disorders of mood lecture slides psych 255
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Comer, Fundamentals ofAbnormal Psychology, 7e
Disorders of Mood
Chapter 6
Slides & Handouts by Karen Clay Rhines, Ph.D.
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Disorders of Mood
#here are t$o %ey emotions in mooddisorders
Depression 'o$, sad state in $hi!h life seems dar% and
its !hallen"es o(er$helmin"
)ania State of breathless euphoria or fren*ied
ener"y
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Disorders of Mood
People $ith depressi(e disorders su+eronly from depression, a pattern !alledunipolar depression
Person has no history of mania
)ood returns to normal $hen depressionlifts
n !ontrast, those $ho display bipolardisorders e-perien!e periods of maniathat alternate $ith periods of depression
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4Comer, Fundamentals of bnormal
Psy!holo"y, 7e
Disorders of Mood
)ood problems ha(e al$ays!aptured peoples interest
)illions of people ha(e mood disorders /!onomi! !osts of mood disorders
amount to many billions of dollars ea!h
year #he human su+erin" is beyond
!al!ulation
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5Comer, Fundamentals of bnormal
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Unipolar Depression
#he term 0depression1 is often usedto des!ribe "eneral sadness orunhappiness
#his loose use of the term !onfuses anormal mood s$in" $ith a !lini!alsyndrome
Clini!al depression !an brin" se(ereand lon"2lastin" psy!holo"i!al painthat may intensify as time "oes by
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How Common IsUnipolar Depression?
round 34 of adults in the 5.S. su+er fromse(ere unipolar depression in any "i(en year s many as 4 su+er from mild forms
round 84 of all adults e-perien!e unipolardepression at some time in their li(es
#he pre(alen!e is similar in Canada,/n"land, Fran!e, and many other !ountries
#he rate of depression is hi"her amon" poorpeople than $ealthier people
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How Common Is UnipolarDepression?
9omen are at least t$i!e as li%ely as men toe-perien!e se(ere unipolar depression
'ifetime pre(alen!e :64 of $omen (s. :4 of
men mon" !hildren, the pre(alen!e is similar amon"
boys and "irls
ppro-imately 34 of people $ith unipolar
depression re!o(er, some $ithout treatment round ;
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What Are the Symptoms ofDepression?
Symptoms may (ary from person to person
Fi(e main areas of fun!tionin" may bea+e!ted /motional symptoms
Feelin" 0miserable,1 0empty,1 0humiliated1
/-perien!in" little pleasure
)oti(ational symptoms 'a!%in" dri(e, initiati(e, spontaneity
=et$een 64 and 4 of those $ith se(eredepression die by sui!ide
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What Are the Symptoms ofDepression?
Fi(e main areas of fun!tionin" may bea+e!ted =eha(ioral symptoms
'ess a!ti(e, less produ!ti(e
Co"niti(e symptoms Hold ne"ati(e (ie$s of themsel(es
=lame themsel(es for unfortunate e(ents
Pessimisti!
Physi!al symptoms Heada!hes, di**y spells, "eneral pain
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Diagnosing UnipolarDepression
major depressive episode is aperiod of t$o or more $ee%s mar%ed
by >(e or more symptoms ofdepression
n e-treme !ases, symptoms arepsy!hoti!, in!ludin"
Hallu!inations
Delusions
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Diagnosing UnipolarDepression
DS)2 lists se(eral types ofdepressi(e disorders
)a?or depressi(e disorder People $ho e-perien!e a ma?or depressi(e
episode $ith no history of mania
Dysthymi! disorder
ndi(iduals $ho e-perien!e a lon"er2lastin"@at least t$o yearsA but less disablin" patternof depression
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Diagnosing UnipolarDepression
DS)2 lists se(eral types of depressi(edisorders
Premenstrual dysphori! disorder
dia"nosis "i(en to $omen $ho repeatedlye-perien!e !lini!ally si"ni>!ant depressi(esymptoms durin" the $ee% before menstruation
Disrupti(e mood re"ulation disorder
Chara!teri*ed by a !ombination of persistentdepressi(e symptoms and re!urrent outbursts ofse(ere temper
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Stress andUnipolar Depression
Stress may be a tri""er for depression
People $ith depression e-perien!e a
"reater number of stressful life e(entsdurin" the month ?ust before the onset oftheir symptoms
Some !lini!ians distin"uish rea!ti(e
