Depression and the cognitive model of emotional disorders
Diathesis-stress model
What are the 5 aspects in Padesky's model
what are the overall evaluations of the cognitive models?
Does rumination account for gender differences in depression?
But do depressed patients see events in a negative way?
interacting cognitive subsystems
does cognition have a causal effect on cognition?
What is the basic idea of cognitive behavioural therapy?
What is some more evidence to support response style theory of depression
Schema
What is the evidence for the hopelessness mode of depression? (Abraham, 80s; Rose, 90s)
What does the attributional reformation say is key? (Seligman, 70s)
what are some facts about depression?
what are some key characteristics of depression according to the DSM?
What study is the learned helplessness model of depression based on? Seligman (70s)
What is the idea behind Beck's cognitive model of depression (70s)
what are some factors associated with chronic depression?
What is the evidence for maladaptive attributional style? (Mezalis, 00s; Hu, 10s)
What are the characteristics of CBT?
what are the aims?
What are the three levels of cognitive structure?
What does the ruminative response scale measure? (Nolen)
meta cognitive model of depression (Nolen, 90s)
What is the evidence to support response style theory of depression (Nolen, 90s)
be aware of causal issues relating to cognition in depression
be aware of cognitive model for emotional disorders and the principles of CBT for depression
be familiar with cog models of depression
general rates have been changing over time
it is a recurrent disorder
that is is one of the most prevalent mental disorders
does prevalence rate vary cross culturally?
what is the estimated current prevalence in adults?
what is the USA life time prevalence rate?
30%
yes
how?
industrialised nations have a higher rate of depression than non - industrialised nations
4-10%
does prevalence vary depending on gender?
yes
how?
does prevalence vary depending on age?
yes
depression is 2/3 times more common in women than men
how?
it used to be most common in the middle-aged but now its more common in the young
what % of people who have already had a depressive episode will have another within the 10 years following?
50%
how?
they have been increasing
it has a high frequency of co-morbidity
with what in particular?
anxiety
it is often associated with the cluster c personality disorders
early life trauma
it has an early age of onset
in what form?
when in partiular?
adolescence - mid 20s
dysthymia
what is dysthymia?
persistant mild depression
what is the cluster c?
the anxious fearful cluster
what disorders does it include?
dependant
obsessive compulsive
avoidant
what types?
physical abuse
neglect
sexual abuse
loss of a parent
that you have a minimum of 5 of the following symptoms within a 2 week period. 1 must be either depressed mood or loss of interest / pleasure
psychomotor agitation / retardation
fatigue
insonmia / hypersomnia
feeling worthless or guilty
significant weight loss
loss of interest / pleasure
recurrent thoughts of death
depressed mood
diminished ability to think / concentrate / indecisiveness
symptoms don't meet criteria for another disorder
symptoms must cause distress or change normal functioning
symptoms are not directly due to substance or medication
that three levels of dysfunctional cognition characterise depression
what are they?
the cognitive triad (negative automatic thoughts about the self, world and future
faulty information processing
negative self schema
catastrophisisation
personalisation
black and white thinking
over generalisation
mind reading
what factors contribute to the development of a deppressenogenic schema?
Is the schema selective?
what is an example of measuring dysfunctional attitudes and schemata
What is a self -schema?
What is a schema?
a structure for coding and evaluation stimuli which enables categorisation and interpretation of experiences in a meaningful way
beliefs about the self
yes
what does this mean?
beliefs are retained despite disconfirming information
experience of loss eg parents / health
period of expecting loss
self-esteem lowering events eg bullying or critical parents
the dysfunctional attitudes scale (Beck)
animals were exposed to a shock which occurrence was either controllable or uncontrollable
what 3 changes in functioning were found?
cognitive deficits
emotional deficits
motivational deficits
how does depression arise?
from a perspective that important environmental changes cannot be controlled
perception of how events are caused is key
What is maladaptive attributional style?
the belief that negative events are attributed to internal stable causes
and positive events are attributed to external unstable causes
a large meta analysis found that controls have a self serving attributional style that patients with psychopathological disorders (esp depression) do not have
meta analysis showed overwhelming support of maladaptive attributional style in psychopathoolgy
some forms of depression are caused by hopelessness
hopeless cognitive styles correlate with personality disorders
What are participants who endorse emotion focused rumination less likely to engage in?
What is the ruminative response style?
Why do people ruminate?
What does distractive response style involve?
What is the rumination style?
