strongly
contrasting phases – high mood (manic phase) followed by very low mood.
24. Explain one strength of the diagnostic guidelines of mood (affective) disorders.
the criteria (ICD-11) have been developed by experts in the field and are regularly updated. This
improves the validity of the guidelines.
they are holistic guidelines with many different types of mood disorders given. This will help the
patient to get a very precise diagnosis and treatment (e.g. bipolar, unipolar).
they are used in many countries around the world to diagnose mental health problems so have good
generalisability. Mood disorders can be diagnosed in a similar way across around the world.
Guidelines are objective and give a precise outline of the mood disorder and its symptoms.
Practitioners can use these guidelines to diagnose their patients with mood disorders based on the
symptoms described.
Example: The criteria (ICD-11) have been developed by experts in the field and are regularly
updated. This improves the validity of the guidelines as experts review the diagnostic criteria and
update them with new findings from research about mood disorders.
25. Describe the treatment and management of depression.
Biological: chemical/drugs (MAOI, SSRIs): MAOI – older antidepressants not frequently used today.
Inhibit monoamine oxidase. This is responsible for breaking down norepinephrine, serotonin and
dopamine. The other more common medication prescribed is selective serotonin reuptake inhibitors
(SSRIs). These can help improve depression by increasing the levels of serotonin in the brain. This
can occur in two ways as the SSRI will increase the amount of serotonin in the blood stream as well
as prevent it being reabsorbed and broken down once it crosses a synapse in the brain.
Electro-convulsive therapy: Involves passing electricity through the brain to induce a seizure. Can be
bilateral or unilateral. The electric current is applied once the patient has been sedated. The seizure
is monitored by the doctor and can last up to a minute. Patients may be given 6 to 12 sessions over
a number of weeks.
Cognitive restructuring (Beck, 1979): This is where the patient participates in a number of therapy
sessions over weeks and/or months to alleviate their symptoms of depression. As it is believed the
depressive symptoms are due to faulty thinking the therapist will help the patient to identify their
faulty thinking and then correct these thinking patterns to more helpful ways of viewing themselves,
the world and the future. Initially the patient and therapist will identify what the thinking patterns are,
and the patient will be helped to come up with alternative thoughts. The patient then goes away
between sessions and practices these alternative thoughts which should then lead to more helpful
behaviours.
Rational emotive behaviour therapy (Ellis, 1962): This follows the ABC model: Activating agent –
what is the behaviour and/or attitude of the patient towards events in their lives. Beliefs – what is the
belief of the patient toward the event. Cognitive – what types of thoughts does the patient have with
regard to the event. Ellis believes if a person has constant negative beliefs about events in their
lives, they are likely to suffer from depression. The goal of therapy is to identify the unhelpful
thoughts and replace them with more rational and constructive thoughts. The patient will go away
between sessions and practice developing more helpful thoughts about life experiences.
26. Evaluate the treatment and management of depression, including a discussion of ethics.
Named issue – Ethics – Candidates can consider both the ethics of the treatments (e.g. side effects,
cost, etc.) or the ethics of the research that investigates the treatment and management of
depression. For example, both the drug and ECT treatment have side effects that will be unpleasant
for the patient whereas the therapies have no side effects but may be too costly for a patient to afford
and therefore they are prevented from feeling better which is unethical. Or the ethics of research
where the participants experience side effects or not and/or whether there is a placebo group who is
not being given the treatment and therefore may not improve in terms of their depression and this is
unethical. Many studies offer the placebo/control condition the opportunity to have the treatment at a
later date which is more ethical.
Validity. • Application of psychology to everyday life (with reference to treatments). • Nature versus
nurture debate with reference to the various treatments. • Comparisons of different treatments. •
Reductionist/holistic nature of the treatments. • Deterministic nature of the treatments. •
Appropriateness of treatments (e.g. cost, time, side-effects). • Research support for effectiveness of
treatments. • Evaluation of research that shows support for effectiveness of treatments.
28. ‘In the future it will be a fact that the cause of depression is biological.’ To what extent do you agree
with this statement?
Explanations of depression: biological: genetic and neurochemical (Oruc et al., 1997)
For:
Research in genetics/DNA makes advances every day; only a matter of time before a gene for
depression is discovered.
Research currently supports genetic links: Oruc et al. (1998) 50% of first-degree relatives of people
with depression are significantly more likely to be depressed.
Research may identify specific chemicals/hormones triggering depression.
Against: • There is still insufficient evidence and that evidence is weak:
Oruc has only 50% and if it were ‘truly genetic’ it would be 100%.