@e-o"enousA depression from endo"enousdepression, $hi!h seems to be a responseto internal fa!tors
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Stress andUnipolar Depression
#odays !lini!ians usually !on!entrateon re!o"ni*in" both the situational
and the internal aspe!ts of any "i(en!ase
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The Biological Model ofUnipolar Depression
/(iden!e from "eneti!, bio!hemi!al,anatomi!al, and immune system
studies su""ests that unipolardepression has biolo"i!al !auses
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The Biological Model ofUnipolar Depression
Beneti! fa!tors
Family pedi"ree, t$in, adoption, and
mole!ular biolo"y "ene studies su""estthat some people inherit a biolo"i!alpredisposition
Resear!hers ha(e found that as many as
:
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The Biological Model ofUnipolar Depression
Beneti! fa!tors
#$in studies demonstrate a stron" "eneti!!omponent
Con!ordan!e rates for identi!al @)A t$ins ;64
Con!ordan!e rates for fraternal @DA t$ins :! "enes
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The Biological Model ofUnipolar Depression
=io!hemi!al fa!tors #s serotonin and norepinephrine
n the 8rmed the # role
Depression li%ely in(ol(es not ?ust serotonin nornorepinephrineG a !ompli!ated intera!tion is at$or%, and other #s may be in(ol(ed
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The Biological Model ofUnipolar Depression
=io!hemi!al fa!tors
/ndo!rine system hormone release
People $ith depression ha(e been found to ha(e
abnormal le(els of !ortisol Hormone released by the adrenal "lands durin" times of
stress
People $ith depression ha(e been found to ha(eabnormal melatonin se!retion
0Dra!ula hormone1
Ither resear!hers are in(esti"atin" de>!ien!ies ofimportant proteins $ithin neurons as tied todepression
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The Biological Model ofUnipolar Depression
=io!hemi!al fa!tors
)odel has produ!ed mu!h enthusiasm buthas !ertain limitations
Relies on analo"ue studies depression2li%esymptoms !reated in lab animals
Do these symptoms !orrelate $ith human emotionsJ
)easurin" brain a!ti(ity has been di!ult andindire!t
Current studies usin" ne$er te!hnolo"y areattemptin" to address this issue
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The Biological Model ofUnipolar Depression
=rain anatomy and brain !ir!uits =iolo"i!al resear!hers ha(e determined that
emotional rea!tions of (arious %inds are tied to
brain !ir!uits #hese are net$or%s of brain stru!tures that $or%
to"ether, tri""erin" ea!h other into a!tion andprodu!in" a parti!ular %ind of emotional rea!tion
lthou"h resear!h is far from !omplete, a
!ir!uit responsible for unipolar depression hasbe"un to emer"e 'i%ely brain areas in the !ir!uit in!lude the prefrontal
!orte-, hippo!ampus, amy"dala, and =rodmann rea:
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The Biological Model ofUnipolar Depression
mmune System
#his system is the bodys net$or% of
a!ti(ities and !ells that >"ht o+ ba!teriaand other forei"n in(aders
9hen stressed, the immune system maybe!ome dysre"ulated, $hi!h somebelie(e may help produ!e depression
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What Are the Biological
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What Are the BiologicalTreatments for Unipolar
Depression?
5sually biolo"i!al treatment meansantidepressant dru"s, but for
se(erely depressed indi(iduals $hodo not respond to other forms oftreatment, it sometimes in!ludesele!tro!on(ulsi(e therapy or brain
stimulation
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What Are the BiologicalTreatments for Unipolar
Depression?
/le!tro!on(ulsi(e therapy @/C#A
Ine of the most !ontro(ersial forms of
treatment #he pro!edure !onsists of tar"eted
ele!tri!al stimulation to !ause a brainsei*ure
#he usual !ourse of treatment is 6 to :sessions spa!ed o(er : to ; $ee%s
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What Are the BiologicalTreatments for Unipolar
Depression?
/le!tro!on(ulsi(e therapy @/C#A
#he dis!o(ery of the e+e!ti(eness of /C# $asa!!idental
#he pro!edure has been modi>ed in re!entyears to redu!e some of the ne"ati(e e+e!ts
For e-ample, patients are "i(en mus!le rela-ants
and anestheti!s before and durin" the pro!edure Patients "enerally report some memory loss
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What Are the BiologicalTreatments for Unipolar
Depression?
