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MOOD DISORDER - UNIPOLAR AND BIPOLAR, EXAMPLE STUDY - SELIGMAN ET AL…
MOOD DISORDER - UNIPOLAR AND BIPOLAR
EXPLANATIONS
BIOLOGICAL
Biochemical
- Suggest the role of different neurotransmitters like dopamine and serotonin. Say that brain chemistry is very complex
Dopamine
is a neurotransmitter that is responsible for the feeling
pleasure and motivation
. Research has found that people with depression have low levels of dopamine. Anti-depressants shown to reduce symptoms of depression by increasing the levels of dopamine and also
support the theory that low levels of dopamine are the cause of depression
Serotonin
is a neurotransmitter that is responsible for
regulating sleep and appetite
as well as mood and anxiety. When serotonin reduces, it results in low mood and changes in sleep and diet which is a common symptom of depression.
SSRI
is a common anti-depressant that increases levels of serotonin, therefore reducing symptoms of depressive disorder
Genetic
explanation suggests that the just like how physical illness can be inherited, mental disorders also have a base of genetic causes. First degree relatives share 50% of their DNA. Evidence suggests that there is "some" genetic explanation. GENETIC EXPLANATION -
ORUC ET AL
A biological explanation for mood disorders often shows the
nature
side of the debate because of the role of genetics and biochemicals. For example, in the study by
Oruc et al
they show genetic cause of developing bipolar disorder among females. However, this study completely ignores the nurture side of the debate , which suggests the environmental cause for mood disorder. While the two explanations seem to be countering, these 2 can interact as well. It can be suggested that a person might have a genetic predisposition to a mood disorder but this can be triggered by environmental influences
PSYCHOLOGICAL
BECKS COGNITIVE THEORY OF DEPRESSION
This theory suggests that a person with depression views things negatively and this becomes a reality for them. For example, if they think that they are not getting better they believe this to be true. This is due to
an underlying process of misinterpretation of information
as a result of negative experiences.
Cognitive distortion
is when a person tends to view things negatively as a result of negative experiences and leads to
NEGATIVE SCHEMAS
Since they have negative schemas, they views things around them negatively
SCHEMAS
are views that a person
knowledge about the world
and is shaped by experiences. As we learn and grow, this information gets categorized in out brain. Schemas become our underlie for cognitive processes such as
reasoning, perception and memory.
LEARNED HELPLESSNESS AND ATTRIBUTION STYLES
It is a person's state of mind when they are enduring an unpleasant situation and they feel like things are uncontrollable and inescapable.
This theory was proposed by
Seligman
who suggests that the symptoms of depression are
due to a lack of control over the outcomes
Learned Helplessness is linked to different
attributional styles
. Attribution is a
cognitive process
in which individuals explain their behaviors and events. This can be biased and incorrect as it depends on the person's experiences
Therefore, based on our experiences with the world, we develop a pattern of thinking and we attribute it to stimuli. For example, if a person endured a rough childhood they may tend to perceive a lack of control over negative events in their life and might have
negavtive attributional styles
BECKS COGNITIVE TRIAD
Negative Views of the World
- Obstacles that affect world
Diagnostic Criteria
- Mood disorders includes Bipolar disorder and Depressive disorder and includes different episodes like
manic, hypomanic, mixed and depressive
Bipolar disorder
TYPE 1
- Consists of
Mixed and Manic
episodes
Manic episodes
include feeling euphoric and high irritability and have high recklessness, impulsivity, rapid speech and change in mood
Mixed episodes
would include depressive and manic episodes. Both would last for 2 weeks and would include general episodes like feel guilty, worthless, etc.
Type 2
- Consists of
hypomanic
episodes with weeks of elevated mood and increased irritability along with increased energy.
It will be significantly different from their regular behavior but it does not affect their daily functioning.
Depressive disorder
-
Symptoms
- Depressed mood/ loss of pleasure along with the feeling worthless, guilt and changes in eating and sleeping pattern. There are
no
mixed and manic episodes
Single episodes with one episode and no history
Recurrent episodes
are 2 or more episodes that are separated for over a few months
Depressive episodes last for 2 weeks and are not due to medication.
MEASURES - BECK'S DEPRESSION INVENTORY (BDI)
21 item self report that assess the
symptoms
of depression
Patients are required to choose one statement out of 4 to best show how they feel.
The total score of the BDI shows the severity of the disorder. 10 being mild, 19-29 moderate and 30 or above severe.
The BDI is the most commonly used tool and has been updated twice. The current version is the BDI II.
It has
high reliability and validity
as it is a
quantitative measure
and this makes it
objective
However, it does not capture the details of understanding a person with depression.
Since it is a
self report
so there is a risk of validity
KEY STUDY - ORUC ET AL (1997)
CONTEXT
- Bipolar disorder is a very complex disorder and it is a combination of biological and psychological factors.
