Abnorm Hand Out Ch07

11Comer, Comer, Fundamentals of Abnormal PsychologyFundamentals of Abnormal Psychology, 5e – Chapter 7, 5e – Chapter 7Slides & Handouts by Karen Clay Rhines, Ph.D.Slides & Handouts by Karen Clay Rhines, Ph.D.

Chapter 7 Chapter 7 HandoutsHandouts

Mood DisordersMood Disorders

2Comer, Comer, Fundamentals of Abnormal PsychologyFundamentals of Abnormal Psychology, 5e – Chapter 7, 5e – Chapter 7


Two key emotions on a continuum:Two key emotions on a continuum:

DepressionDepression Low, sad state in which life seems dark and Low, sad state in which life seems dark and

overwhelmingoverwhelming

ManiaMania State of breathless euphoria or frenzied energyState of breathless euphoria or frenzied energy

Depression Mania



Most people with a mood disorder Most people with a mood disorder experience only depressionexperience only depression This pattern is called ____________________This pattern is called ____________________

Person has no history of mania Person has no history of mania Mood returns to normal when depression liftsMood returns to normal when depression lifts

Some people experience periods of Some people experience periods of depression that alternate with periods depression that alternate with periods of maniaof mania This pattern is called ______________________This pattern is called ______________________



These disorders have always These disorders have always captured people’s interestcaptured people’s interest Millions of people have mood disordersMillions of people have mood disorders

Economic costs of mood disorders Economic costs of mood disorders amount to more than $80 billion each amount to more than $80 billion each yearyear

Human suffering is incalculableHuman suffering is incalculable


Unipolar DepressionUnipolar Depression

The term “depression” is often used The term “depression” is often used to describe general sadness or to describe general sadness or unhappinessunhappiness This usage confuses a normal mood This usage confuses a normal mood

swing with a clinical syndromeswing with a clinical syndrome

Clinical depression can bring severe Clinical depression can bring severe and long-lasting psychological pain and long-lasting psychological pain that may intensify over timethat may intensify over time


How Common Is How Common Is Unipolar Depression?Unipolar Depression?

About 7% of the U.S. population experiences About 7% of the U.S. population experiences severe unipolar depression each year severe unipolar depression each year As many as 5% experience mild depressionAs many as 5% experience mild depression

The prevalence is similar in Canada, The prevalence is similar in Canada, England, France, and many other countriesEngland, France, and many other countries

Approximately 17% of all adults experience Approximately 17% of all adults experience unipolar depression at some time in their unipolar depression at some time in their liveslives Rates have been steadily increasing since 1915Rates have been steadily increasing since 1915


How Common Is How Common Is Unipolar Depression?Unipolar Depression?

In almost all countries, women are _______ as In almost all countries, women are _______ as likely as men to experience severe unipolar likely as men to experience severe unipolar depressiondepression Lifetime prevalence: 26% of women vs. 12% of Lifetime prevalence: 26% of women vs. 12% of

menmen

These rates hold true across socioeconomic These rates hold true across socioeconomic classes and ethnic groupsclasses and ethnic groups

Approximately 50% recover within six weeks, Approximately 50% recover within six weeks, some without treatmentsome without treatment Most will experience ____________ at some pointMost will experience ____________ at some point


What Are the Symptoms What Are the Symptoms of Depression?of Depression?

Symptoms may differ from person to personSymptoms may differ from person to person

Five main areas of functioning may be Five main areas of functioning may be affected:affected: Emotional symptomsEmotional symptoms

Feeling “miserable,” “empty,” “humiliated”Feeling “miserable,” “empty,” “humiliated”

Experiencing little pleasureExperiencing little pleasure

Motivational symptomsMotivational symptoms Lacking drive, initiative, spontaneityLacking drive, initiative, spontaneity

Between 6% and 15% of those with severe depression Between 6% and 15% of those with severe depression commit suicidecommit suicide


What Are the Symptoms What Are the Symptoms of Unipolar Depression?of Unipolar Depression?

Five main areas of functioning may be Five main areas of functioning may be affected:affected: Behavioral symptomsBehavioral symptoms

Less active, less productiveLess active, less productive

Cognitive symptomsCognitive symptoms Hold negative views of themselvesHold negative views of themselves

Blame themselves for unfortunate eventsBlame themselves for unfortunate events

PessimismPessimism

Physical symptomsPhysical symptoms Headaches, dizzy spells, general painHeadaches, dizzy spells, general pain


Diagnosing Unipolar Diagnosing Unipolar DepressionDepression

Criteria 1: Major depressive episodeCriteria 1: Major depressive episode Marked by five or more symptoms Marked by five or more symptoms

lasting two or more weekslasting two or more weeks In extreme cases, symptoms are psychotic, In extreme cases, symptoms are psychotic,

including including ______________________________________________________

____________________________________________________

Criteria 2: _______________________Criteria 2: _______________________



Diagnosing Unipolar Diagnosing Unipolar DepressionDepression

Two diagnoses to consider:Two diagnoses to consider: ______________________________________________________________

Criteria 1 and 2 are metCriteria 1 and 2 are met

______________________________________________________________ Symptoms are “mild but chronic”Symptoms are “mild but chronic”

Depression is longer lasting but less disablingDepression is longer lasting but less disabling

Consistent symptoms for at least 2 yearsConsistent symptoms for at least 2 years

When dysthymic disorder leads to major When dysthymic disorder leads to major depressive disorder, the sequence is called depressive disorder, the sequence is called “___________________”“___________________”


What Causes Unipolar What Causes Unipolar Depression?Depression?