/le!tro!on(ulsi(e therapy @/C#A
/C# is !learly e+e!ti(e in treatin" unipolar
depression, but it has been di!ult todetermine $hy /C# $or%s so $ell
Studies >nd impro(ement in 6
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What Are the BiologicalTreatments for Unipolar
Depression?
ntidepressant dru"s
n the 8
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What Are the BiologicalTreatments for Unipolar
Depression?
ntidepressant dru"s )I inhibitors Iri"inally used to treat #=, do!tors noti!ed
that the medi!ation seemed to ma%e patients
happier #he dru" $or%s bio!hemi!ally by slo$in"
do$n the bodys produ!tion of )I )I brea%s do$n norepinephrine
)I inhibitors stop this brea%do$n from o!!urrin"
#his leads to a rise in norepinephrine a!ti(ity and aredu!tion in depressi(e symptoms
ppro-imately half of patients $ho ta%e these dru"s arehelped by them
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What Are the BiologicalTreatments for Unipolar
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ntidepressant dru"s )I inhibitors
)I inhibitors pose a potential dan"er
People $ho ta%e )Is e-perien!e adan"erous rise in blood pressure if they eatfoods !ontainin" tyramine @!heese, bananas,$ineA
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What Are the BiologicalTreatments for Unipolar
Depression?
ntidepressant dru"s #ri!y!li!s
n sear!hin" for medi!ations for
s!hi*ophrenia, resear!hers dis!o(eredthat imipramine relie(ed depressi(esymptoms
mipramine and related dru"s are %no$n as
tri!y!li!s be!ause they share a three2rin"mole!ular stru!ture
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What Are the BiologicalTreatments for Unipolar
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ntidepressant dru"s #ri!y!li!s
Hundreds of studies ha(e found that
depressed patients ta%in" tri!y!li!s ha(eimpro(ed mu!h more than similarpatients ta%in" pla!ebos
Dru"s must be ta%en for at least < days
before su!h impro(ement is seen
bout 6nd symptomimpro(ement
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What Are the BiologicalTreatments for Unipolar
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ntidepressant dru"s #ri!y!li!s
)ost patients $ho immediately stop
ta%in" tri!y!li!s upon relief of symptomsrelapse $ithin one year
Patients $ho ta%e tri!y!li!s for >(eadditional months @0maintenan!e therapy1A
ha(e a si"ni>!antly de!reased ris% of relapse
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Depression? ntidepressant dru"s #ri!y!li!s
#ri!y!li!s are belie(ed to redu!e depression bya+e!tin" neurotransmitter @#A reupta%eme!hanisms
#o pre(ent an # from remainin" in the synapse too lon",a pumpli%e me!hanism re!aptures the # and dra$s itba!% into the presynapti! neuron
#he reupta%e pro!ess appears to be too e!ient in somepeople, dra$in" in too mu!h of the # from the synapse
#his redu!tion in # a!ti(ity in the synapse is thou"ht toresult in !lini!al depression
#ri!y!li!s blo!% the reupta%e pro!ess, thus in!reasin" #a!ti(ity in the synapse
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What Are the BiologicalTreatments for Unipolar
Depression? Se!ond2"eneration antidepressants
third "roup of e+e!ti(e antidepressant dru"s isstru!turally di+erent from the )I inhibitors andtri!y!li!s
)ost of the dru"s in this "roup are labeled sele!ti(eserotonin reupta%e inhibitors @SSRsA
#hese dru"s in!rease serotonin a!ti(ity spe!i>!ally@no other #s are a+e!tedA
#his !lass in!ludes Muo-etine @Pro*a!A, sertraline @oloftA,
and es!italopram @'e-aproA Sele!ti(e norepinephrine reupta%e inhibitors and
serotonin2norepinephrine reupta%e inhibitors arealso no$ a(ailable
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What Are the BiologicalTreatments for Unipolar
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Se!ond2"eneration antidepressant dru"s n e+e!ti(eness and speed of a!tion of these
dru"s are on a par $ith the tri!y!li!s, yet theirsales ha(e s%yro!%eted Clini!ians often prefer these dru"s be!ause it is harder
to o(erdose on them than on other %inds ofantidepressants
#here are no dietary restri!tions li%e there are $ith)I inhibitors
#hey ha(e fe$er side e+e!ts than the tri!y!li!s
#hese dru"s may !ause some undesired e+e!tsof their o$n, in!ludin" a redu!tion in se- dri(e
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What Are the BiologicalTreatments for Unipolar
Depression?
s popular as antidepressant dru"sare, it is important to re!o"ni*e thatthey do not $or% for e(eryone
/(en the most su!!essful of them failsto help at least N per!ent of !lients$ith depression
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What Are the BiologicalTreatments for Unipolar
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=rain stimulation
n re!ent years, three additional
biolo"i!al approa!hes ha(e beende(eloped
Oa"us ner(e stimulation
#rans!ranial ma"neti! stimulation
Deep brain stimulation
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What Are the BiologicalTreatments for Unipolar
Depression?