Psychological
factors include traumatic factors in the environment whereas
biological factors
involve the brain chemistry and genetics
Under
biological
factors, there are
3 neurotransmitters
that are associated with bipolar disorder and they are
dopamine, serotonin and non-adrenaline
Previous research shows that genetics is
at least partly
responsible for the
development
of bipolar but it is very difficult to find the specific gene combination that is responsible.
MAIN THEORIES AND EXPLANATION
-
Bipolar disorder is thought to be the
most likely psychological disorder to be inherited
as genetic factors make up
80%
chance for the
cause
of bipolar
However, it is very difficult to find specific genes that are responsible. One way to start investigating is to look at the neurotransmitters involved. Since we know the 3, we can look at the genes involved these neurochemical
pathways
Furthermore, researchers also suggests that since
low levels of serotonin are implied to be the origins of bipolar
, it's better to start looking at genetic factors in the serotonin levels (whether specific genetics variations and genes are linked to bipolar disorder)
AIM
- To investigate whether certain
serotonin receptors and transporters were responsible for the susceptibility of bipolar
DESIGN
42 unrelated patients were taken from Croatian hospitals and 16 of these p's had first degree relatives with mood disorders.
25 females
and
17 males
took part in the study between the ages
31-70
years old
MATCHED PAIR DESIGN
- 40 people in the control group and were compared based on their age and sex.
DNA testing
was carried to see if people with mood disorder had
polymorphism
in their genes. This is because any alteration in the genes could result in a disturbance in the biochemical pathways can be linked to depressive disorders.
RESULTS
There were no significant associations between the 2 samples and so P's with
bipolar
were
not more likely to have polymorphism
. This means that p's with a family history of mood disorders were also no more likely to have polymorphism
The researchers suggested that
serotonin was
sexually dimorphic
. So the p's were analyzed by gender and the found that
polymorphism was more common in women with bipolar
Therefore, this suggests that
polymorphism could be responsible for an increased risk of bipolar disorder in females only.
Sexually dimorphic
means that males and females of any species exhibit distinct differences in their features that are apart from reproductive organs. For example, lions have manes whereas lionesses do not.
EVALUATION
Small sample size
- Genetic studies require a larger sample, and this study needs more women
Less control of EV
BECAUSE researchers suggests that p's in the control group were TOO YOUNG to be potentially susceptible to bipolar so
age
is the EV
High Validity and Reliability
because the DNA resting was conducted in a Lab setting
Deterministic
- because it shows that individuals with a family history of bipolar are more likely to develop bipolar. HOWEVER, in this study, there is only a
small genetic susceptibility for females
INDICATING that there might be other causes
TREATMENTS
BIOLOGICAL
MAOI
Stands for Monoamine Oxidase Inhibitors and they prevent the breakdown of the neurotransmitters dopamine, serotonin and norepinephrine by the enzyme
monoamine oxidase
.
They allow them to remain in the brain in high levels.
They also have numerous side effects like headaches, nausea, vomiting, diarrhea, and constipation. They also interfere with other medications and cause negative effects like high BP and headaches. These kind of medications also have the issue of
withdrawal
and they are only used when other treatments were ineffective
TRICYCLICS
They were developed in the 1950's and are used only when other treatments were ineffective.
They work by increasing the levels of serotonin and norepinephrine and stop them from getting reabsorbed. When these levels increase, they reduce the symptoms of depression
They are effective but they have a lot of side effects like- drowsiness, nausea, vomiting, blurred vision, and weight gain.
SSRI
Stands for
Selective Serotonin Reuptake Inhibitors
and they work by stopping serotonin once it has crossed the synapse. This means that serotonin increases in the brain and it reduces the symptoms of depression.
SSRI generally have fewer and lesser side effects than Tricyclics and MAOI are the most commonly used anti-depressants.
Fewer side effects is important as it improves the patient's quality of life as side effects can stop the patient from their treatment. So they are more likely to continue their treatment. Studies have shown that tricyclics, MAOIs and SSRI are more effective treatments for depression than placebo and the improvement in most noticeable in patients with moderate to severe depression
PSYCHOLOGICAL
BECK'S COGNTIVE RESTRUCTURING
Becks cognitive restructuring aims gains "
control over a patient's cognitive organization
". It is a form of
talk therapy
between the patient and therapist and it involves various techniques like
questioning, identifying illogical thoughts and CHANGING PERSONS WAY OF THINKING.
STEP 1
-
The process begins by explaining Beck's cognitive theory along with the triad. This is important because it helps them to understand how their way of thinking is contributed or linked to the disorder.
Then the patients are taught to
observe and record
their thoughts as this will help them recognize their irrational thoughts
STEP 2
-
Once the patient can recognize these thoughts, the therapist makes them understand how these thoughts are linked to their thoughts and behavior and how this influences the others.