Stress may be a trigger for depressionStress may be a trigger for depression People with depression experience a greater People with depression experience a greater

number of stressful life events during the month number of stressful life events during the month just prior to the onset of their symptomsjust prior to the onset of their symptoms

Some clinicians distinguish _________________ Some clinicians distinguish _________________ depression from _________________ depression, depression from _________________ depression, which seems to be a response to internal factorswhich seems to be a response to internal factors

The utility of this distinction is questionable and The utility of this distinction is questionable and today’s clinicians usually concentrate on recognizing today’s clinicians usually concentrate on recognizing the situational and the internal aspects of any given the situational and the internal aspects of any given casecase



The Biological ViewThe Biological View Genetic factorsGenetic factors

Family pedigree, twin, adoption, and molecular Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people biology gene studies suggest that some people inherit a _______________inherit a _______________

Researchers have found that as many as 20% of Researchers have found that as many as 20% of relatives of those with depression are themselves relatives of those with depression are themselves depressed, compared with fewer than 10% of the depressed, compared with fewer than 10% of the general populationgeneral population

Twin studies demonstrate a ___________________________: Twin studies demonstrate a ___________________________: Rates for identical (MZ) twins = 46%Rates for identical (MZ) twins = 46% Rates for fraternal (DZ) twins = 20% Rates for fraternal (DZ) twins = 20%

Molecular biology studies also have implicated a Molecular biology studies also have implicated a genetic factor in many cases of unipolar depressiongenetic factor in many cases of unipolar depression



The Biological ViewThe Biological View Biochemical factorsBiochemical factors

NTs: ___________ and ______________NTs: ___________ and ______________ In the 1950s, medications for high blood pressure In the 1950s, medications for high blood pressure

were found to cause depressionwere found to cause depression Some lowered serotonin, others lowered Some lowered serotonin, others lowered

norepinephrinenorepinephrine

This led to “discovery” of effective antidepressant This led to “discovery” of effective antidepressant medications which relieved depression by increasing medications which relieved depression by increasing either serotonin or norepinephrineeither serotonin or norepinephrine

Depression likely involves not just serotonin nor Depression likely involves not just serotonin nor norepinephrine… a complex interaction is at work, norepinephrine… a complex interaction is at work, and other NTs may be involvedand other NTs may be involved




Endocrine system / hormone releaseEndocrine system / hormone release People with depression have been found to People with depression have been found to

have abnormal levels of _____________have abnormal levels of _____________ Released by the adrenal glands during times of stressReleased by the adrenal glands during times of stress

People with depression have been found to People with depression have been found to have _______________________________have _______________________________

““Dracula hormone”Dracula hormone”

Other researchers are investigating whether Other researchers are investigating whether deficiencies of important proteins within deficiencies of important proteins within neurons are tied to depressionneurons are tied to depression




Model has produced enthusiasm but Model has produced enthusiasm but has significant limitations: has significant limitations: ______________________________________________________________________________

Do these symptoms correlate with human Do these symptoms correlate with human emotions?emotions?

______________________________________________________________________________ Current studies using modern technology are Current studies using modern technology are

attempting to address this issueattempting to address this issue


What Are the Biological What Are the Biological Treatments for Unipolar Treatments for Unipolar

Depression?Depression? Biological treatments can bring great Biological treatments can bring great

relief to people with unipolar relief to people with unipolar depressiondepression

Usually biological treatment means Usually biological treatment means antidepressant drugs, but for severely antidepressant drugs, but for severely depressed persons who do not depressed persons who do not respond to other forms of treatment, respond to other forms of treatment, it sometimes includes it sometimes includes electroconvulsive therapyelectroconvulsive therapy



Depression?Depression? Electroconvulsive therapy (ECT)Electroconvulsive therapy (ECT)

The use of ECT was -- and is -- controversialThe use of ECT was -- and is -- controversial It is now used frequently but only in severe casesIt is now used frequently but only in severe cases

The procedure consists of targeted electrical The procedure consists of targeted electrical stimulation to cause a brain seizurestimulation to cause a brain seizure

The usual course of treatment is 6The usual course of treatment is 6 to to 12 sessions 12 sessions spaced over two to four weeksspaced over two to four weeks

Treatment may be bilateral or unilateralTreatment may be bilateral or unilateral




The discovery of the effectiveness of ECT The discovery of the effectiveness of ECT was accidental and based on a fallacious was accidental and based on a fallacious link between __________ and _________link between __________ and _________

The procedure has been modified in recent The procedure has been modified in recent years to reduce some of the negative effectsyears to reduce some of the negative effects For example, patients are given muscle relaxants For example, patients are given muscle relaxants

and anesthetics before and during the procedureand anesthetics before and during the procedure

Patients generally report some Patients generally report some __________________________________