Oa"us ner(e stimulation
Depression resear!hers surmised they mi"htbe able to stimulate the brain by ele!tri!allystimulatin" the (a"us ner(e throu"h the useof a pulse "enerator implanted under thes%in of the !hest
Resear!h has found that the pro!edurebrin"s si"ni>!ant relief to as many as ;
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What Are the BiologicalTreatments for Unipolar
Depression?
#rans!ranial ma"neti! stimulation nother te!hniEue desi"ned to stimulate the
brain $ithout the undesired e+e!ts of /C#,
#)S has been found to redu!e depression$hen administered daily for : to ; $ee%s
Deep brain stimulation #heori*in" a 0depression s$it!h1 lo!ated
deep $ithin the brain, resear!hers ha(esu!!essfully e-perimented $ith ele!trodeimplantation in the brains =rodman rea : Resear!h is in its earliest sta"es
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sychological Models ofUnipolar Depression
#hree main models
Psy!hodynami! model
o stron" resear!h support
=eha(ioral model
)odest resear!h support
Co"niti(e (ie$s Considerable resear!h support
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sychological Models ofUnipolar Depression
Psy!hodynami! model 'in% bet$een depression and "rief
9hen a lo(ed one dies, an un!ons!ious pro!essbe"ins and the mourner re"resses to the oral sta"eand mer"es his or her identity $ith that of the lostperson, symboli!ally re"ainin" the lost person
For most people, this rea!tion is temporary
For some, "rief $orsens o(er time if "rief is se(ere andlon"2lastin", depression results
nstead of a!tual loss, some people e-perien!e0symboli!1 @or ima"inedA loss instead
e$er psy!hoanalysts @ob?e!t relations theoristsApropose that depression results $hen peoplesrelationships lea(e them feelin" unsafe and inse!ure
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sychological Models ofUnipolar Depression
Psy!hodynami! model
Studies ha(e o+ered "eneral support forthe psy!hodynami! idea that depression
may be tri""ered by a ma?or loss Resear!h supports the theory that early
losses set the sta"e for later depression
Ho$e(er, resear!h does not indi!ate thatloss is al$ays at the !ore of depression andnot all studies >nd e(iden!e bet$een!hildhood loss and later depression
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sychological Models ofUnipolar Depression
Psy!hodynami! treatment
Psy!hodynami! therapists use the same
basi! pro!edures for all psy!holo"i!aldisorders
Free asso!iation
#herapist interpretation
Re(ie$ of past e(ents and feelin"s
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sychological Models ofUnipolar Depression
Psy!hodynami! treatment
Despite su!!essful !ase reports, resear!hers ha(efound that lon"2term psy!hodynami! therapy is onlyo!!asionally helpful in !ases of unipolar depression
#$o features may be parti!ularly limitin"
Depressed !lients may be too passi(e or $eary to fullyparti!ipate in subtle therapy dis!ussions
Depressed !lients may be!ome dis!oura"ed and end
treatment too early $hen treatment is unable to pro(ideEui!% relief
Short2term approa!hes ha(e performed better thantraditional approa!hes
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sychological Models ofUnipolar Depression
=eha(ioral model Depression results from !han"es in re$ards
and punishments people re!ei(e in their
li(es 'e$insohn su""ests that the positi(e re$ards in
life d$indle for some people, leadin" them toperform fe$er and fe$er !sonstru!ti(e beha(iors,and they spiral to$ard depression
Resear!h supports the relationship bet$eenthe number of re$ards re!ei(ed and thepresen!e or absen!e of depression So!ial re$ards are espe!ially important
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sychological Models ofUnipolar Depression
=eha(ioral treatment
=eha(ioral therapists use a (ariety of
strate"ies to help in!rease the numberof re$ards e-perien!ed by their !lients
Reintrodu!e !lients to pleasurable a!ti(itiesand e(ents, often usin" a $ee%ly s!hedule
ppropriately reinfor!e their depressi(e andnondepressi(e beha(iors
Help them impro(e their so!ial s%ills
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sychological Models ofUnipolar Depression
=eha(ioral treatment
#he beha(ioral te!hniEues seem to be ofonly limited help $hen ?ust one of them isapplied
9hen t$o or more of the te!hniEues are!ombined, beha(ioral treatment does seem toredu!e depressi(e symptoms, parti!ularly if mild
t is $orth notin" that 'e$insohn himself has!ombined beha(ioral te!hniEues $ith !o"niti(estrate"ies in re!ent years
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sychological Models ofUnipolar Depression
Co"niti(e model
#$o main theories
'earned helplessness e"ati(e thin%in"
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sychological Models ofUnipolar Depression
