Depression and Its Social Impact

Course Information

• Course: Year 3: PS3112 Clinical Psychology
• Date: 1 October 2024
• Speaker: Dr Aftab Laher
• Topic: Psychological Understanding and Treatment of Depression

Additional Information

• Dr Aftab Laher is a Consultant Clinical Psychologist.
• He is an Accredited Cognitive Behavioural Psychotherapist.
• He is an Honorary Lecturer in Clinical Psychology.
• He is in the School of Psychology at the University of Leicester.

Looking After Yourself (and Others)

• The presentation advises students to step out or do what feels safe if they are experiencing distress.
• Students can speak with the presenter or contact the Student Wellbeing Service at 0116 223 1780 or [email protected]

Aims

• Explore the nature of "depression".
• Provide an overview of classification and clinical diagnosis.
• Examine the causes and theories of depression.
• Consider the clinical assessment of depression.
• Summarize the psychological treatment approaches to depression.
• Focus on CBT for adults.
• Critically examine how depression has been conceptualized, categorized, and treated.

Nature of Depression

• Quotations are provided from various sources describing depression.
• J.K. Rowling describes depression as the absence of hope and a deadened feeling, different from sadness.
• Dorothy Rowe describes depression as a prison.
• An anonymous source describes depression as walking down a dark hallway, not knowing when the light will turn on.

Depression as a Clinical Syndrome

• Depression is a clinical syndrome distinct from sadness, characterized by a non-transient depressed mood.
• Key themes include pervasive feelings of loss, emptiness, entrapment, worthlessness, and hopelessness.
• Impairment in daily functioning.
• Clinical presentation can be "masked" or vary.
• Symptoms include physiological, emotional, cognitive-motivational, behavioral, and social/interpersonal components.
• Recognizing depression as a societal construct is important.

Epidemiology of Depression

• 280 million people worldwide experience depression (WHO, 2023).
• The lifetime prevalence is estimated at 2%-21%. (Gutiérrez-Rojas et al., 2020).
• Prevalence in community samples reached 32% during the COVID-19 pandemic (Dettman et al., 2022).
• A significant portion of primary care patients experience recovery from depression (35-60%) with some experiencing chronic illness. (Steinert et al., 2014).
• The risk of recurrence is over 50% with one major episode.

Overview of Classification & Diagnosis

• The WHO's International Classification of Diseases and the DSM system produced by the APA are two major systems for classifying and diagnosing psychological disorders.
• Specific ICD and DSM subtypes of depressive and bipolar disorders are listed.

Caution Regarding Diagnostic Systems

• Diagnostic systems can be helpful but also hinder the understanding of psychological disorders.
• There's debate on how diagnostic categories are developed and applied.
• Systems may promote "over-pathologizing" or "over-medicalizing" psychological disorders,
• Socio-cultural context is frequently disregarded.

ICD-11 and DSM-5-TR

• Specific depressive and bipolar disorders from ICD-11 and DSM-5-TR are presented in lists.

Major Depressive Disorder

• Diagnostic criteria are outlined in a table from the DSM-5, including symptoms (e.g., depressed mood or loss of interest, nearly daily for 2 weeks, etc.).
• Diagnostic criteria for recurrent MDD are also listed in the table

Other Syndromes with Depression

• Other conditions associated with depression listed include; Seasonal affective disorder (SAD), psychotic depression, post-natal depression, and adjustment disorders (reactive depression).

Causes & Theories of Depression

• The presentation outlines various factors contributing to depression, including:
• • Lifestyle.
• • Life history.
• • Personality.
• • Other illnesses.
• • Socio-cultural context.
• • Genetics/ biomedical factors.
• • Life events/ stress/ big changes.
• • Conditioning/ learning.
• • Cognitive style/ outlook/ meaning-making.
• • Drugs/ alcohol

Depression Often Associated With

• A list of factors often correlated with depression is presented, encompassing bereavement, relationship difficulties, work problems, family problems, isolation, and role change/ loss of personal identity.

Theoretical Approaches

• Biological, behavioural, personality, psychodynamic, attachment, cognitive, and interpersonal models are discussed as potential explanations for depression.