ECT is clearly effective in treating unipolar ECT is clearly effective in treating unipolar depressiondepression

Studies find improvement in _____________ of patients Studies find improvement in _____________ of patients

The procedure seems particularly effective in The procedure seems particularly effective in cases of ______________________________, but it has cases of ______________________________, but it has been difficult to determine why ECT works so wellbeen difficult to determine why ECT works so well

Although effective, the use of ECT has declined Although effective, the use of ECT has declined since the 1950s, because of the memory loss since the 1950s, because of the memory loss caused by the procedure and the emergence of caused by the procedure and the emergence of effective antidepressant drugseffective antidepressant drugs



Depression?Depression? Antidepressant drugsAntidepressant drugs

In the 1950s, two kinds of drugs were In the 1950s, two kinds of drugs were found to be effective:found to be effective: Monoamine oxidase inhibitors (MAO Monoamine oxidase inhibitors (MAO

inhibitors)inhibitors)

TricyclicsTricyclics

These drugs have been joined in recent These drugs have been joined in recent years by a third group, the second-years by a third group, the second-generation antidepressantsgeneration antidepressants




Depression?Depression? Antidepressant drugs: MAO inhibitorsAntidepressant drugs: MAO inhibitors

Originally used to treat TB, doctors noticed that Originally used to treat TB, doctors noticed that the medication seemed to make patients happierthe medication seemed to make patients happier

The drug works biochemically by slowing down The drug works biochemically by slowing down the body’s production of MAOthe body’s production of MAO

__________________________________________________________________________

__________________________________________________________________________

This leads to a rise in norepinephrine activity and a This leads to a rise in norepinephrine activity and a reduction in depressive symptoms reduction in depressive symptoms

About half the patients who take these drugs are helped About half the patients who take these drugs are helped by themby them



Depression?Depression? Antidepressant drugs: MAO Antidepressant drugs: MAO

inhibitorsinhibitors MAO inhibitors potentially pose a MAO inhibitors potentially pose a

serious danger!serious danger! Blood pressure may rise to a potentially Blood pressure may rise to a potentially

fatal level if one eats foods with tyramine fatal level if one eats foods with tyramine (cheese, bananas, wine) while taking MAO (cheese, bananas, wine) while taking MAO inhibitorsinhibitors



Depression?Depression? Antidepressant drugs: TricyclicsAntidepressant drugs: Tricyclics

In searching for medications for In searching for medications for schizophrenia, researchers discovered schizophrenia, researchers discovered that imipramine lessened depressive that imipramine lessened depressive symptomssymptoms Imipramine and related drugs are known as Imipramine and related drugs are known as

tricyclics because they share a three-ring tricyclics because they share a three-ring molecular structuremolecular structure



Depression?Depression? Antidepressant drugs: Tricyclics Antidepressant drugs: Tricyclics

Hundreds of studies have found that Hundreds of studies have found that depressed patients taking tricyclics depressed patients taking tricyclics have improved much more than similar have improved much more than similar patients taking placebospatients taking placebos ________________________________________________________________________________________



Depression?Depression? Antidepressant drugs: Tricyclics Antidepressant drugs: Tricyclics

Most patients who immediately stop Most patients who immediately stop taking tricyclics upon relief of taking tricyclics upon relief of symptoms _____________________________symptoms _____________________________

Patients who take tricyclics for five Patients who take tricyclics for five additional months additional months (“____________________”) have a (“____________________”) have a significantly decreased risk of relapsesignificantly decreased risk of relapse

As a result, clinicians often keep their As a result, clinicians often keep their patients on the drugs ______________patients on the drugs ______________



Depression?Depression? Antidepressant drugs: TricyclicsAntidepressant drugs: Tricyclics

Tricyclics are believed to reduce depression by Tricyclics are believed to reduce depression by affecting neurotransmitter (NT) ____________affecting neurotransmitter (NT) ____________

To prevent an NT from remaining in the synapse too To prevent an NT from remaining in the synapse too long, a pumplike mechanism recaptures the NT and long, a pumplike mechanism recaptures the NT and draws it back into the presynaptic neurondraws it back into the presynaptic neuron

The reuptake process appears to be ________________ in The reuptake process appears to be ________________ in some people, drawing in too much of the NT from the some people, drawing in too much of the NT from the synapsesynapse

This reduction in NT activity in the synapse is thought This reduction in NT activity in the synapse is thought to result in clinical depressionto result in clinical depression

Tricyclics block the reuptake process, thus Tricyclics block the reuptake process, thus __________________ in the synapse __________________ in the synapse




Depression?Depression? Second-generation antidepressant drugsSecond-generation antidepressant drugs

A third group of effective antidepressant drugs is A third group of effective antidepressant drugs is structurally different from the MAO inhibitors and structurally different from the MAO inhibitors and tricyclicstricyclics

Most of the drugs in this group are labeled Most of the drugs in this group are labeled ____________________________________________________________________

These drugs act only on serotonin (no other NTs are These drugs act only on serotonin (no other NTs are affected)affected)

____________________________________________________________________________________________________

Selective norepinephrine reuptake inhibitors and Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are serotonin-norepinephrine reuptake inhibitors are also now availablealso now available



Depression?Depression? Second-generation antidepressant drugsSecond-generation antidepressant drugs

