Psychological Problems: Depression & Addiction

Unipolar depression - Unipolar depression: a mood disorder where people feel periods of feeling sad and a lack of motivation. Symptoms of unipolar depression - Mental health problem: It is a form of psychological problem characterised by symptoms affecting the mind and behaviour....

Unipolar depression - Unipolar depression: a mood disorder where people feel periods of feeling sad and a lack of motivation. Symptoms of unipolar depression - Mental health problem: It is a form of psychological problem characterised by symptoms affecting the mind and behaviour. - Main symptoms: - Lowering of mood - Lack of energy - Lack of motivation to do things - Other symptoms: - Feeling suicidal - Feelings of guilt or blaming themselves for problems - Lack of self-esteem - Poor appetite/ Increase in normal appetite - Extreme tiredness not relieved by sleep - Poor sleep - Not enjoying activities that they used to like doing Episode Symptoms Features Mild 4 symptoms A patient will be upset but able to carry out everyday activities Moderate 5-6 symptoms Patient has serious problems carrying out daily tasks Severe 7+ symptoms Patient may have suicidal thoughts or engage in self-harm Incidence of depression over time - Martin Seligman (1988) found that people in the 1980s were 10 times more likely to be diagnosed with depression than in the 1940s. - The King’s Fund (2008) estimates that by 2026, 1.45 million people will be diagnosed with depression. - Brandon Hidaka (2012) suggests modern living is more stressful alongside sleep deprivation, poor diet and increased social isolation lead to the increase in depression. - Jean Twenge et al (2010) found that young adults in 2007 were more likely to be diagnosed with depression. - Liu yi Lin et al (2016) Research linked high levels of social media usage to higher risk of depression. How depression affects individuals and society - Individual: 1  - Increasing risk of suicide. 10 - 15% of patients with severe depression will commit suicide. - Society: - People with depression are less motivated to work. - In 2014-2015, 9.9 million days of work were missed because of stress, depression or anxiety.(HSE) - There are costs for the company as they have to cover the workload. - There is a high cost of treatment for patients. - More people diagnosed with depression = more people needing treatment. - Antidepressant drugs used to treat depression are expensive. - In 2007, it cost the NHS 1.7 billion for treatments involving depression. Genetic explanation of unipolar depression - There is evidence that if someone in your family is diagnosed with depression then you are more likely to be diagnosed with depression. - This indicates that depression might be inherited. - A study by Craig Hyde (2016) supports this. Twin Studies (Peter McGuffin et al. (1996)) - Monozygotic twins share 100% of their genes. - If one monozygotic twin became depressed, there was a 46% chance that their co-twin would also develop depression. - Dizygotic twins share 50% of their genes. - If one dizygotic twin became depressed, there was a 20% chance that their co- twin would also develop depression. - Not all family members related to depressed people become depressed. - Some people might have a genetic predisposition to become depressed and require a trigger to become depressed. (Diathesis stress model) Strengths and Weaknesses of the genetic explanation - Strengths: - The genetic explanation will remove the stigma associated with depression as people cannot blame you for being depressed. - There is a lot of research evidence to support the genetic explanation. - Weaknesses: - The genetic explanation is deterministic because it assumes that if you have certain genes you will inevitably be depressed. - The genetic explanation is reductionist and ignores other factors such as depression often being linked to life events. 2 Beck’s cognitive triad - Cognitive theory: An explanation for depression that focuses on how thought processes influence behaviour. - Beck believes that depression can be explained through negative thought patterns. - The Triad: - Negative view of the self - Negative view of the future - Negative view of the world Ellis’s ABC model - Activating event: - Something bad happens making the person feel unsettled. - Beliefs: - The thoughts that the person associated with the event: - Rational (healthy) - Irrational (unhealthy) - Consequences: - If the person has rational thoughts, they will have positive emotional consequences. - If the person has irrational thoughts, they will have negative emotional consequences (such as depression) Strengths and Weaknesses of the cognitive theory - Strengths: - It combines nature and nurture factors. - It recognizes that events could explain why the person has become depressed. - It has real life applications. - It is used in Cognitive behavioural therapy to treat depression. - Weaknesses: - It is difficult to tell whether irrational thoughts are a cause or symptom of depression. - Some types of depression (such as postnatal depression) cannot be explained by cognitive theory. Cognitive behavioural therapy as a treatment for depression - The main aim of CBT: - Help the patient change the way they think - Help the patient to change the way they act to improve the symptoms they are having. 