Co"niti(e model
'earned helplessness
#his theory asserts that people be!omedepressed $hen they thin% that
#hey no lon"er ha(e !ontrol o(er thereinfor!ements @re$ards and punishmentsA intheir li(es
#hey themsel(es are responsible for this helplessstate
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sychological Models ofUnipolar Depression
Co"niti(e model
'earned helplessness
#heory is based on Seli"mans $or% $ith laboratory
do"s
Do"s sub?e!ted to un!ontrollable sho!% $ere later pla!edin a shuttle bo-
/(en $hen presented $ith an opportunity to es!ape,do"s that had e-perien!ed un!ontrollable sho!%s madeno attempt to do so
Seli"man theori*ed that the do"s had 0learned1 to be0helpless1 to do anythin" to !han"e ne"ati(e situations,and dre$ parallels to human depression
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sychological Models ofUnipolar Depression
Co"niti(e model
'earned helplessness
#here has been si"ni>!ant resear!h supportfor this model
Human sub?e!ts $ho under"o helplessnesstrainin" s!ore hi"her on depression sur(eys
nimal sub?e!ts lose interest in se- and so!iala!ti(ities
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sychological Models ofUnipolar Depression
Co"niti(e model 'earned helplessness
Re!ent (ersions of the theory fo!us on attributions
Internalattributions that are globaland stablelead to"reater feelin"s of helplessness and possibly depression
/-ample 0 am inadeEuate at e(erythin" and al$ays $ill be.1
f people ma%e other %inds of attributions, this rea!tionis unli%ely
/-ample 0She ne(er did %no$ $hat she $anted1Qe-ternal, but 0#he $ay (e beha(ed the past!ouple $ee%s ble$ this relationship1 Qspe!i>!. 0dont usually a!t li%e that1 Qunstable.
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sychological Models ofUnipolar Depression
Co"niti(e model
'earned helplessness
Some theorists ha(e re>ned thehelplessness model yet a"ain in re!entyears they su""est that attributions areli%ely to !ause depression only $hen theyfurther produ!e a sense of hopelessnessinan indi(idual
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sychological Models ofUnipolar Depression
Co"niti(e model
'earned helplessness
lthou"h this theory has been (eryinMuential, it has imperfe!tions
)u!h of the resear!h relies on animal sub?e!ts
#he attributional !omponent of the theory raises
parti!ularly di!ult Euestions, espe!ially in termsof animal models of depression
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sychological Models ofUnipolar Depression
Co"niti(e model
e"ati(e thin%in"
=e!% theori*es four interrelated !o"niti(e!omponents !ombine to produ!e unipolardepression
. )aladapti(e attitudes
Self2defeatin" attitudes are de(eloped durin"
!hildhood
=e!% su""ests that upsettin" situations later in life!an tri""er an e-tended round of ne"ati(e thin%in"
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sychological Models ofUnipolar Depression
Co"niti(e model
:. #his ne"ati(e thin%in" typi!ally ta%es
three forms, !alled the !o"niti(e triad ndi(iduals repeatedly interpret @A their
e-perien!es, @:A themsel(es, and @NA theirfutures in ne"ati(e $ays, leadin" to
depression
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sychological Models ofUnipolar Depression
Co"niti(e model
e"ati(e thin%in"
N. Depressed people also ma%e errors in their
thin%in", in!ludin"
rbitrary inferen!es
)inimi*ation of the positi(e and ma"ni>!ation of thene"ati(e
;. Depressed people also e-perien!e automati!thou"hts
steady train of unpleasant thou"hts that su""estinadeEua!y and hopelessness
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sychological Models ofUnipolar Depression
Co"niti(e model
)any studies ha(e produ!ed e(iden!e in
support of=e!%s e-planation
Hi"h !orrelation bet$een the le(el of depressionand the number of maladapti(e attitudes held
=oth the !o"niti(e triad and errors in lo"i! are
seen in people $ith depression utomati! thin%in" has been lin%ed to
depression
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sychological Models ofUnipolar Depression
Co"niti(e treatments
=e!%s !o"niti(e therapy L $hi!h in!ludes a numberof beha(ioral te!hniEues L is desi"ned to help!lients re!o"ni*e and !han"e their ne"ati(e
!o"niti(e pro!esses #his approa!h follo$s four phases and usually lasts
fe$er than :< sessions
Phases
. n!reasin" a!ti(ities and ele(atin" mood
:. Challen"in" automati! thou"hts
N. dentifyin" ne"ati(e thin%in" and biases
;. Chan"in" primary attitudes
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sychological Models ofUnipolar Depression
Co"niti(e treatments I(er the past se(eral de!ades, hundreds of
studies ha(e sho$n that !o"niti(e therapyhelps unipolar depression round
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The Socioc!lt!ral Model ofUnipolar Depression