The effectiveness and speed of action of these The effectiveness and speed of action of these drugs is on par with the tricyclics, yet they drugs is on par with the tricyclics, yet they boast enormous salesboast enormous sales

Clinicians often prefer these drugs because it is Clinicians often prefer these drugs because it is _________________ on them than on other kinds of _________________ on them than on other kinds of antidepressantsantidepressants

There are _____________________________There are _____________________________

There have ____________________________There have ____________________________

These drugs may cause some undesired effects These drugs may cause some undesired effects of their own, __________________________________of their own, __________________________________


Psychological Models of Psychological Models of Unipolar DepressionUnipolar Depression

Three main models:Three main models: Psychodynamic modelPsychodynamic model

Not strongly supported by researchNot strongly supported by research

Behavioral modelBehavioral model Modestly supported by researchModestly supported by research

Cognitive modelCognitive model Has considerable research supportHas considerable research support



Psychodynamic viewPsychodynamic view Link between depression and ________Link between depression and ________

When a loved one dies, the mourner regresses to the oral When a loved one dies, the mourner regresses to the oral stagestage

For most people, grief is temporaryFor most people, grief is temporary

If grief is severe and long-lasting, depression resultsIf grief is severe and long-lasting, depression results

Those with oral stage issues (unmet or excessively met Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depressionneeds) are at greater risk for developing depression

Some people experience “___________” (not actual) lossSome people experience “___________” (not actual) loss

Newer psychoanalysts focus on relationships with others Newer psychoanalysts focus on relationships with others (object relations theorists)(object relations theorists)



Psychodynamic viewPsychodynamic view Strengths:Strengths:

Studies have offered general support for the Studies have offered general support for the psychodynamic idea that depression may be psychodynamic idea that depression may be triggered by a major loss triggered by a major loss

Research supports the theory that early Research supports the theory that early losses set the stage for later depressionlosses set the stage for later depression

Research also suggests that people whose Research also suggests that people whose childhood needs were improperly met are childhood needs were improperly met are more likely to become depressed after more likely to become depressed after suffering a losssuffering a loss



Psychodynamic viewPsychodynamic view

Limitations:Limitations: Early losses don’t inevitably lead to Early losses don’t inevitably lead to

depressiondepression May not be May not be typicallytypically responsible for development responsible for development

of depressionof depression

Many research findings are inconsistentMany research findings are inconsistent

Theory is largely untestable because of its Theory is largely untestable because of its reliance on unconscious processesreliance on unconscious processes



Psychodynamic therapyPsychodynamic therapy Psychodynamic therapists use the same Psychodynamic therapists use the same

basic procedures for all psychological basic procedures for all psychological disorders:disorders: ________________________________________________________

________________________________________________________



Psychodynamic therapyPsychodynamic therapy Despite successful case reports, researchers have Despite successful case reports, researchers have

found that long-term psychodynamic therapy is only found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depressionoccasionally helpful in cases of unipolar depression

Two features may be particularly limiting:Two features may be particularly limiting: ________________________________________________________________________________________________________

Depressed clients may become discouraged and end Depressed clients may become discouraged and end treatment too early when treatment doesn’t provide fast treatment too early when treatment doesn’t provide fast reliefrelief

______________________________ have performed better ______________________________ have performed better than traditional approachesthan traditional approaches



Behavioral viewBehavioral view Depression results from changes in Depression results from changes in

____________________________ people receive ____________________________ people receive in their livesin their lives As life changes, we experience a change (loss) of As life changes, we experience a change (loss) of

rewardsrewards

Research by Lewinsohn supports the Research by Lewinsohn supports the relationship between the number of relationship between the number of rewards received and the presence or rewards received and the presence or absence of depressionabsence of depression _______________ are especially important_______________ are especially important


Treatments for Unipolar Treatments for Unipolar Depression: Psychological Depression: Psychological

ApproachesApproaches Behavioral therapyBehavioral therapy

Lewinsohn developed a behavioral Lewinsohn developed a behavioral therapy for unipolar depression:therapy for unipolar depression: ___________________________________________, ___________________________________________,

often using a weekly scheduleoften using a weekly schedule

______________________________________________________________________________________ Use a contingency management approachUse a contingency management approach

______________________________________________________________________________________


Treatments for Unipolar Treatments for Unipolar Depression: Psychological Depression: Psychological

ApproachesApproaches Behavioral therapyBehavioral therapy

The behavioral techniques seem to be of The behavioral techniques seem to be of only limited help when just one of them only limited help when just one of them is appliedis applied When treatment programs combine two or When treatment programs combine two or

three of the techniques, as Lewinsohn had three of the techniques, as Lewinsohn had envisioned, depressive symptoms envisioned, depressive symptoms (especially mild symptoms) seem to be (especially mild symptoms) seem to be reduced reduced



Cognitive viewsCognitive views Two main theories:Two main theories:

Learned helplessnessLearned helplessness

Negative thinkingNegative thinking



Cognitive viewsCognitive views Learned helplessness Learned helplessness

Theory holds that people become depressed Theory holds that people become depressed when they think that:when they think that:

They no longer have control over the They no longer have control over the reinforcements in their livesreinforcements in their lives