The patients are required to try to
catch
automatic and dysfunctional thoughts and record them. This is practiced outside therapy sessions because it is a skill to be applied in real life situations.
These thoughts can be challenged during therapy sessions, to see whether they are the actual reflection or not
STEP 3
-
The purpose of
reality testing
is to see whether patients are able to identify and recognize negative distortions of their thinking. Therapists use techniques like
reattributing
which is when they discuss whether the cause of their upsetting situation is experienced internally or externally.
This is useful as it reframes the patient's way of thinking over an upsetting situations.
-Therapy stops when a person is able to
use cognitive restructuring
in their daily life and see a reduction in their symptoms
Cognitive restructuring is shown to be a manageable and effective treatment for depressive disorder. In a study by
WILES ET AL
, 469 p's were randomly allocated into the usual care group and CBT group. The results showed that those in the CBT condition were three times more likely to respond to the treatment and showed a reduction in symptoms.
ELLI'S RATIONAL EMOTIVE BEHAVIOR THERAPY
It is a form of therapy based on the principles of
stoicism
.
Stoicism
is the principle which states that an individual is not directly affected by external things but rather their own perception of their experiences.
Albert Elli claimed this belief to be the core of his theory on how depression should be recognized and treated. He argued that the cause of depression is
an individual's own internal construction
(perception and attributions).
*WHAT HAPPENS IN REBT??
-
In REBT, an individual is explained the
ABC model
(just like how Beck explains cognitive theory and triad). The most important aspect is
B
which is the
beliefs about the event
.
The reason why B is important is because, while many people face adversities in their life, it is their own perception and views of the event that affects us.
A person how has fixed negative views is more likely to develop depressive disorder.
STEP 1
-
The goal of this therapy is to help people to
maintain a constructive and rational patterns of thinking.
They are supposed to identify and change thoughts that lead to guilt, self pity and other behaviors like withdrawal, addiction, etc.
This is done by a technique called
disputing
where therapists in REBT forcefully challenge irrational thoughts and
reformulate dysfunctional thoughts
.
EXPLANATION OF ABC MODEL
The therapist enables the patient to understand that whatever setback they might be experiencing, it is how they
choose
to act upon it.
The therapist also enable the patient to recognize that the
consequence
is only
partly responsible
as a result of
activating the event
.
The individual is taught to realize that negative thought about the event are
self destructing habits
and that they should replace it with healthier ones.
Ellis argues that the
tendency
to experience negative thoughts has been ingrained in that individual and REBT
focuses on the present moment experience
LYON AND WOODS
conducted a
meta-analysis
on 70 REBT outcome studies.
Meta-analysis
is when data from different studies about the same subject get combined and analyzed to get an understanding of the trends.
The researchers examined a total of 236 comparisons in baseline, control group and other psychotherapies.
The results showed that those who received REBT showed
significant improvement over baseline and control groups
BIOLOGICAL AND PSYCHOLOGICAL TREATMENTS
Biological treatment
- Cheaper than psychological and are easier. But come with a lot of side effects that might cause p's to discontinue their course of anti-depressants.
Psychological treatments
- Its time consuming and expensive. However, there are no side effects and can be used in long term situations. Psychological treatments also deal with the
actual cause
so in a way it treats the root cause.
EXAMPLE STUDY - SELIGMAN ET AL (1988)
Different attributional styles
Stable
- The negative events are going to be constant
Global
- Chance that more things are likely to go even more wrong
Internal
- They believe negative events are their fault
There were
39 p's with depression
and
12 patients with bipolar
Mix of the genders, all from the same outpatient clinic, had a mean age of 36 years
Compared to a non clinical group of 10 people --> Control group
All p's were supposed to complete a short form of the BDI to
assess the severity of symptoms
and also had to complete the
Attributional Style Questionnaire (ASQ)
which consisted of 12 hypothetical situations and p's were asked to make
casual attributions
about who or what was responsible for each event. They then had to rate all of this on a 7 point scale based on
internal, stability and globally
.
The aim of the study was to investigate whether different attributional styles could predict the symptoms of depression
RESULTS
Showed that people with unipolar and bipolar were
pessimistic and had a negative attributional style
. They tended to attribute situations with
themselves
(internal),
permanent
(stable), and
affecting many areas of their lifestyle
(global)
People with depression going to cognitive therapy were shown to have an
improved
attributional style with an
correlation
to
improved
attributional style as well as BDI scores.
RESEARCH METHOD AND DESIGN
The ASQ and BDI are
highly reliable and valid measures
The link between the BDI and ASQ was
correlational
so it is not possible to find a
cause and effect
relationship
Rather than the attributional styles predicting symptoms, an improvement in symptoms could predict the changes in attribution
Negative views about the future
- Whatever they do, they are going to face rejection
Negative views of oneself
- Feeling worthless and guilt