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Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7Slides & Handouts by Karen Clay Rhines, Ph.D.
1
Chapter 7Chapter 7
Mood DisordersMood Disorders
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Mood DisordersMood Disorders
Two key emotions on a continuum:
Depression Low, sad state in which life seems dark and
overwhelming
Mania State of breathless euphoria or frenzied energy
Depression Mania
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Mood DisordersMood Disorders
Most people with a mood disorder experience only depression This pattern is called unipolar depression
Person has no history of mania Mood returns to normal when depression lifts
Some people experience periods of depression that alternate with periods of mania This pattern is called bipolar disorder
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Mood DisordersMood Disorders
These disorders have always captured people’s interest Millions of people have mood disorders
Economic costs of mood disorders amount to more than $80 billion each year
Human suffering is incalculable
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Unipolar DepressionUnipolar Depression
The term “depression” is often used to describe general sadness or unhappiness This usage confuses a normal mood
swing with a clinical syndrome
Clinical depression can bring severe and long-lasting psychological pain that may intensify over time
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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How Common Is How Common Is Unipolar Depression?Unipolar Depression?
About 7% of the U.S. population experiences severe unipolar depression in any given year As many as 5% experience mild depression
The prevalence is similar in Canada, England, France, and many other countries
Approximately 17% of all adults experience unipolar depression at some time in their lives Rates have been steadily increasing since 1915
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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How Common Is How Common Is Unipolar Depression?Unipolar Depression?
In almost all countries, women are twice as likely as men to experience severe unipolar depression Lifetime prevalence: 26% of women vs. 12% of men
These rates hold true across socioeconomic classes and ethnic groups
Approximately 50% recover within six weeks, some without treatment Most will experience another episode at some point
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Symptoms What Are the Symptoms of Depression?of Depression?
Symptoms may differ from person to person
Five main areas of functioning may be affected: Emotional symptoms
Feeling “miserable,” “empty,” “humiliated”
Experiencing little pleasure
Motivational symptoms Lacking drive, initiative, spontaneity
Between 6% and 15% of those with severe depression commit suicide
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Symptoms What Are the Symptoms of Unipolar Depression?of Unipolar Depression?
Five main areas of functioning may be affected: Behavioral symptoms
Less active, less productive
Cognitive symptoms Hold negative views of themselves
Blame themselves for unfortunate events
Pessimism
Physical symptoms Headaches, dizzy spells, general pain
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Diagnosing Unipolar Diagnosing Unipolar DepressionDepression
Criteria 1: Major depressive episode Marked by five or more symptoms
lasting two or more weeks In extreme cases, symptoms are psychotic,
including Hallucinations
Delusions
Criteria 2: No history of mania
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Diagnosing Unipolar Diagnosing Unipolar DepressionDepression
Two diagnoses to consider: Major depressive disorder
Criteria 1 and 2 are met
Dysthymic disorder Symptoms are “mild but chronic”
Depression is longer lasting but less disabling
Consistent symptoms for at least two years
When dysthymic disorder leads to major depressive disorder, the sequence is called “double depression”
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Causes Unipolar What Causes Unipolar Depression?Depression?
Stress may be a trigger for depression People with depression experience a greater
number of stressful life events during the month just prior to the onset of their symptoms
Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors
The utility of this distinction is questionable and today’s clinicians usually concentrate on recognizing the situational and the internal aspects of any given case
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Causes Unipolar What Causes Unipolar Depression?Depression?
The Biological ViewThe Biological View Genetic factors
Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a predisposition
Researchers have found that as many as 20% of relatives of those with depression are themselves depressed, compared with fewer than 10% of the general population
Twin studies demonstrate a strong genetic component: Rates for identical (MZ) twins = 46% Rates for fraternal (DZ) twins = 20%
Molecular biology studies also have implicated a genetic factor in many cases of unipolar depression
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Causes Unipolar What Causes Unipolar Depression?Depression?