They themselves are responsible for this helpless They themselves are responsible for this helpless statestate




Theory is based on Seligman’s work with Theory is based on Seligman’s work with laboratory dogslaboratory dogs

Dogs subjected to uncontrollable shock were Dogs subjected to uncontrollable shock were later placed in a shuttle box later placed in a shuttle box

Even when presented with an opportunity to Even when presented with an opportunity to escape, dogs that had experienced uncontrollable escape, dogs that had experienced uncontrollable shocks made no attempt to do soshocks made no attempt to do so

Seligman theorized that the dogs had “learned” Seligman theorized that the dogs had “learned” to be “helpless” and drew parallels to human to be “helpless” and drew parallels to human depressiondepression




There has been _______________ research There has been _______________ research support for this modelsupport for this model

Human subjects who undergo helplessness training Human subjects who undergo helplessness training score higher on depression scales and demonstrate score higher on depression scales and demonstrate passivity in laboratory trialspassivity in laboratory trials

Animal subjects lose interest in sex and social Animal subjects lose interest in sex and social activitiesactivities

In rats, uncontrollable negative events result in lower In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brainserotonin and norepinephrine levels in the brain




Recent versions of the theory focus on _____________Recent versions of the theory focus on _____________ __________ attributions that are _______ and ______ lead to __________ attributions that are _______ and ______ lead to

greater feelings of helplessness and possibly depression greater feelings of helplessness and possibly depression Example: “It’s all my fault [internal]. I ruin everything Example: “It’s all my fault [internal]. I ruin everything

I touch [global] and I always will [stable]” I touch [global] and I always will [stable]” If they make other kinds of attributions, this reaction is If they make other kinds of attributions, this reaction is

unlikelyunlikely Example: “The way I’ve behaved the past couple of Example: “The way I’ve behaved the past couple of

weeks blew this relationship [specific], I don’t know weeks blew this relationship [specific], I don’t know what got into me – I don’t usually act like that what got into me – I don’t usually act like that [unstable], and she never did know what she wanted [unstable], and she never did know what she wanted [external]”[external]”




Some theorists have refined the Some theorists have refined the helplessness model yet again in recent helplessness model yet again in recent years; they suggest that attributions are years; they suggest that attributions are likely to cause depression only when they likely to cause depression only when they further produce a sense of hopelessness in further produce a sense of hopelessness in an individualan individual




Strengths:Strengths: Hundreds of studies have supported the relationship Hundreds of studies have supported the relationship

between styles of attribution, helplessness, and between styles of attribution, helplessness, and depressiondepression

Limitations:Limitations: Laboratory helplessness does not parallel depression in Laboratory helplessness does not parallel depression in

every wayevery way Much of the research relies on animal subjectsMuch of the research relies on animal subjects The attributional component of the theory raises The attributional component of the theory raises

particularly difficult questions in terms of animal models particularly difficult questions in terms of animal models of depressionof depression



Cognitive viewsCognitive views Negative thinkingNegative thinking

Beck theorizes four interrelated cognitive Beck theorizes four interrelated cognitive components combine to produce unipolar components combine to produce unipolar depression:depression:

1.1. __________________________________________________________________

Self-defeating attitudes are developed during Self-defeating attitudes are developed during childhoodchildhood

Beck suggests that upsetting situations later in Beck suggests that upsetting situations later in life can trigger further rounds of negative life can trigger further rounds of negative thinkingthinking



Cognitive viewsCognitive views

2.2. This negative thinking often takes This negative thinking often takes three forms, called the three forms, called the ____________________:____________________:

Individuals repeatedly interpret (1) their Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their experiences, (2) themselves, and (3) their futures in negative ways, leading to futures in negative ways, leading to depressiondepression



Cognitive viewsCognitive views Negative thinkingNegative thinking

3.3. Depressed people also make ___________________, Depressed people also make ___________________, including:including: Arbitrary inferencesArbitrary inferences

Minimization of the positive and magnification of the Minimization of the positive and magnification of the negativenegative

4.4. Depressed people experience _________________Depressed people experience _________________ A steady train of unpleasant thoughts that suggest A steady train of unpleasant thoughts that suggest

inadequacy and hopelessnessinadequacy and hopelessness



Cognitive viewsCognitive views Strengths:Strengths:

There is significant research support for Beck’s There is significant research support for Beck’s model:model:

High correlation between the level of depression High correlation between the level of depression and the number of maladaptive attitudesand the number of maladaptive attitudes

Both the cognitive triad and errors in logic are Both the cognitive triad and errors in logic are seen in people with depressionseen in people with depression

Automatic thinking has been linked to depressionAutomatic thinking has been linked to depression

Limitations:Limitations: Research fails to show that such cognitive patterns Research fails to show that such cognitive patterns

are the cause and core of unipolar depressionare the cause and core of unipolar depression



Cognitive therapyCognitive therapy Beck’s cognitive therapy – the leading Beck’s cognitive therapy – the leading

cognitive treatment for unipolar depression – cognitive treatment for unipolar depression – is designed to help clients recognize and is designed to help clients recognize and change their negative cognitive processeschange their negative cognitive processes

