Abnormal Psychology- TB4 SPA Lecture 1

Abnormal psychology- TB4 SPA Lecture 1- depression DSM-5- major depressive disorder (5 or more) ● Depressed mood ● Diminished interest or pleasure in activities ● Significant weight change ● Insomnia or hypersomnia ● Psychomotor agitation or retardation ● Fatigue or loss of energy ● Feelings of worthlessness or excessive or inappropriate guilt ● Diminished ability to think or concentrate ● Recurrent thoughts of death Serotonin ● Delgado et al (1999): previous depressed patients given tryptophan free diet for 2 days. Over half showed sig increase in depressive symptoms ● Booji et al (2002) reviewed depletion literature- range of intervening factors that heavily influence the impact of serotonin depletion, including the number of prior episodes of depression. ● Caspi et al (2003): Uher and McGuffin (2010) found a strong relationship between the precise polymorphism of the gene for serotonin reuptake sites and depressive response to early life stress. ‘S’ type gene most predictive of a negative response to stress ● SSRIs block to reuptake ● Yatham et al (1999) one of the first studies to clearly show the effects of successful antidepressant treatment (desipramine) on brain serotonin function ● Gaddes et al (2003) meta analysis of just 31 antidepressant clinical studies, clearly showing they helped prevent relapse, even after just 1-2 months treatment The psychology ● Emperor Marcus Aurelis- kept a notebook just for himself of positive thoughts and ideas, later collected under the title ‘meditations’ ● Many ideas seen in ‘meditations’ are now used in CBT ● To explain why some people more susceptible to become depressed in response to adverse events, the person’s attribution style became a focus for research ● Abramson, seilgman and Teasdale (1978): if an event is perceived as negative, attribution is made implicitly of the causes ○ 3 dimensions to attribution styleinternal/external(you/me), global/specific (spatial) and stable/unstable (temporal) ● Metalsky et al 1982: new students were tested for attributional style, and asked what exam grade later in the year they would consider a failure ● The more internal or global students attributional styles for negative outcomes were.. The more severe their depressive mood reactions to the.. Receipt of a low midterm grade..students who were extremely external or specific in their attributional styles for negative outcomes.. Actually were invulnerable to depressive mood reactions upon receipt of the low midterm grade ● Negative attributional style and inclination to learned helplessness may be an important predictor of vulnerability to depression through adverse life events ● Ishiyma and brecht (2016) looked very carefully at the conditions that moderate rats' laughter, rats will actively seek out tickling. Rats will only laugh when they are happy ● Rygula et al (2012) 2 stages; first, rats were trained to associate low tone with a positive lever-reward task, and a high tone with a negative lever-avoid-footshock task. With ambiguous tone, tickled rats that laughed then tended to pick the positive reward lever, while non laughing rats did not ● Seligman (1991,2011)- identified most pessimistic 25% of princeton students entrants and allocated either to control or 16 hours of learned-optimism workshops. 32% of controls experienced significant episode of depression, only 22% of those take to the workshops Treatment ● Myrna Weissman (1982): “depression...occurs in an interpersonal context and that clarifying and renegotiating this context…is important to the person’s recovery”. Four likely areas: ○ Grief reaction: if present, clients explore their relationship with lost person, and acknowledge and express feelings of anger. New attitudes to lost person ‘fill the empty space’ of depressive mood. ○ Interpersonal role dispute: if differing expectations between partners/parents of roles continues, resentments/depression may result. Therapy aims to resolve role disputes, & hence alleviate depression. ○ Interpersonal role transition: significant life events, e.g. moving from home can be difficult to cope with. Therapy aims to develop social support systems and interpersonal psychological skills required for new role, and hence to boost self-esteem. ○ Interpersonal deficits: depression may be from a lack of social skills, shyness. Therapy explores social skills/assertiveness training. ● Mufson et al (20040- compared IPT with treatment as usual (TAU:school based counselling) in adolescents. IPT more effective from 8 weeks onwards ● Aaron (1967,1991) & Judith Beck: people develop depression directly as a result of negative thinking, i.e. negative thinking directly leads to depression: ○ Maladaptive attitudes / negative schemas ○ Begin in childhood, e.g. belief that self-worth or parental affection depends upon success in school. May ‘lie dormant’ until a particularly adverse event is experienced. ○ The Cognitive Triad ○ Once reactivated, negative schemas cause 3 types of negative thinking: ○ Negative thoughts about oneself, e.g. “I am inadequate and worthless” ○ Negative thoughts about the current situation ○ Negative thoughts about the future, e.g. “there is no hope for the future, things will never improve”. ○ Errors in logic maintain the cognitive triad, e.g. ○ Arbitrary inference: negative conclusions from little or even contradictory evidence, e.g. if glanced at in the street, assumes “They must think I’m really stupid” ○ Selective abstraction: inappropriate focus on negative aspects of a generally positive situation, e.g. at a dinner that otherwise went very well, a single clatter of a fork taken to indicate a disastrous night. ○ Overgeneralisation: a single negative event is taken to apply at all times/places, e.g. following the dinner above, a person might concluded “I’m always absolutely hopeless at socialising”. ○ Automatic thoughts: ■ “I always mess things up” ■ “I always say the wrong thing” ■ “I’m a burden on my friends” ■ “They don’t really like me at all” ● Four phases: ○ Increasing activities and mood: behavioural aspect to therapy - schedule of activities drawn up, participation in which is expected to improve mood, though not remove depressive thinking. ○ Examining & invalidating automatic thoughts: patients taught to recognise and record negative thoughts. Therapist challenges validity of thoughts. ○ Identifying distorted thinking and negative bias: errors in logic exposed and challenged. ○ Altering primary