So!io!ultural theorists propose thatunipolar depression is "reatly inMuen!edby the so!ial !onte-t that surrounds
people #his belief is supported by the >ndin" that
depression is often tri""ered by outsidestressors
#here are t$o %inds of so!io!ultural (ie$s #he family2so!ial perspe!ti(e
#he multi!ultural perspe!ti(e
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The Socioc!lt!ral Model ofUnipolar Depression
#he Family2So!ial Perspe!ti(e #he belief in the !onne!tion bet$een de!linin"
so!ial re$ards and depression @as dis!ussedby the beha(ioristsA is !onsistent $ith theFamily2So!ial Perspe!ti(e Depression has been tied repeatedly to the
una(ailability of so!ial support People $ho are separated or di(or!ed display three
times the depression rate of married or $ido$ed persons
and double the rate of people $ho ha(e ne(er beenmarried
t also appears that people $ho are isolated and $ithoutintima!y are parti!ularly li%ely to be!ome depressed intimes of stress
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The Socioc!lt!ral Model ofUnipolar Depression
Family2So!ial #reatments
#herapists $ho use family and so!ialapproa!hes help depressed !lients!han"e their approa!h to !loserelationships in their li(es
#he most e+e!ti(e family2so!ial
approa!hes are interpersonalpsy!hotherapy and !ouple therapy
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The Socioc!lt!ral Model ofUnipolar Depression
Family2So!ial #reatments
nterpersonal therapy @P#A
#his model holds that four interpersonal
problems may lead to depression and must beaddressed
nterpersonal loss
nterpersonal role dispute
nterpersonal role transition nterpersonal de>!its
Studies su""est that P# is as e+e!ti(e as!o"niti(e therapy for treatin" depression
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The Socioc!lt!ral Model ofUnipolar Depression
Family2So!ial #reatments
Couple therapy
#he main type of !ouple therapy isbeha(ioral marital therapy @=)#A
Fo!us is on de(elopin" spe!i>! !ommuni!ationand problem2sol(in" s%ills
f marria"e is >lled $ith !onMi!t, =)# is ase+e!ti(e as other therapies for redu!in"depression
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The Socioc!lt!ral Model ofUnipolar Depression
#he )ulti!ultural Perspe!ti(e
#$o issues ha(e !aptured the interest ofmulti!ultural theorists
Bender and depression
stron" lin% e-ists bet$een "ender anddepression
9omen !ross2!ulturally are t$i!e as li%ely as mento re!ei(e a dia"nosis of unipolar depression
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The Socioc!lt!ral Model ofUnipolar Depression
#he )ulti!ultural Perspe!ti(e
(ariety of theories has been o+ered
#he artifact theory holds that $omen and menare eEually prone to depression, but that!lini!ians often fail to dete!t depression in men
#he hormone explanation holds that hormone!han"es tri""er depression in many $omen
#he life stress theory su""ests that $omen inour so!iety e-perien!e more stress than men
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The Socioc!lt!ral Model ofUnipolar Depression
#he )ulti!ultural Perspe!ti(e
(ariety of theories has been o+ered
#he body dissatisfaction explanation states that
females in 9estern so!iety are tau"ht, almostfrom birth, to see% a lo$ body $ei"ht andslender body shape L "oals that areunreasonable, unhealthy, and often unattainable
#he lack-of-control theory pi!%s up the learnedhelplessness resear!h and ar"ues that $omenmay be more prone to depression be!ause theyfeel less !ontrol than men o(er their li(es
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The Socioc!lt!ral Model ofUnipolar Depression
#he )ulti!ultural Perspe!ti(e
(ariety of theories has been o+ered
#he rumination theory holds that people$ho ruminate $hen sad L %eep fo!usin" ontheir feelin"s and repeatedly !onsider the!auses and !onseEuen!es of theirdepression L are more li%ely to be!omedepressed and stay depressed lon"er
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The Socioc!lt!ral Model ofUnipolar Depression
#he )ulti!ultural Perspe!ti(e
/a!h e-planation o+ers food for thou"htand has "athered ?ust enou"hsupportin" e(iden!e to ma%e itinterestin" @and ?ust enou"h !ontrarye(iden!e to raise Euestion about its
usefulnessA
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The Socioc!lt!ral Model ofUnipolar Depression
#he )ulti!ultural Perspe!ti(e
#$o issues ha(e !aptured the interest ofmulti!ultural theorists
Cultural ba!%"round and depression
Depression is a $orld$ide phenomenon, and!ertain symptoms seem to be !onstant a!ross all!ountries, in!ludin" sadness, ?oylessness, an-iety,tension, la!% of ener"y, loss of interest, and
thou"hts of sui!ide
=eyond su!h !ore symptoms, resear!h su""eststhat the pre!ise pi!ture of depression (aries from!ountry to !ountry