This approach follows four phases and This approach follows four phases and usually lasts fewer than 20 sessionsusually lasts fewer than 20 sessions

Phases:Phases:1.1. ____________________________________________________________________

2.2. ____________________________________________________________________

3.3. ____________________________________________________________________

4.4. ____________________________________________________________________



Cognitive therapyCognitive therapy Over the past three decades, hundreds Over the past three decades, hundreds

of studies have shown that cognitive of studies have shown that cognitive therapy helps unipolar depressiontherapy helps unipolar depression

Around _________ of clients show Around _________ of clients show __________ _________________ of __________ _________________ of symptomssymptoms

This treatment has also been used in a This treatment has also been used in a group therapy formatgroup therapy format


The Sociocultural Model of The Sociocultural Model of Unipolar DepressionUnipolar Depression

Sociocultural theorists propose that Sociocultural theorists propose that unipolar depression is greatly influenced unipolar depression is greatly influenced by the social structure in which people by the social structure in which people livelive This belief is supported by the finding that This belief is supported by the finding that

depression is often triggered by outside depression is often triggered by outside stressorsstressors

Researchers have also found links between Researchers have also found links between depression and culture, gender, race, and depression and culture, gender, race, and social supportsocial support



How are culture and depression How are culture and depression related?related? Depression is a worldwide phenomena, Depression is a worldwide phenomena,

but the experience of symptoms differs but the experience of symptoms differs from culture to culturefrom culture to culture For example, non-Westerners report more For example, non-Westerners report more

__________ (rather than psychological) __________ (rather than psychological) symptomssymptoms

As cultures become more Western, symptoms As cultures become more Western, symptoms shiftshift



How do gender and race relate to depression?How do gender and race relate to depression? Rates of depression are much higher among women than menRates of depression are much higher among women than men

One sociocultural theory holds that the ______________ One sociocultural theory holds that the ______________ _________________ in society leaves them particularly prone _________________ in society leaves them particularly prone to depressionto depression

Few differences have been seen Few differences have been seen overall overall among Caucasians, among Caucasians, African Americans, and Hispanic Americans, African Americans, and Hispanic Americans, _______________________________________________:_______________________________________________:

In a study of one Native American village, lifetime risk was In a study of one Native American village, lifetime risk was 37% among women, 19% among men, and 28% overall37% among women, 19% among men, and 28% overall

These findings are thought to be the result of economic and These findings are thought to be the result of economic and social pressuressocial pressures



How does social support relate to How does social support relate to depression?depression? The availability of social support seems to The availability of social support seems to

influence the likelihood of depressioninfluence the likelihood of depression Rates of depression vary based on marital statusRates of depression vary based on marital status

Interpersonal conflict may be a factorInterpersonal conflict may be a factor

Isolation and lack of intimacy also are key Isolation and lack of intimacy also are key factors factors

Research shows that depressed people who lack social Research shows that depressed people who lack social support remain depressed longer than those who have support remain depressed longer than those who have a supportive spouse or warm friendshipsa supportive spouse or warm friendships



The most effective sociocultural The most effective sociocultural approaches to treating unipolar approaches to treating unipolar depression are _____________ and depression are _____________ and ____________________________________ The techniques used in these The techniques used in these

approaches borrow from other modelsapproaches borrow from other models



Interpersonal therapy (IPT)Interpersonal therapy (IPT) This model holds that four interpersonal This model holds that four interpersonal

problems may lead to depression and must problems may lead to depression and must be addressed:be addressed:

Interpersonal lossInterpersonal loss Interpersonal role disputeInterpersonal role dispute Interpersonal role transitionInterpersonal role transition Interpersonal deficitsInterpersonal deficits

Studies suggest that IPT is as effective as Studies suggest that IPT is as effective as cognitive therapy for treating depressioncognitive therapy for treating depression



Couple therapyCouple therapy The main type of couple therapy is The main type of couple therapy is

behavioral marital therapy (BMT)behavioral marital therapy (BMT) Focus is on developing specific Focus is on developing specific

communication and problem-solving skillscommunication and problem-solving skills

If marriage is conflictual, BMT is as If marriage is conflictual, BMT is as effective as other therapies for reducing effective as other therapies for reducing depressiondepression


Bipolar DisordersBipolar Disorders

People with a bipolar disorder People with a bipolar disorder experience both the experience both the __________________ and the __________________ and the ______________________________________________________________ They describe their life as an emotional They describe their life as an emotional

roller coasterroller coaster


What Are the Symptoms What Are the Symptoms of Mania?of Mania?

Unlike those experiencing depression, people Unlike those experiencing depression, people in a state of mania typically experience in a state of mania typically experience dramatic and inappropriate rises in mood dramatic and inappropriate rises in mood

Five main areas of functioning may be Five main areas of functioning may be affected:affected:

1.1. Emotional symptomsEmotional symptoms Active, powerful emotions in search of outletActive, powerful emotions in search of outlet

2.2. Motivational symptomsMotivational symptoms Need for constant excitement, involvement, Need for constant excitement, involvement,

companionshipcompanionship


What Are the Symptoms What Are the Symptoms of Mania?of Mania?