Biological Factors

• Moderate heritability is seen through twin and family.
• Neurotransmitter imbalances/ dysregulation (serotonin, norepinephrine, cortisol, and dopamine) are potential contributing factors.
• Other brain and neuropsychological abnormalities can also play a role.

Behavioural Factors

• Learned Helplessness (classical conditioning).
• Reduction in positive reinforcement/ increase in negative reinforcement (operant conditioning).
• Social learning.
• Formation of "vicious cycles" of depression-sustaining behaviours.

Psychodynamic Approach

• Freud's concepts of mourning and melancholia are compared, differentiating them.
• Both conditions involve pain.
• Loss is a key element.

Later Developments (Neo-Freudian)

• Object Relations Theory, an updated psychodynamic approach is shown
• Depressive vulnerability originates from caregiver interactions.
• Depression often arises from losing close relationships.

Attachment Theory

• John Bowlby and Mary Ainsworth's influence on attachment theory is noted.
• An attachment theory model of self and other is presented.
• Children with inadequate care may develop negative self-images and negative views of others.

Cognitive Models

• The theory of causal attribution (re-formulated learned helplessness).
• Attribution of depression to internal, stable, global factors is highlighted – factors like these.
• Beck's cognitive-behavioral approach, emphasizing thinking and behavior.
• Evolved formulation- acknowledging socio-cultural context.

Assessment

• Comprehensive clinical assessments are vital.
• Clinical interviews, observations, and psychometric questionnaires (e.g. PHQ-9, BDI-II, HADS) are highlighted as valuable tools
• Information from other sources is important when obtained with patient consent.

Classification of Depression

• Onset (sudden/ gradual).
• Severity (mild/moderate/severe).
• Features (melancholic, catatonic, etc.).
• Duration.
• Course/ recurrence (longitudinal, seasonal, rapid cycling, etc.).
• Aspects to consider when classifying depression.

Core Dimensions

• Physiological, emotional, cognitive-motivational, behavioral, and social/interpersonal domains are core aspects to consider when analyzing depression.
• Listing of specific examples of these dimensions and descriptions is presented.

Treatment

• Talking therapies, including CBT, IPT, and others are presented as ways to approach treatment
• Brain stimulation approaches are also mentioned.

CBT

• CBT is an evidence-based therapy aimed at identifying unhelpful thoughts and behaviors.
• The therapy method employs techniques like cognitive restructuring, behavioural activation, and others.
• Brief CBT models, online approaches, and approaches for cognitive impairment are listed.

Aims of CBT

• To change unhelpful thoughts, beliefs, behaviours, and patterns of interacting with the environment while addressing adverse systemic and environmental variables.
• Involves cognitive reframing (using 'talking' and 'writing' to challenge negative thinking).
• Behaviour changes, activity planning, and 'experiments' are incorporated
• Social and environmental context modifications are encouraged.

CBT Model Core Aspects

• Reciprocal interactions between biological/psychological, and social/environmental systems are key aspects in the model
• Prominence in cognition, especially subjective meaning/appraisal, is vital within the CBT approach.

IPT

• A short-term therapy focusing on current interpersonal relationships and needs.
• The onset and fluctuations of depression are understood through the lens of interpersonal issues.
• Methods to deal with interpersonal problems effectively.

IPT – Core Aspects

• Difficulties in interpersonal roles, transitions, loss, and deficits are central areas of interest for IPT.

IPT– How it Works

• Three phases are involved:
• • Phase 1 (2-4 sessions): Understanding the issues, agreeing on diagnosis, and collaboratively planning goals.
• • Phase 2 (4-8 sessions): Actionable steps are used to solve problems and achieve goals.
• • Phase 3 (2-3 sessions): Preparing for the end of therapy and maintaining gains.

Behavioural Activation

• A therapy method used to reduce depression rooted in behavioral therapy.
• Focuses on increasing engaging and rewarding behaviours to confront the cycle of inactivity and disengagement, improving motivation and energy.

Summary

• Depression is more complex than sadness. It is a pervasive condition requiring several factors.
• Multiple factors influence individuals and depression is often multi-factorial.
• Several types of therapy can be effective, including CBT and IPT.
• Medication and biological interventions may be necessary for severe or persistent cases.

Additional Points

• A website for the speaker's contact information is included.