The Biological ViewThe Biological View Biochemical factors
NTs: serotonin and norepinephrine In the 1950s, medications for high blood pressure
were found to cause depression Some lowered serotonin, others lowered
norepinephrine
This led to the “discovery” of effective antidepressant medications which relieved depression by increasing either serotonin or norepinephrine
Depression likely involves not just serotonin nor norepinephrine… a complex interaction is at work, and other NTs may be involved
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Causes Unipolar What Causes Unipolar Depression?Depression?
The Biological ViewThe Biological View Biochemical factors
Endocrine system / hormone release People with depression have been found to
have abnormal levels of cortisol Released by the adrenal glands during times of stress
People with depression have been found to have abnormal melatonin secretion
“Dracula hormone”
Other researchers are investigating whether deficiencies of important proteins within neurons are tied to depression
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Causes Unipolar What Causes Unipolar Depression?Depression?
The Biological ViewThe Biological View Biochemical factors
Model has produced enthusiasm but has significant limitations:
Relies on analogue studies: depression-like symptoms created in lab animals
Do these symptoms correlate with human emotions?
Measuring brain activity has been difficult Current studies using modern technology are
attempting to address this issue
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Biological treatments can bring great
relief to people with unipolar depression
Usually biological treatment means antidepressant drugs, but for severely depressed persons who do not respond to other forms of treatment, it sometimes includes electroconvulsive therapy
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Electroconvulsive therapy (ECT)
The use of ECT was -- and is -- controversial It is now used frequently but only in severe cases
The procedure consists of targeted electrical stimulation to cause a brain seizure
The usual course of treatment is 6 to 12 sessions spaced over two to four weeks
Treatment may be bilateral or unilateral
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Electroconvulsive therapy (ECT)
The discovery of the effectiveness of ECT was accidental and based on a fallacious link between psychosis and epilepsy
The procedure has been modified in recent years to reduce some of the negative effects
For example, patients are given muscle relaxants and anesthetics before and during the procedure
Patients generally report some memory loss
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Electroconvulsive therapy (ECT)
ECT is clearly effective in treating unipolar depression
Studies find improvement in 60%–70% of patients
The procedure seems particularly effective in cases of severe depression with delusions, but it has been difficult to determine why ECT works so well
Although effective, the use of ECT has declined since the 1950s, because of the memory loss caused by the procedure and the emergence of effective antidepressant drugs
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Antidepressant drugs
In the 1950s, two kinds of drugs were found to be effective:
Monoamine oxidase inhibitors (MAO inhibitors)
Tricyclics
These drugs have been joined in recent years by a third group, the second-generation antidepressants
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Antidepressant drugs: MAO inhibitors
Originally used to treat TB, doctors noticed that the medication seemed to make patients happier
The drug works biochemically by slowing down the body’s production of MAO
MAO breaks down norepinephrine
MAO inhibitors stop this breakdown from occurring
This leads to a rise in norepinephrine activity and a reduction in depressive symptoms
About half the patients who take these drugs are helped by them
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Antidepressant drugs: MAO
inhibitors MAO inhibitors potentially pose a
serious danger! Blood pressure may rise to a potentially
fatal level if one eats foods with tyramine (cheese, bananas, wine) while taking MAO inhibitors
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Antidepressant drugs: Tricyclics
In searching for medications for schizophrenia, researchers discovered that imipramine lessened depressive symptoms
Imipramine and related drugs are known as tricyclics because they share a three-ring molecular structure
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Antidepressant drugs: Tricyclics
Hundreds of studies have found that depressed patients taking tricyclics have improved much more than similar patients taking placebos
About 60%–65% of patients find symptom improvement
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Antidepressant drugs: Tricyclics
Most patients who immediately stop taking tricyclics upon relief of symptoms relapse within one year
Patients who take tricyclics for five additional months (“continuation therapy”) have a significantly decreased risk of relapse
As a result, clinicians often keep their patients on the drugs indefinitely
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Antidepressant drugs: Tricyclics
Tricyclics are believed to reduce depression by affecting neurotransmitter (NT) reuptake
To prevent an NT from remaining in the synapse too long, a pumplike mechanism recaptures the NT and draws it back into the presynaptic neuron