Five main areas of functioning may be Five main areas of functioning may be affected:affected:

3. Behavioral symptoms3. Behavioral symptoms Very active – move quickly; talk loudly or rapidlyVery active – move quickly; talk loudly or rapidly

Key word: ____________!Key word: ____________!

4. Cognitive symptoms4. Cognitive symptoms Show poor judgment or planningShow poor judgment or planning

Especially prone to poor (or no) planningEspecially prone to poor (or no) planning

5. Physical symptoms5. Physical symptoms High energy level – often in the presence of little or no restHigh energy level – often in the presence of little or no rest


Diagnosing Bipolar Diagnosing Bipolar DisordersDisorders

Criteria 1: Manic episodeCriteria 1: Manic episode Three or more symptoms of mania Three or more symptoms of mania

lasting one week or morelasting one week or more In extreme cases, symptoms are psychotic In extreme cases, symptoms are psychotic

Criteria 2: History of maniaCriteria 2: History of mania If currently experiencing hypomania or If currently experiencing hypomania or

depressiondepression



DSM-IV-TR distinguishes between two DSM-IV-TR distinguishes between two kinds of bipolar disorder:kinds of bipolar disorder: Bipolar I disorderBipolar I disorder

Full manic and major depressive episodesFull manic and major depressive episodes

Most sufferers experience an alternation of Most sufferers experience an alternation of episodesepisodes

Some experience mixed episodesSome experience mixed episodes

Bipolar II disorderBipolar II disorder Hypomanic episodes and major depressive Hypomanic episodes and major depressive

episodesepisodes




Without treatment, the mood Without treatment, the mood episodes tend to recur for people episodes tend to recur for people with either type of bipolar disorderwith either type of bipolar disorder

Regardless of particular pattern, Regardless of particular pattern, individuals with bipolar disorder individuals with bipolar disorder tend to experience depression more tend to experience depression more than mania over the yearsthan mania over the years



Between 1% and 2.6% of adults in Between 1% and 2.6% of adults in the world suffer from a bipolar the world suffer from a bipolar disorder at any given timedisorder at any given time

The disorders are equally common in The disorders are equally common in women and menwomen and men Women may experience more Women may experience more

depressive episodes and fewer manic depressive episodes and fewer manic episodes than menepisodes than men



The prevalence of the disorders is The prevalence of the disorders is the same across socioeconomic the same across socioeconomic classes and ethnic groupsclasses and ethnic groups

Onset usually occurs between 15 Onset usually occurs between 15 and 44 years of ageand 44 years of age

In most cases, the manic and In most cases, the manic and depressive episodes eventually depressive episodes eventually subside, only to recur at a later timesubside, only to recur at a later time



A final diagnostic option:A final diagnostic option: If a person experiences numerous If a person experiences numerous

episodes of hypomania and mild episodes of hypomania and mild depressive symptoms, a diagnosis of depressive symptoms, a diagnosis of cyclothymic disorder is appropriatecyclothymic disorder is appropriate Mild symptoms for two or more years, Mild symptoms for two or more years,

interrupted by periods of normal moodinterrupted by periods of normal mood

Affects 0.4% of the populationAffects 0.4% of the population

May blossom into bipolar I or II disorderMay blossom into bipolar I or II disorder


What Causes Bipolar What Causes Bipolar Disorders?Disorders?

Throughout the first half of the 20th Throughout the first half of the 20th century, the search for the cause of century, the search for the cause of bipolar disorders made little progressbipolar disorders made little progress

More recently, biological research has More recently, biological research has produced some promising cluesproduced some promising clues New insights have come from research New insights have come from research

into NT activity, ion activity, brain into NT activity, ion activity, brain structure, and genetic factors structure, and genetic factors



NeurotransmittersNeurotransmitters After finding a relationship between low After finding a relationship between low

norepinephrine and unipolar norepinephrine and unipolar depression, early researchers expected depression, early researchers expected to find a link between high to find a link between high norepinephrine levels and manianorepinephrine levels and mania This theory is supported by some research This theory is supported by some research

studies; bipolar disorders may be related to studies; bipolar disorders may be related to overactivity of norepinephrineoveractivity of norepinephrine



NeurotransmittersNeurotransmitters Because serotonin activity often Because serotonin activity often

parallels norepinephrine activity in parallels norepinephrine activity in unipolar depression, theorists expected unipolar depression, theorists expected that mania would also be related to that mania would also be related to high serotonin activityhigh serotonin activity Although no relationship with HIGH Although no relationship with HIGH

serotonin has been found, bipolar disorder serotonin has been found, bipolar disorder may be linked to LOW serotonin activity, may be linked to LOW serotonin activity, which seems contradictory…which seems contradictory…



Neurotransmitters Neurotransmitters This apparent contradiction is addressed by This apparent contradiction is addressed by

the “____________________” about mood the “____________________” about mood disorders:disorders: Low serotonin may “open the door” to a mood Low serotonin may “open the door” to a mood

disorder and permit norepinephrine activity to disorder and permit norepinephrine activity to define the particular form the disorder will take:define the particular form the disorder will take:

Low serotonin + Low norepinephrine = Low serotonin + Low norepinephrine = ________________________________

Low serotonin + High norepinephrine = Low serotonin + High norepinephrine = ________________________________