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The Socioc!lt!ral Model ofUnipolar Depression
#he )ulti!ultural Perspe!ti(e
Depressed people in non29estern!ountries are more li%ely to be troubledby physi!al symptoms of depressionthan by !o"niti(e ones
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The Socioc!lt!ral Model ofUnipolar Depression
#he )ulti!ultural Perspe!ti(e 9ithin the 5nited States, resear!hers ha(e
found fe$ di+eren!es in depression symptomsamon" members of di+erent ethni! or ra!ial
"roups or amon" o(erall rates of depression Ho$e(er, often stri%in" di+eren!es e-ist
bet$een ra!ialethni! "roups in the recurrenceof depression
Hispani! meri!ans and fri!an meri!ans are ndin" possibly related tolimited treatment opportunities
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The Socioc!lt!ral Model ofUnipolar Depression
#he )ulti!ultural Perspe!ti(e
Resear!h also has re(ealed thatdepression is distributed une(enly$ithin some minority "roups
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The Socioc!lt!ral Model ofUnipolar Depression
)ulti!ultural treatments
Culture2sensiti(e see% to address theuniEue issues fa!ed by members of!ultural minority "roups
#hey in!lude spe!ial !ultural trainin" oftherapists, hei"htened a$areness of !ultural(alues, stressors, and pre?udi!es fa!ed by!lients, and e+orts by therapists to help!lients re!o"ni*e the impa!t of !ulture ontheir self2(ie$s
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The Socioc!lt!ral Model ofUnipolar Depression
)ulti!ultural treatments
Culture2sensiti(e approa!hesin!reasin"ly are bein" !ombined $ithtraditional forms of psy!hotherapy tohelp impro(e the li%elihood of minority!lients o(er!omin" their disorders
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Bi l Di d
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Bipolar Disorders
People $ith a bipolar disordere-perien!e both the lo$s ofdepression and the hi"hs of mania
)any des!ribe their li(es as anemotional roller !oaster
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What Are the Symptoms ofMania?
5nli%e those e-perien!in" depression, peoplein a state of mania typi!ally e-perien!edramati! and inappropriate rises in mood anda!ti(ity
Fi(e main areas of fun!tionin" may be a+e!ted
/motional symptoms
!ti(e, po$erful emotions in sear!h of outlet
)oti(ational symptoms eed for !onstant e-!itement, in(ol(ement,
!ompanionship
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What Are the Symptoms ofMania?
Fi(e main areas of fun!tionin" may bea+e!ted
=eha(ioral symptoms
Oery a!ti(e L mo(e Eui!%ly tal% loudly or rapidly Flamboyan!e is not un!ommon
Co"niti(e symptoms
Sho$ poor ?ud"ment or plannin"
)ay ha(e trouble remainin" !oherent or in tou!h $ith reality
Physi!al symptoms
Hi"h ener"y le(el L often in the presen!e of little or norest
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Diagnosing Bipolar
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ag os g po aDisorders
People are !onsidered to be in a fullmanic episode $hen, for at least one$ee%, they display an abnormally hi"h or
irritable mood, in!reased a!ti(ity orener"y, and at least three othersymptoms of mania
n e-treme !ases, symptoms are psy!hoti!
9hen symptoms are less se(ere, theperson is said to be e-perien!in" ahypomanic episode
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g g pDisorders
DS)2 distin"uishes t$o %inds ofbipolar disorder
=ipolar disorder
Full mani! and ma?or depressi(e episodes
)ost e-perien!e an alternation of episodes
Some ha(e mi-ed episodes
=ipolar disorder Hypomani! episodes alternate $ith ma?or
depressi(e episodes
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g g pDisorders
9ithout treatment, mood episodestend to re!ur for people $ith eithertype of bipolar disorder
f people e-perien!e four or moreepisodes $ithin a one2year period, theirdisorder is further !lassi>ed as rapid
cycling
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g g pDisorders
=et$een 4 and :.64 of all adults inthe $orld su+er from a bipolardisorder at any "i(en time
#he disorders are eEually !ommon in$omen and men
#he disorders are more !ommonamon" people $ith lo$ in!omes thanthose $ith hi"h in!omes
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g g pDisorders
Inset usually o!!urs bet$een thea"es of and ;; years
n most untreated !ases, the mani! anddepressi(e episodes e(entually subside,only to re!ur at a later time
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g g pDisorders
9hen a person e-perien!es numerousperiods of hypomani! symptoms andmild depression, DS)2 assi"ns a
dia"nosis of !y!lothymi! disorder Symptoms !ontinue for t$o or more years,
interrupted by periods of normal mood
#he disorder usually be"ins in adoles!en!e
and a+e!ts at least
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pDisorders?
