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1. Explanations of One Disorder – DEPRESSION Behavioural Explanations The behavioural explanations would suggest that affective disorders are learnt through operant or…
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  • 1. Explanations of One Disorder – DEPRESSION Behavioural Explanations The behavioural explanations would suggest that affective disorders are learnt through operant or classical conditioning. It can also occur through social learning theory, as tested by Field et al (1988). Key Stud: Field et al (1988) Infants of Depressed Mothers Show ‘Depressed’ behaviour even with Non-depressed adults AIM: It has been previously found that infants of depressed mothers mirror this depressive behaviour during interactions with their mothers. The aim of this study was to determine whether the ‘depressed’ behaviour (e.g. less positive mood and lower activity levels) in infants noted during interactions with their ‘depressed’ mothers generalises to their interactions with non depressed adults. SAMPLE: 74 mothers (n = 40 depressed mothers, 34 non depressed mothers) and their 3 -6 month old infants. The mothers were from two ethnic groups (N = 38 blank, N = 36 Cubans). Mothers were recruited from a university infant clinic. Depression of mothers was measured using the Becks Depression Inventory Scale and the Profile of Mood states inventory. METHOD: Quasi experiment, the independent variable was whether the baby had a depressed mother or a non depressed mother. The dependent variable was the level of depressive behaviour the babies showed in their interactions with non depressed adults. DESIGN: Snap shot, independent measures design. PROCEDURE: The mothers and infants were videotaped in a 3 min, face to face interaction, where the mothers were asked to ‘pretend you are playing with your infant at home’. Following the interaction, the infant was situated face to face with the non depressed stranger of the same ethnicity of the mother, who were blind to the condition of the infant. This interaction was also videoed. MEASUREMENTS: Behaviour ratings: The videotapes were rated by research assistants who were blind to the condition of the infant. The videos were scored on the Interaction Rating Scale which measures different behaviours such as gaze behaviour, head orientation and game playing. Inter-rater reliability was applied to one third of the video tapes, where another researcher also analysed the videos. This was found to be .81 - . 95. FINDINGS: Interaction behaviour of depressed versus non depressed mother and infant: Depressed mothers received lower rating of interaction with their child than non depressed mothers. In addition, infants of depressed versus non depressed mothers received lower interaction ratings. Interactions of infants of depressed versus non depressed mothers with the strangers: The infants of depressed mothers received lower ratings than infants of non depressed mothers when interacting with a stranger. CONCLUSIONS: This would suggest that babies may learn to model the depressed behaviour of their mothers, and this is generalised to their interactions with others. This could indicate that depression is learned through social learning theory.
  • 2. Biological explanation for depression Key Study Polanczyk et al (2009) Protective Effect of CRHR1 Gene Variants on the Development of Adult Depression Following Childhood Maltreatment AIM: To find out whether a haplotype in a gene called corticotropin-releasing hormone receptor 1 gene (CRHR1) was associated with protection against adult depressive symptoms in individuals who were maltreated as children (as assessed by the Childhood Trauma Questionnaire [CTQ]). SAMPLE: Female participants were drawn from a longitudinal study that was being conducted called the E-Risk Study (N = 1116) who had been followed up to the age of 40 years. These participants had been assessed for maltreatment as children using the CTQ. Participants were from England. METHOD: Quasi experiment, with the independent variable being whether the participant had the haplotype in the CRHR1 gene or not. The dependent variable was the development of adult depression. A blood test would have been administered to test for the presence of the haplotype in the CRHR1 gene. MEASUREMENTS: Occurrence of depression in the past year and recurrent depression. FINDINGS: In the E-Risk Study, the presence of the CRHR1 was associated with a significant protective effect. In this effect, women who reported childhood maltreatment on the CTQ were protected against depression. CONCLUSION: From this it can be concluded that in a population of maltreated individuals, the development of depression will be lessened if that person has a haplotype in the presence of certain gene, CRHR1. This would suggest that there is a biological basis for the development of depression.
  • 3. EVALUATION OF POLANCZYK (2009) 1. How useful is this study? HINT: What applications to the real world can be made based on the findings of this study? 2. Is there anything about this study that makes it less useful? 3. Give 2 strengths and 2 weaknesses of the sample. 4. How reliable do you think the findings of this study are? Use evidence from the study to back up your point. 5. How valid are the findings from this study? 6. Can you think of any ethical problems arising from this study?