The reuptake process appears to be too effective in some people, drawing in too much of the NT from the synapse
This reduction in NT activity in the synapse is thought to result in clinical depression
Tricyclics block the reuptake process, thus increasing NT activity in the synapse
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Second-generation antidepressant drugs
A third group of effective antidepressant drugs is structurally different from the MAO inhibitors and tricyclics
Most of the drugs in this group are labeled selective serotonin reuptake inhibitors (SSRIs)
These drugs act only on serotonin (no other NTs are affected)
This class includes fluoxetine (Prozac) and sertraline (Zoloft)
Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar
Depression?Depression? Second-generation antidepressant drugs
The effectiveness and speed of action of these drugs is on par with the tricyclics yet they boast enormous sales
Clinicians often prefer these drugs because it is harder to overdose on them than on other kinds of antidepressants
There are no dietary restrictions like there are with MAO inhibitors
There have fewer side effects than the tricyclics
These drugs may cause some undesired effects of their own, including a reduction in sex drive
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar Depression Unipolar Depression
Three main models: Psychodynamic model
Not strongly supported by research
Behavioral model Modestly supported by research
Cognitive model Has considerable research support
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Psychodynamic view Link between depression and grief
When a loved one dies, the mourner regresses to the oral stage
For most people, grief is temporary
If grief is severe and long-lasting, depression results
Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression
Some people experience “symbolic” (not actual) loss
Newer psychoanalysts focus on relationships with others (object relations theorists)
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Psychodynamic view Strengths:
Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss
Research supports the theory that early losses set the stage for later depression
Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after suffering a loss
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Psychodynamic view
Limitations: Early losses don’t inevitably lead to
depression May not be typically responsible for development
of depression
Many research findings are inconsistent
Theory is largely untestable because of its reliance on unconscious processes
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Psychodynamic therapy Psychodynamic therapists use the same
basic procedures for all psychological disorders:
Free association
Therapist interpretation
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Psychodynamic therapy Despite successful case reports, researchers have
found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression
Two features may be particularly limiting: Depressed clients may be too passive or weary to fully
participate in clinical discussions Depressed clients may become discouraged and end
treatment too early when treatment doesn’t provide fast relief
Short-term approaches have performed better than traditional approaches
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Behavioral view Depression results from changes in rewards
and punishments people receive in their lives
As life changes, we experience a change (loss) of rewards
Research by Lewinsohn supports the relationship between the number of rewards received and the presence or absence of depression
Social rewards are especially important
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Treatments for Unipolar Treatments for Unipolar Depression: Psychological Depression: Psychological
ApproachesApproaches Behavioral therapy
Lewinsohn developed a behavioral therapy for unipolar depression:
Reintroduce clients to pleasurable activities and events, often using a weekly schedule
Appropriately reinforce their depressive and nondepressive behaviors
Use a contingency management approach
Help them improve their social skills
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Treatments for Unipolar Treatments for Unipolar Depression: Psychological Depression: Psychological
ApproachesApproaches Behavioral therapy
The behavioral techniques seem to be of only limited help when just one of them is applied
When treatment programs combine two or three of the techniques, as Lewinsohn had envisioned, depressive symptoms (especially mild symptoms) seem to be reduced
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Two main theories:
Learned helplessness
Negative thinking
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Learned helplessness
Theory holds that people become depressed when they think that:
They no longer have control over the reinforcements in their lives
They themselves are responsible for this helpless state
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Learned helplessness
Theory is based on Seligman’s work with laboratory dogs
Dogs subjected to uncontrollable shock were later placed in a shuttle box
Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so
Seligman theorized that the dogs had “learned” to be “helpless” and drew parallels to human depression
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Learned helplessness
There has been significant research support for this model