attitudes: fundamental maladaptive attitudes challenged. ● Hollon et al (2005): CBT most effective in reducing relapse over the long term, compared with antidepressants ● Overactive subgenual cingulate gyrus (brodmann area 25) associated with treatmentresistant depression. Deep brain stimulation aims to reduce this activity ● Mayberg et al(2005) overactivity of subgenual cingulate gyrus (brodmann area 25) associated with sadness and treatment resistant depression. Inhibition of this region through chronic stimulation of a nearby area lifted depression in 4 out of 6 depressed patients Reading● Genetic factors ○ 37% heritability for MDD ○ Polymorphism of serotonin transporter gene puts people at greater risk for depression ● Neurotransmitters ○ ● ● ● 3 neurotransmitters have been studied the most in terms of their possible role in mood disorders… norepinephrine, dopamine and serotonin ○ People with depression are less responsive to drugs that increase dopamine levels - suggesting diminished function of reward system in brain Brain function ○ Functional brain imaging studies suggest that episodes of MDD are associated with changes in the many brain systems that are involved in emotions ○ The most studied areas are; ■ the amygdala- assess how saliant and emotionally important a stimulus is, activity is increased in people with MDD ■ anterior cingulate- greater activation ■ dorsolateral prefrontal cortex- diminished activity ■ Hippocampus- diminished activation ■ Striatum- diminished activity Neuroendocrine system: cortisol dysregulation ○ The HPA axis (hypothalamic-pituitary- adrenocortical axis) may be overly active during episodes of of MDD, which is consistent with the idea that stress reactivity is an important part of depression ○ HPA axis triggers the release of cortisol ○ Various findings link depression to high cortisol levels Social factors in depression○ Interpersonal problems are very common for those with depression, but showing cause and effect takes much more than just documenting this correlation ○ Longitudinal studies showing that's an interpersonal factors present before onset are extremely important. ○ Childhood adversity early parental death Physical abuse or sexual abuse increases the risk that later in the adolescence or Adulthood the personal develop depression and that their depressive symptoms will be chronic.One aspect of Childhood adversity child abuse concert the stage for many of the other risk factors of depression including a negative cognitive Style poor marital relationship quality increased rates of Life stress and altered activity and brain regions ○ The role of my recent stressful life events and triggering episodes of depression is well established ○ Certain types of life events such as those involving into personal loss and humiliation appear particularly likely to trigger depressive episodes ○ It has been suggested that new biological factors + social factors form a diatheses That increase the risk for mood disorders in the context of other triggers or stresses ○ Family problems are another important interpersonal predictor of depression. a long line of research has focused on expressed emotion defined as a family members critical or hostile comments towards or emotional over involvement with the person with depression ○ ● ● the onset of depression can also be predicted by certain types of problems and a person's into personal Style. in one line of longitudinal research and excessive need for reassurance has been found to predict depression psychological Factors in depression ○ Neuroticism-A personality trait that involves a tendency to experience frequent and intense negative effect project the onset of depression. ○ Cognitive theories- pessimistic and self-critical thoughts can tortured a person with depression. and cognitive theories negative thoughts and beliefs are seen as major causes of depression. ■ BecksTheory- argued that depression is associated with a negative triad; negative views of the self the world and the future. according to this model and childhood people with depression quiet negative schemas the experiences such as loss of a parent the social rejection of peers for the depressive attitude of apparent. schemas are different from conscious thoughts they are underlying set of beliefs that upgrade outside with person's awareness shaped the way of person make sensitivity experiences. once activated negative schemas are believed to cause cognitive biases or tendencies to process information in certain negative ways. one widely used instrument to test Becks Theory the self-report scale called the dysfunctional attitude scale which includes items concerning whether people would consider themselves worthwhile or lovable. ■ Hopelessness theory- according hopelessness theory, the most important trigger of is hopeless, which is defined by the belief that that desirable outcomes will not not occur and that there is is nothing a person can do to change this. This model places emphasis on two key dimensions of attributions ● stable/unstable ● global/specific ■ Rumination theory- while becks theory and the hopelessness model tend to focus on the nature of negative thoughts, this theory suggested that a way of thinking called rumination may increase the risk of depression. Rumination is defined as a tendency to relatively dwell on sad experiences. Psychological treatment of depression ○ Interpersonal psychotherapy (as explained in lecture notes) ○ Cognitive therapy ■ An adaption of CT is mindfulness based cognitive therapy- focuses or preventing relapse after successful treatment for recurrent episodes of major depression. Based on the assumption that the person become vulnerable to relapse because of repeated associations between sad mood and patterns of self-devaluing ○ ● Behavioural Activation Therapy- originally developed as a stand alone treatment, now part of Becks treatment. Based on the idea that many of risk factors for depression interfere with receiving positive reinforcement. ○ Behavioural Couples Therapy- because depression is often ied to relationship problems, including marital distress. Researchers have studied couples therapy as a treatment for depression Biological treatment for mood disorders○ ECT ( see activity notes for week 2) ○ Medications■ MAO inhibitors, tricyclic antidepressants and SSRIs (antidepressants) ■ Anticonvulsants and antipsychotics (mood stabilizers) ○ TMS- approved by FDA for a small subset of people with depression