  • 4. Cognitive Explanations for Depression The cognitive approach is concerned with trying to explain behaviour by looking at our perception, language, attention, memory and through processes. Particular attention has been paid to the extent to which depressed individuals demonstrate ‘cognitive biases’ towards certain pictures and words, which the following study explored. To gain a better understanding, have a go at some of the attentional bias games yourself! (click on the resources icon in the top right hand corner) Joorman et al (2006) Selective Attention to Emotional Faces Following Recovery From Depression AIM: To determine whether there was attentional bias in the processing of emotional faces in currently and formerly depressed participants versus controls. SAMPLE: A mixture of formerly depressed people, currently depressed people and healthy controls. METHOD: A quasi experiment, with the independent variable being whether the participant was currently depressed, formerly depressed or a healthy control and the dependent variable being which facial expression (happy or sad) the participant paid most attention to. DESIGN: Snap shot, independent measures design. PROCEDURE: Using a specialised computer programme, researchers presented two faces at the same time to each participant, one of which displayed an emotion (either happy or sad), the other was an emotionally neutral stimulus. MEASURES: Attentional Bias: Specialised equipment monitored which facial expression the participant was paying most attention to. FINDINGS: Whereas both currently and formerly depressed participants selectively attended to the sad faces, the control participants selectively avoided the sad faces and oriented toward the happy faces, a positive bias that was not observed for either of the depressed groups. CONCLUSION: These results indicate that there is an attentional bias towards negative facial expressions in depressed and formerly depressed individuals which could provide a cognitive explanation that some people are ‘pre programmed’ to become depressed as they are more likely to focus on negative stimuli, which could ultimately affect their mood in a negative way.
  • 5. ALPHABET EVALUATION OF THE JOORMAN STUDY Using each letter in the alphabet to start your sentence, can you make an evaluative point about this study? A B C D E F G H I J K L M N O P Q R S T U W X Y Z
  • 6. Dear Deirdre, I’ve been feeling very down recently; I haven’t wanted to spend time with friends or family, I can’t concentrate at work and I keep staring into space. These days I don’t even want to get out of bed. I spoke with my doctor and he has said it sounds like I have depression. I have heard of this before, but can you tell me exactly what this is, and what has caused this? It seems to have come out of no where and I want to know why it has happened to me. From Down in Dundee YOUR TASK Using all the information you have been learning about in the categorising disorders and explanations of disorders bullet points, write back to this person explaining what depression is and what might have caused it. Include all three explanations in your letter.
  • 7. Can you summarise the Field et al study in 7 sentences? 1. 2. 3. 4. 5. 6. 7. Can you summarise the Polancyzk et al study in 7 sentences? 1. 2. 3. 4. 5. 6. 7. Can you summarise the Joorman et al study in 7 sentences? 1. 2. 3. 4. 5. 6. 7.
  • 8. Treatments for one Disorder- Affective- Depression Treatments of disorders is a contentious issue in that different psychologists define treatment differently. The issue surrounds whether we try and cure the organic cause, or whether we try and manage the symptoms so the individual can lead a normal life. Behavioural Treatments Behaviourist treatments for depression are based on the assumption that depressed behaviours are learned and therefore can be unlearned. The idea is that some people may be depressed because they are rewarded in sense that they receive a great deal of attention from their friends, family and their therapist. Expectations of them may be lowered and they may not need to work as a result they have compelling reasons to remain in depressed ‘state’. So the behaviourist would argue that the best course of treatment should be one that teaches the patient that they will be reinforced for non-depressive behaviours. An example of a behavioural treatment is called Token Economy which is when: Key Study Reisinger (1975) AIM: To find out whether a behavioural therapy: token economy, could be used to help treat an inpatient with a diagnosis of depression. She had previously failed all other types of treatment. METHOD: A case study PARTICIPANT: A white female, 20 years old who had been an inpatient for 6 years. PROCEDURE: The participant was informed of how she could gain or be fined tokens. She was instructed that the value of each token (poker chip) was such that it could be traded in to purchase better sleeping facilities, to watch television, to go on trips etc. The participant received a token from staff at the hospital when she was observed smiling. Social reinforcements were also given alongside the token such as ‘well done’. A fine, which resulted in the removal of a token was also applied in the participant cried.. Staff kept records of the tokens in a ‘bank account’ and the participant was allowed to trade in the tokens for desired things or to pay fines. In total, the procedure lasted 20 weeks, with various other more complex elements being introduced throughout the weeks. MEASUREMENTS: • The ‘Smiling Response’: a slight opening of the mouth and an upward turning of the lips. • The ‘Crying Response’: Tears coming from eyes for 5 – 30 minutes. Responses were recorded by staff, 3 x a day with each rating being a 2 hr maximum duration, arranged in conjunction with meal times. Observers were at least 10 ft away from the participant when making recordings. Inter-rater reliability was used with more than one person recording responses. A .95 coefficient was found across ratings. FINDINGS: At baseline, the participant was reported smiling 0 times a week, and crying 30 times a week. In the final week of treatment, the participant was recorded as smiling 27 times, and only crying 2 times. A follow up at 14 months indicated that the patient had no recommendation for hospitalisation or further treatment. CONCLUSIONS: The study would demonstrate that behavioural therapies can be very effective in the treatment of depression.