Human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials
Animal subjects lose interest in sex and social activities
In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Learned helplessness
Recent versions of the theory focus on attributions Internal attributions that are global and stable lead to
greater feelings of helplessness and possibly depression Example: “It’s all my fault [internal]. I ruin everything
I touch [global] and I always will [stable]” If people make other kinds of attributions, this reaction is
unlikely Example: “The way I’ve behaved the past couple of
weeks blew this relationship [specific], I don’t know what got into me – I don’t usually act like that [unstable], and she never did know what she wanted [external]”
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Learned helplessness
Some theorists have refined the helplessness model yet again in recent years; they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Learned helplessness
Strengths: Hundreds of studies have supported the relationship
between styles of attribution, helplessness, and depression
Limitations: Laboratory helplessness does not parallel depression in
every way Much of the research relies on animal subjects The attributional component of the theory raises
particularly difficult questions in terms of animal models of depression
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Negative thinking
According to Beck, four interrelated cognitive components combine to produce unipolar depression:
1. Maladaptive attitudes
Self-defeating attitudes are developed during childhood
Beck suggests that upsetting situations later in life can trigger further rounds of negative thinking
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views
2. This negative thinking often takes three forms, called the cognitive triad: Individuals repeatedly interpret (1) their
experiences, (2) themselves, and (3) their futures in negative ways, leading to depression
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Negative thinking
3. Depressed people also make errors in their thinking, including: Arbitrary inferences
Minimization of the positive and magnification of the negative
4. Depressed people experience automatic thoughts A steady train of unpleasant thoughts that suggest
inadequacy and hopelessness
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive views Strengths:
There is significant research support for Beck’s model:
High correlation between the level of depression and the number of maladaptive attitudes
Both the cognitive triad and errors in logic are seen in people with depression
Automatic thinking has been linked to depression
Limitations: Research fails to show that such cognitive patterns
are the cause and core of unipolar depression
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive therapy Beck’s cognitive therapy – the leading
cognitive treatment for unipolar depression – is designed to help clients recognize and change their negative cognitive processes
This approach follows four phases and usually lasts fewer than 20 sessions
Phases:1. Increasing activities and elevate mood
2. Challenging automatic thoughts
3. Identifying negative thinking and biases
4. Changing primary attitudes
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression
Cognitive therapy Over the past three decades, hundreds
of studies have shown that cognitive therapy helps unipolar depression
Around 50%–60% of clients show a near-total elimination of symptoms
This treatment has also been used in a group therapy format
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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The Sociocultural Model of The Sociocultural Model of Unipolar DepressionUnipolar Depression
Sociocultural theorists propose that unipolar depression is greatly influenced by the social structure in which people live This belief is supported by the finding that
depression is often triggered by outside stressors
Researchers have also found links between depression and culture, gender, race, and social support
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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The Sociocultural Model of The Sociocultural Model of Unipolar DepressionUnipolar Depression
How are culture and depression related? Depression is a worldwide phenomena,
but the experience of symptoms differs from culture to culture
For example, non-Westerners report more physical (rather than psychological) symptoms
As cultures become more Western, symptoms shift
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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The Sociocultural Model of The Sociocultural Model of Unipolar DepressionUnipolar Depression
How do gender and race relate to depression? Rates of depression are much higher among women than
men One sociocultural theory holds that the complexity of
women’s roles in society leaves them particularly prone to depression
Few differences have been seen overall among Caucasians, African Americans, and Hispanic Americans, but striking differences exist in specific subcultures:
In a study of one Native American village, lifetime risk was 37% among women, 19% among men, and 28% overall
These findings are thought to be the result of economic and social pressures
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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The Sociocultural Model of The Sociocultural Model of Unipolar DepressionUnipolar Depression