What does the content of rumination represent?
behaviours and thoughts that repeatedly focus on attention on one's depressive symptoms and their implications
automatic negative thoughts
emotion focusing
to work out their problems
active structure problem solving
turning one's attention away from one's depressive symptoms and causes
What are effective distractive responses?
engrossing activities with a high probability of positive reinforcement, activity alone not enough
the frequency at which people think certain thoughts when depressed eg analysation
a study that induced a depressed state and then assigned participants to one of four conditions
ruminative passive
distractive passive
distractive active
read sentences focused on self-questioning and emotions
read factual sentences
sort country names according to industrialisation
ruminative active
sort positive and negative traits according to self-description
What did the study find?
distracting conditions lead to decreased depressed mood
activity will see more on a decrease in depressed mood than passive
R were more depressed than prior
DA group were less depressed than prior induction
depression rates are 2:1 women:men
Nolen found women are more likely to ruminate
when ruminations were partialed out gender differences disappeared
remination increases risk of depression
rumination correlates with self harm
men are more likely to fight off negative mood with distraction method
methods other than rumination lead to other pathologies
rumination predicts depression onset
rumination is a risk facto for other things too; eating disorder, substance abuse
rumination is a maladaptive emotion reaction an emotion dysregulation is an important cause of psychopathology
Craighead 70s
classified students as depressed or non-depressed
had them perform an ambiguous task
had positive feedback 30% or 70% of the time
Found
depressed recalled less positive feedback than non dep
depressed recalled negative feedback more accurately than non dep
depressed remember negative memories quicker
when encoding negative words and relating them to themselves, depressed had better recall
meta analyses overwhelming conclusion that depressed report more neg cognition, dysfunctional attitudes
dysfunctional cognition remains after depression is in remission
higher levels of dysfunctional cognition correlates with more likely relapse following recoevry
most studies show cognitive style of recovered do not differ from non-depressed
is there a cognitive vulnerability?
What is the Diathesis stress model?
Beck said depressenogenic schema lays dormant until triggered by event
you're only vulnerable when negative cognitions are triggered
What did Miranda 80s find about patients with a history of depression?
no history vs history of depression
mood induction
low mood positively correlates with dysfunctional attitudes in pps with history and not with the ones with no history
What did Dent 80s find about negativity of cognitions?
who remains depressed can be predicted by negativity of cognitions during depression
what did Segal 00s find about CBT vs pharmacotherapy?
CBT treated depressed have less of an increase in dysfunctional attitudes than drug treated post sad mood induction
What did Teasdale 90s find about cognitive response to depressed mood and stressors?
that there are individual differences in the extent to and what negative thinking processes are activated depending on mood and stressors
cognition is important in understanding depressive reactions to stressful events
there is substancial evidence to support the cognitive vulnerability hypothesis
the extent to which extreme global and negative views about the self are elevated by stressful events and low mood determines vulnerability to depression
perhaps too much emphasis is given to cognition and the social content is overlooked somewhat
event
interpretation/meaning
emotion
neighbour eg
feelings
behaviour
biology
thoughts
environment
Core beliefs (schemas)
What are the goals of CBT?
negative automatic thoughts
core beliefs
assumptions
What are core beliefs?
What does activation of core beliefs result in?
How do the "rules" work?
What are the in nature?
if... then... - they guide daily actions
absolute
high emotion with persistant repetitive bias themes in thoughts
deep cognitive structures representing how we understand self, world and others
help client construct a more balanced view of self, world, future
construct a model of the interactions between thought, feeling, biology, and behaviour
change links that maintain issues
uses socratic questioning
empirical approach
involves frequent feedback
goal driven
collaborative
What are the general principles of CBT for depression?
collaborative: work together for common goals
use of experiments
highly structred eg homework
socratic questioning
provide rationale to understand problems
What are the key techniques for CBT in depression?
behavioural changes, changing hyppthesis
cognitive change, addressing thinking errors, guided discovery, allows to test the role of thinking
examples, daily diary, though records
how does CBT tackle specific cognitive distortions?
catastrophising - whats the worst?
overgeneralising - be specific
mind reading - ask self evidence?
labelling - doesn't mean that
self-blame - don't
cant stand it - can
filtering - consider whole picture
black and white thinking - look for grey
What are some techniques in cognitive therapy?
change rules / core beliefs
role play to explore changes in behaviour and changes in feelings
how is depressed mood measured?
BDI
HADS
What does CBT today look like?
mindfulness based
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