There may be an underlying genetic link, but this only becomes active with interactions with the
environment.
Many studies show twins where one develops a disorder and the other does not because of
environmental influences such as peers.
The response of the body may be biological, and this may be due to a chemical imbalance, but the
cause of depression can also be an external event and that will never change.
30. ‘Medical techniques, such as drugs, can treat all patients with depression effectively.’ To what extent
do you agree with this statement? Use examples of research you have studied to support your
answer.
Syllabus: treatment and management of depression; biological: chemical/drugs (MAO, SSRIs).
For:
the use of drugs is quick and easy – simply swallow a pill and nothing else;
drugs can help by relieving the symptoms of depression;
drugs do work. Kahn et al. (1986) found benzodiazepines, for example, were more effective than a
placebo; • drugs do not need relaxation techniques, cognitive therapies or any other time-consuming
exercises;
Against:
drugs can remove the cause of depression (if the cause is biochemical), otherwise do not cure,
merely make the symptoms easier to live with;
drugs are addictive and so are not good for treating a person long-term;
drugs may be costly;
alternative cognitive-behavioural techniques can be used such as those by Beck and Ellis.
31. One drug treatment for depression is monoamine oxidase inhibitors (MAOIs). The effectiveness of
this treatment can be tested using randomised control trials. Explain how MAOIs work when treating
depression.
MAOIs inhibit the enzyme monoamine oxidase. This enzyme normally breaks down noradrenaline,
serotonin and dopamine, but if these neurotransmitters are not broken down, they stay at normal
high levels and so ‘reduce depression’.
32. Suggest how randomised control trials can be used to study the effectiveness of MAOIs.
Participants are randomly allocated to conditions of MAOI or control (equal chance of being in either
condition)
For example a participant has a 50/50 chance of being in an experimental (MAOI) group or a control
(non-receiving of MAOI) group.
33. Give one strength of a randomised control trial.
Researchers do not allocate participants to conditions so there is no bias.
Instead participants are allocated randomly by chance, so reducing extraneous variables.
34. Suggest one treatment for depression, other than MAOIs.
Electroconvulsive therapy. Muscle relaxant given; electricity applied bilaterally or unilaterally; patient
convulses (twitches because of muscle relaxant); Patient is unconscious, then wakes and recovers.
Beck et al. (1979) cognitive restructuring is a stage process, (i) explanation of therapy (ii)
identification of unpleasant emotions, (iii) the situations in which these occur and (iv) associated
negative automatic thoughts. (v) challenge the negative thoughts and (vi) replace them with positive
thoughts. (vii) challenge the underlying dysfunctional beliefs and (viii) therapy ends.
Rational emotive behaviour therapy. (REBT) Ellis focused on how illogical beliefs are maintained
through: A: an activating event, B: the belief held about A, C: the consequences – thoughts, feelings
or behaviours – resulting from A. RET therefore involves: D: disputing the irrational beliefs, E: the
effects of successful disruption of the irrational beliefs.
SSRIs: (e.g. Prozac) act on the neurotransmitter serotonin to stop it being reabsorbed and broken
down after it has crossed a synapse.
35. Discuss the strengths and weaknesses of using drugs to treat depression. You should include a
conclusion in your answer.
Strengths:
drugs easy to take; swallowing a pill.
drugs mean the patient is passive in their treatment (an advantage for many people).
drugs (MAOIs) inhibit production of neurochemicals associated with depression
Weaknesses:
drugs are addictive so should be short-term use only.
drugs may not be taken as prescribed (non-adherence).
drugs ignore the role of alternative cuases of depression (treat symptom, not cause).
36. Depression can be treated with medical treatments and it can be managed with psychological
treatments. Medical treatments include the use of electro-convulsive therapy (ECT) and
chemical/drug treatments. Depression can also be treated psychologically. Outline the procedure of
ECT for depression.
muscle relaxant given.
electricity applied bilaterally or unilaterally.
patient convulses (twitches because of muscle relaxant).
patient is unconscious, then wakes and recovers.
37. Explain one chemical/drug treatment for depression.
MAOIs inhibit the enzyme monoamine oxidase.
This enzyme normally breaks down noradrenaline, serotonin and dopamine, but these
neurotransmitters are not broken down, they stay at normal high levels and so ‘reduce depression’.
SSRIs prevent serotonin from being reabsorbed and broken down after crossing a synapse.
38. Suggest one weakness of this chemical/drug treatment for depression.
side effects: hypertension, dizziness, nausea, fatigue, headaches, insomnia.
drugs have to be taken according to a treatment program for example they have to be taken twice
per day, every day or the depression returns.
drugs are addictive which may occur after 3 or 4 weeks and withdrawal symptoms may be worse
that initial depression.