How does social support relate to depression? The availability of social support seems to
influence the likelihood of depression Rates of depression vary based on marital status
Interpersonal conflict may be a factor
Isolation and lack of intimacy also are key factors
Research shows that depressed people who lack social support remain depressed longer than those who have a supportive spouse or warm friendships
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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The Sociocultural Model of The Sociocultural Model of Unipolar DepressionUnipolar Depression
The most effective sociocultural approaches to treating unipolar depression are interpersonal psychotherapy and couple therapy The techniques used in these
approaches borrow from other models
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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The Sociocultural Model of The Sociocultural Model of Unipolar DepressionUnipolar Depression
Interpersonal therapy (IPT) This model holds that four interpersonal
problems may lead to depression and must be addressed:
Interpersonal loss Interpersonal role dispute Interpersonal role transition Interpersonal deficits
Studies suggest that IPT is as effective as cognitive therapy for treating depression
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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The Sociocultural Model of The Sociocultural Model of Unipolar DepressionUnipolar Depression
Couple therapy The main type of couple therapy is
behavioral marital therapy (BMT) Focus is on developing specific
communication and problem-solving skills
If marriage is conflictual, BMT is as effective as other therapies for reducing depression
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Bipolar DisordersBipolar Disorders
People with a bipolar disorder experience both the lows of depression and the highs of mania They describe their life as an emotional
roller coaster
Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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What Are the Symptoms What Are the Symptoms of Mania?of Mania?
Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood
Five main areas of functioning may be affected:
1. Emotional symptoms Active, powerful emotions in search of outlet
2. Motivational symptoms Need for constant excitement, involvement,
companionship
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What Are the Symptoms What Are the Symptoms of Mania?of Mania?
Five main areas of functioning may be affected:
3. Behavioral symptoms Very active – move quickly; talk loudly or rapidly
Key word: flamboyance!
4. Cognitive symptoms Show poor judgment or planning
Especially prone to poor (or no) planning
5. Physical symptoms High energy level – often in the presence of little or no
rest
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Diagnosing Bipolar Diagnosing Bipolar DisordersDisorders
Criteria 1: Manic episode Three or more symptoms of mania
lasting one week or more In extreme cases, symptoms are psychotic
Criteria 2: History of mania If currently experiencing hypomania or
depression
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Diagnosing Bipolar Diagnosing Bipolar DisordersDisorders
DSM-IV-TR distinguishes between two kinds of bipolar disorder: Bipolar I disorder
Full manic and major depressive episodes
Most sufferers experience an alternation of episodes
Some experience mixed episodes
Bipolar II disorder Hypomanic episodes and major depressive
episodes
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Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 7
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Diagnosing Bipolar Diagnosing Bipolar DisordersDisorders
Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder
Regardless of particular pattern, individuals with bipolar disorder tend to experience depression more than mania over the years
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Diagnosing Bipolar Diagnosing Bipolar DisordersDisorders
Between 1% and 2.6% of adults in the world suffer from a bipolar disorder at any given time
The disorders are equally common in women and men Women may experience more
depressive episodes and fewer manic episodes than men
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Diagnosing Bipolar Diagnosing Bipolar DisordersDisorders
The prevalence of the disorders is the same across socioeconomic classes and ethnic groups
Onset usually occurs between 15 and 44 years of age
In most cases, the manic and depressive episodes eventually subside, only to recur at a later time
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Diagnosing Bipolar Diagnosing Bipolar DisordersDisorders
A final diagnostic option: If a person experiences numerous
episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is appropriate
Mild symptoms for two or more years, interrupted by periods of normal mood
Affects 0.4% of the population
May blossom into bipolar I or II disorder
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What Causes Bipolar What Causes Bipolar Disorders?Disorders?
Throughout the first half of the 20th century, the search for the cause of bipolar disorders made little progress
More recently, biological research has produced some promising clues New insights have come from research
into NT activity, ion activity, brain structure, and genetic factors
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What Causes Bipolar What Causes Bipolar Disorders?Disorders?