  • 9. Biological Treatments for Affective Disorders – Depression Biological treatments are probably the ones most people will think of when talking about treating depression. Antidepressants vary in their action, but all act upon the neurological system of the body, often varying the amount of neurotransmitters, such as serotonin, lack of which is associated with depression. Key Study Karp & Frank (1995) – Combination Therapy and the Depressed Woman Aim- To compare drug treatment and non-drug treatments for depression. Methodology – A review article of previous research into the effectiveness of single treatments and combined drug and psychotherapeutic treatments of depression. Participants – The research which was reviewed concentrated on women diagnosed with depression. There were nine pieces of research, from 1974 to 1992. 520 women took part in the selected studies. Design – Independent measures design was used in most of the studies, with patients either having single drug treatments, single psychological treatment, combined treatments and placebo treatments. Procedure – Depression was analysed using a variety of depression inventories, all patients were tested prior to actual treatment, they were also tested after treatment using the inventories and in some cases after a period of time as a follow up. Due to the nature of the study health practitioners were sometimes used to assess the patients. Findings – It was found that for most of the studies adding psychological treatments to drug therapy did not increase the effectiveness of the drug therapy. Occasionally studies did show that there was less attrition when combination therapies were used. This means that people were more likely to continue with treatment if cognitive therapy was given in addition to drug therapy. Conclusions- Although it would seem logical that two treatments are better than one, the evidence does not show any better outcomes for patients offered combined therapy as opposed to only drug therapy, showing the effectiveness of drug therapy on depression. Grave Evaluation Poem….
  • 10. Key Study Beck (1978) Aim – To compare the effectiveness of cognitive behavioural therapy and drug therapy Methodology – Controlled experiment with participants allocated to one of two conditions Design – Independent measures design with random allocation to cognitive therapy or drug therapy Participants – 44 patients diagnosed with moderate to severe depression attending psychiatric outpatients’ clinics. Procedure – Patients were assessed for depression using three self report measures: • Beck Depression Inventory • Hamilton Rating Scale • Rasking Scale For 12 weeks, participants had either a 1 hr cognitive therapy sessions twice a week or 100 Impramine capsules prescribed by a visiting Dr, once a weeks. The cognitive sessions were controlled and therapists were observed to ensure they were all delivering the therapy in the same way. Findings – Both groups showed significant decrease in depression symptoms on all three rating scales. The cognitive treatment group showed significantly higher improvements on self report and observer ratings of 78.9% compared to only 20% improvements for those on the drug therapy. In addition, the drop out rate was only 5% for the cognitive therapy group versus 32% for the drug therapy group. Conclusions – Cognitive Therapy leads to better treatment of depression than drug based therapies. In addition they also increase adherence to treatment compared to drug based therapies. Think about the following issues in relation to the above study…. GENERALISATIONS ETHICS RELIABILITY VALIDITY USEFULNESS ETHNOCENTRISM Design a marketing campaign to promote the use of the study using the above issues as strengths. You could make up a song, poem or jingle if you like!
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