39. Outline two psychological treatments for depression.
Beck et al. (1979) cognitive restructuring is a stage process, (i) explanation of therapy (ii)
identification of unpleasant emotions, (iii) the situations in which these occur and (iv) associated
negative automatic thoughts. (v) challenge the negative thoughts and (vi) replace them with positive
thoughts. (vii) challenge the underlying dysfunctional beliefs and (viii) therapy ends.
Rational emotive behaviour therapy. (REBT) Ellis focused on how illogical beliefs are maintained
through: A: an activating event, B: the belief held about A, C: the consequences – thoughts, feelings
or behaviours – resulting from A. RET therefore involves: D: disputing the irrational beliefs, E: the
effects of successful disruption of the irrational beliefs.
40. Discuss the strengths and weaknesses of using ECT for the treatment of depression. You should
include a conclusion in your answer.
Strengths:
it is a medical treatment, prescribed by and applied by medical doctors.
it is necessary for patients where all other medications have not worked.
it successfully treats many patients both with schizophrenia and depression.
Weaknesses:
how ECT works still isn’t known.
ECT can be given to a person without their consent (they are not ‘of sound mind’).
ECT has side-effects, both long and short term. Can include: loss of memory (temporary or worse)
aspects of short-term or long-term memory. In people with other conditions it may affect the central
nervous system and cardiovascular system
41. Describe explanations of depression.
Genetic and neurochemical (Oruc et al., 1997): Depression has a genetic basis. Oruc et al. found the
participants in their study with bipolar disorder – sixteen of the participants had at least one first
degree relative who had a major affective disorder. In addition, polymorphisms in the genes of the
participants could be responsible for the increased risk of developing bipolar disorder (just with the
females in the sample). Also credit neurochemical explanation (low levels of serotonin).
Cognitive (Beck, 1979): Depression due to faulty processing of information. Created the cognitive
triad (negative views about the world, negative views about oneself and negative views about the
future) which all influence each other and can lead the depressed individual to spiral into lowering
moods.
Learned helplessness / attributional style (Seligman, 1988): Attributional Style Questionnaire given to
39 unipolar depressed patients at the beginning and end of cognitive therapy and also after a one
year follow-up. Also gave this to 12 bipolar patients during a depressed episode. Found a pessimistic
explanatory style for bad events correlated with severity of depression. As therapy progressed
depression reduced as the explanatory style became less pessimistic. This continued to remain
improved at the one-year follow-up. Learned helplessness is where the depressed person has
learned they are helpless in the unpleasant situation they are currently living in and they no longer
try to make their life/mood better
42. Evaluate explanations of depression, including a discussion about reductionism versus holism.
Named issue – Reductionism versus holism – the genetic/neurochemical explanation is more
reductionist as it suggests depression has a genetic/biochemical cause and does not explain any
other causes. Not everyone who has a first degree relative with depression will develop it and
therefore other explanations could also explain the development of depression. The cognitive
explanation is more holistic as it considers complex thought processes involved in the development
of depression, however it could be considered to be somewhat reductionist as it ignores learning
depression and/or genetic factors. Learned helplessness is also more holistic than
genetic/neurochemical explanations as it looks at the more complex process of learning depression
from life experiences. However, it could also be considered to be environmentally reductionist as it
does not consider genetic/neurochemical causes.
Nature versus nurture debate with reference to the various explanations. Comparisons of different
explanations Application of psychology to everyday life (with reference to explanations)
Deterministic nature of the explanations Evidence to support the explanations (and an evaluation
of this evidence)
43. Identify two characteristics of bipolar disorder.
Two strongly contrasting phases – high mood (manic phase) followed by very low mood. High mood
phase symptoms – euphoria, increased activity/energy, racing thoughts, impulsiveness. Low mood
phase symptoms – depressed mood, low energy/oversleeping, lack of interest in normal activities.
44. Describe rational emotive behaviour therapy (REBT) as a treatment for depression (Ellis, 1962).
This follows the ABC model. Activating agent – what is the behaviour and/or attitude of the patient
towards events in their lives. Beliefs – what is the belief of the patient toward the event.
Consequence – behavioural response in relation to the belief about the event. Ellis believes if a
person has constant negative beliefs about events in their lives, they are likely to suffer from
depression. The goal of therapy is to identify the unhelpful thoughts and replace them with more
rational and constructive thoughts. The patient will go away between sessions and practice
developing more helpful thoughts about life experiences and the depression symptoms should
improve.