Neurotransmitters After finding a relationship between low
norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania
This theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine
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What Causes Bipolar What Causes Bipolar Disorders?Disorders?
Neurotransmitters Because serotonin activity often
parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity
Although no relationship with HIGH serotonin has been found, bipolar disorder may be linked to LOW serotonin activity, which seems contradictory…
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What Causes Bipolar What Causes Bipolar Disorders?Disorders?
Neurotransmitters This apparent contradiction is addressed
by the “permissive theory” about mood disorders:
Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take:
Low serotonin + Low norepinephrine = Depression
Low serotonin + High norepinephrine = Mania
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What Causes Bipolar What Causes Bipolar Disorders?Disorders?
Ion activity Ions, which are needed to send incoming
messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder
This improper transport may cause neurons to fire too easily (mania) or to resist firing (depression)
There is some research support for this theory
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What Causes Bipolar What Causes Bipolar Disorders?Disorders?
Brain structure Brain imaging studies have identified a
number of abnormal brain structures in people with bipolar disorder; in particular, the basal ganglia and cerebellum among others
It is not clear what role such structural abnormalities play
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What Causes Bipolar What Causes Bipolar Disorders?Disorders?
Genetic factors Many experts believe that people inherit a
biological predisposition to develop bipolar disorders
Family pedigree studies support this theory; when one twin or sibling has bipolar disorder, the likelihood for the other twin or sibling increases:
Identical (MZ) twins = 40% likelihood
Fraternal (DZ) twins and siblings = 5% to 10% likelihood
General population = 1% to 2.6% likelihood
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What Causes Bipolar What Causes Bipolar Disorders?Disorders?
Genetic factors Recently, genetic linkage studies have
examined the possibility of “faulty” genes Other researchers are using techniques
from molecular biology to further examine genetic patterns
Such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders
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What Are the Treatments What Are the Treatments for Bipolar Disorders?for Bipolar Disorders?
Until the latter part of the 20th century, people with bipolar disorders were destined to spend their lives on an emotional roller coaster Psychotherapists reported almost no success Antidepressant drugs were of limited help
These drugs sometimes triggered manic episodes
ECT only occasionally relieved either the depressive or the manic episodes of bipolar disorder
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The use of lithium, a metallic element occurring as mineral salt, has dramatically changed this picture It is extraordinarily effective in treating
bipolar disorders and mania Determining the correct dosage for a
given patient is a delicate process Too low = no effect Too high = lithium intoxication (poisoning)
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Lithium provides improvement for more than 60% of patients with mania Most patients also experience fewer new
episodes while on the drug
Lithium also is a prophylactic drug, one that actually prevents symptoms from developing
Lithium also helps those with bipolar disorder overcome their depressive episodes
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What Are the Treatments What Are the Treatments for Bipolar Disorders?for Bipolar Disorders?
Researchers do not fully understand how lithium operates They suspect that it changes synaptic activity
in neurons, but in a different way than antidepressant drugs
Although antidepressant drugs affect a neuron’s initial reception on NTs, lithium seems to affect a neuron’s second messengers
Another theory is that lithium corrects bipolar functioning by directly changing sodium and potassium ion activity in neurons
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What Are the Treatments What Are the Treatments for Bipolar Disorders?for Bipolar Disorders?
Psychotherapy alone is rarely helpful for persons with bipolar disorder
Lithium therapy alone is also not always sufficient, either 30% or more of patients don’t respond, may not
receive the correct dose, or may relapse while taking it
As a result, clinicians often use psychotherapy as an adjunct to lithium (or other medication-based) therapy
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Therapy focuses on medication management, social skills, and relationship issues
Few controlled studies have tested the effectiveness of such adjunctive therapy Growing research suggests that it helps
reduce hospitalization, improve social functioning, and increase clients’ ability to obtain and hold a job