#hrou"hout the >rst half of the :
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pDisorders?
eurotransmitters
fter >ndin" a relationship bet$een lo$norepinephrine and unipolar depression,early resear!hers e-pe!ted to >nd a lin%bet$een hi"h norepinephrine le(els andmania
#his theory is supported by some resear!hstudies bipolar disorders may be related too(era!ti(ity of norepinephrine
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What Ca!ses Bipolar
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pDisorders?
eurotransmitters
=e!ause serotonin a!ti(ity oftenparallels norepinephrine a!ti(ity inunipolar depression, theorists e-pe!tedthat mania $ould also be related to hi"hserotonin a!ti(ity
lthou"h no relationship $ith hi"h serotoninhas been found, bipolar disorder may belin%ed to lowserotonin a!ti(ityG
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pDisorders?
eurotransmitters
#his apparent !ontradi!tion is addressedby the 0permissi(e theory1 about mood
disorders
'o$ serotonin may 0open the door1 to a mooddisorder andpermitnorepinephrine a!ti(ity tode>ne the parti!ular form the disorder $ill
ta%e 'o$ serotonin 'o$ norepinephrine Depression
'o$ serotonin Hi"h norepinephrine )ania
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pDisorders?
on a!ti(ity
ons, $hi!h are needed to send in!omin"messa"es to ner(e endin"s, may beimproperly transported throu"h the !ellsof indi(iduals $ith bipolar disorder
Some theorists belie(e that irre"ularities
in the transport of these ions may !auseneurons to >re too easily @maniaA or tostubbornly resist >rin" @depressionA
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pDisorders?
=rain stru!ture
=rain ima"in" and postmortem studiesha(e identi>ed a number of abnormalbrain stru!tures in people $ith bipolardisorder in parti!ular, the basal "an"liaand !erebellum amon" others
t is not !lear $hat role su!h stru!turalabnormalities play
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Disorders?
Beneti! fa!tors
)any theorists belie(e that peopleinherit a biolo"i!al predisposition tode(elop bipolar disorders
Family pedi"ree studies support this theory
denti!al @)A t$ins ;
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Disorders?
Beneti! fa!tors
Resear!hers ha(e !ondu!ted genetic linkagestudies to identify possible patterns of
inheritan!e Ither resear!hers are usin" te!hniEues from
mole!ular biolo"y to further e-amine "eneti!patterns in lar"e families
Su!h $ide2ran"in" >ndin"s su""est that anumber of "eneti! abnormalities probably!ombine to help brin" about bipolar disorders
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Treatments for Bipolar
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Disorder
5ntil the latter part of the :
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Disorder" #ithi!m and $therMood Sta%ili&ers
#he use of lithium @a metalli!element naturally o!!urrin" asmineral saltA and other mood2
stabili*ers has dramati!ally !han"edthis pi!ture
97Comer, bnormal Psy!holo"y, 3e
Treatments for BipolarDisorder" #ithi!m and $ther
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Disorder" #ithi!m and $therMood Sta%ili&ers
ll manner of resear!h has attested to thee+e!ti(eness of lithium and other moodstabili*ers in treatin" mani! episodes
)ore than 6
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Disorder" #ithi!m and $therMood Sta%ili&ers
Resear!hers do not fully understand ho$mood stabili*in" dru"s operate #hey suspe!t that the dru"s !han"e
synapti! a!ti(ity in neurons, but in adi+erent $ay from that of antidepressantdru"s lthou"h antidepressant dru"s a+e!t a neurons
initial re!eption on #s, mood stabili*ers seem toa+e!t a neurons se!ond messen"ers
#hese dru"s also in!rease the produ!tion ofneuroprote!ti(e proteins, $hi!h mayde!rease bipolar symptoms
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Treatments for BipolarDisorder" Ad'!ncti(e
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Disorder" Ad'!ncti(esychotherapy
Psy!hotherapy alone is rarely helpful forpersons $ith bipolar disorder
)ood stabili*in" dru"s alone are also
not al$ays su!ient N
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Disorder" Ad'!ncti(esychotherapy
#herapy fo!uses on medi!ationmana"ement, so!ial s%ills, andrelationship issues
Fe$ !ontrolled studies ha(e tested thee+e!ti(eness of su!h ad?un!ti(e therapy
Bro$in" resear!h su""ests that it helpsredu!e hospitali*ation, impro(es so!ialfun!tionin", and in!reases !lients ability toobtain and hold a ?ob