Ion activityIon activity Ions, which are needed to send incoming Ions, which are needed to send incoming

messages to nerve endings, may be messages to nerve endings, may be improperly transported through the cells improperly transported through the cells of individuals with bipolar disorderof individuals with bipolar disorder

This improper transport may cause This improper transport may cause neurons to fire too easily (mania) or to neurons to fire too easily (mania) or to resist firing (depression) resist firing (depression) There is some research support for this theoryThere is some research support for this theory



Brain structureBrain structure Brain imaging studies have identified a Brain imaging studies have identified a

number of abnormal brain structures in number of abnormal brain structures in people with bipolar disorder; in people with bipolar disorder; in particular, the basal ganglia and particular, the basal ganglia and cerebellum among otherscerebellum among others It is not clear what role such structural It is not clear what role such structural

abnormalities playabnormalities play



Genetic factorsGenetic factors Many experts believe that people Many experts believe that people

__________________ _______________________ to __________________ _______________________ to develop bipolar disordersdevelop bipolar disorders

Family pedigree studies support this theory; when Family pedigree studies support this theory; when one twin or sibling has bipolar disorder, the one twin or sibling has bipolar disorder, the likelihood for the other twin or sibling increases:likelihood for the other twin or sibling increases:

Identical (MZ) twins = 40% likelihoodIdentical (MZ) twins = 40% likelihood

Fraternal (DZ) twins and siblings = 5% to 10% Fraternal (DZ) twins and siblings = 5% to 10% likelihoodlikelihood

General population = 1% to 2.6% likelihoodGeneral population = 1% to 2.6% likelihood



Genetic factorsGenetic factors Recently, genetic linkage studies have Recently, genetic linkage studies have

examined the possibility of “faulty” genesexamined the possibility of “faulty” genes Other researchers are using techniques Other researchers are using techniques

from molecular biology to further from molecular biology to further examine genetic patterns examine genetic patterns

Such wide-ranging findings suggest that Such wide-ranging findings suggest that a number of genetic abnormalities a number of genetic abnormalities probably combine to help bring about probably combine to help bring about bipolar disordersbipolar disorders


What Are the Treatments What Are the Treatments for Bipolar Disorders?for Bipolar Disorders?

Until the latter part of the 20Until the latter part of the 20thth century, century, people with bipolar disorders were people with bipolar disorders were destined to spend their lives on an destined to spend their lives on an emotional roller coasteremotional roller coaster Psychotherapists reported almost no successPsychotherapists reported almost no success Antidepressant drugs were of limited helpAntidepressant drugs were of limited help

These drugs sometimes triggered manic episodesThese drugs sometimes triggered manic episodes

ECT only occasionally relieved either the ECT only occasionally relieved either the depressive or the manic episodes of bipolar depressive or the manic episodes of bipolar disorderdisorder



The use of lithium, a metallic element The use of lithium, a metallic element occurring as mineral salt, has occurring as mineral salt, has dramatically changed this picturedramatically changed this picture It is extraordinarily effective in treating It is extraordinarily effective in treating

bipolar disorders and maniabipolar disorders and mania Determining the correct dosage for a Determining the correct dosage for a

given patient is a delicate processgiven patient is a delicate process Too low = ______________________________Too low = ______________________________ Too high = ______________________________Too high = ______________________________



Lithium provides improvement Lithium provides improvement ________________________________________________________________ Most patients also experience ______________ Most patients also experience ______________

while on the drugwhile on the drug

Lithium also is a _________________, one that Lithium also is a _________________, one that actually prevents symptoms from developingactually prevents symptoms from developing

Lithium also helps those with bipolar Lithium also helps those with bipolar disorder overcome their depressive disorder overcome their depressive episodesepisodes



Researchers do not fully understand how Researchers do not fully understand how lithium operateslithium operates They suspect that it changes synaptic activity They suspect that it changes synaptic activity

in neurons, but in a different way than in neurons, but in a different way than antidepressant drugsantidepressant drugs

Although antidepressant drugs affect a neuron’s Although antidepressant drugs affect a neuron’s initial reception on NTs, initial reception on NTs, ________________________________________________________________________________________

Another theory is that lithium corrects bipolar Another theory is that lithium corrects bipolar functioning by directly changing sodium and functioning by directly changing sodium and potassium ion activity in neuronspotassium ion activity in neurons



__________________________________________________________________________

Lithium therapy alone is also not always Lithium therapy alone is also not always sufficient, eithersufficient, either 30% or more of patients 30% or more of patients

______________________, ________________, or ______________________, ________________, or __________________________________

As a result, clinicians often use As a result, clinicians often use psychotherapy as an adjunct to lithium (or psychotherapy as an adjunct to lithium (or other medication-based) therapyother medication-based) therapy



Therapy focuses on medication Therapy focuses on medication management, social skills, and management, social skills, and relationship issuesrelationship issues

Few controlled studies have tested the Few controlled studies have tested the effectiveness of such adjunctive therapyeffectiveness of such adjunctive therapy Growing research suggests that it helps Growing research suggests that it helps

______ ________________, ___________________, ______ ________________, ___________________, and _____________________________________and _____________________________________

Documents

Abnorm Hand Out Ch07