3  - First stage of CBT: - The patient discusses all their symptoms and explains how they feel and what makes them feel that way. - Second stage of CBT: - This challenges the irrational ways of thinking of the patient. - The patient can recognize thoughts that are negative/positive. - The patient will have a series of sessions of CBT. - The patient will try to change the way they think. - Evidence published by the NHS in 2012 suggests that patients who are treated with CBT show a significant improvement in their symptoms. Strengths and Weaknesses of using CBT to treat depression - Strengths: - There is evidence to suggest CBT is effective. - This is supported by Matthijs Beltman et al. (2010) - It may be a longer-lasting treatment than just antidepressants. - Patients learn to control their symptoms by changing their negative thoughts. - It may help patients feel better because they learn how to deal with their own symptoms as they no longer feel helpless. - Weaknesses: - It relies on patients wanting to change their behaviour. - However, a symptom of depression is the lack of motivation making therapy ineffective. - There are ethical issues as some people argue that it is unethical for the therapist to tell their patients that they think the wrong way. Drug therapy as a treatment for depression - Neurotransmitters: chemicals that pass messages from one neuron to another. - Noradrenaline: a type of neurotransmitter involved in mood and released when stressed. Types of antidepressants - Selective serotonin reuptake inhibitors (SSRIs) - They block the reuptake of serotonin so that it is available for longer improving mood. - Serotonin and noradrenaline reuptake inhibitors (SNRIs) - They block the reuptake of both serotonin and noradrenaline, enhancing the effect of serotonin and noradrenaline to improve mood. - Monoamine oxidase inhibitors (MAOIs) - They prevent monoamine oxidase from breaking down serotonin and noradrenaline making more available improving mood. 4  - Tricyclics (TCAs) - They boost the effect of serotonin and noradrenaline by preventing their reabsorption and improving mood. Strengths and weaknesses of drug therapy as a treatment of depression - Strengths: - They can improve a patient’s symptoms allowing them to access other psychological therapies. - There is evidence that drug therapy is effective: - The Royal College of Psychiatrists report that 50-65% of patients with moderate to severe symptoms of depression show improvement when given antidepressants. - Only 25-30% of patients with similar symptoms were given a placebo. - Weaknesses: - Drug therapy can have unpleasant side effects for some patients. - MAOIs can cause dangerous side effects if combined with certain foods. - Antidepressants can make people feel drowsy, nauseous and dizzy and cause disturbed sleep. - Tricyclics can be very dangerous if the patient takes too many. - Drugs improve the symptoms of depression but do not tackle the cause of depression. - The long-term outcomes of depression treatment are actually becoming worse. - Patients are likely to relapse after treatment. Addiction: symptoms, features, incidence and influence - Addiction: a mental health problem where people feel they need a substance/activity in order to be able to go about their normal routine. - Withdrawal: a set of unpleasant physical and psychological symptoms someone gets when they are trying to quit or cannot satisfy their addiction. Symptoms of addiction - To be diagnosed as an addict, at least 3 of the symptoms need to be present. - The symptoms of dependance disorder: - A feeling that the person needs to take the substance. - Ignoring evidence that the use of the substance is harmful - Replacing normal, fun activities with time using the substance - Tolerance to the substance meaning they need to increase the amount used to get the same effect over time - Stopping or reducing the use of the substance 5  -Physical withdrawal symptoms (such as shaking, sweating) when the substance is not used for a period of time. - The symptoms of behavioural addiction: - They need to do the activity regularly - Reducing the activity is very difficult - They have to do the activity more often - They ignore arguments that the activity is unhealthy - They spend more time doing the activity than other things they used to enjoy. Features of addiction - Public health England stated that in 2014-2015 there were 141,646 adults being treated for problems with substance misuse. - Internet addiction is not recognized as a mental health problem but it can be recognized as a form of behavioural addiction. - Many people have suggested that young adults may be more prone to reliance on the internet. How have incidences of addiction changed over time? - The definition of addiction has changed to include internet addiction and addiction to video games (behavioural addictions). - Society’s relationship with drugs has changed. - Opiates used to be prescribed for medical purposes. - Now people who regularly use opiates or cocaine are considered addicts. - Statistics suggest the number of addictions in society is rising. - Drugs have become cheaper to access. (Center of social justice, 2006) How does addiction affect individuals and society? - Individuals: - The addicted person may ignore their family and not go to work. - They will spend money on their addiction as opposed to their necessities. - Society: - Addicts may develop health problems and have to take time away from work costing the company. - Substance misuse costs the NHS 488 million. - Some people with addictions may turn to criminal behaviour to fund their addiction. - The NHS claims that drug-related crimes cost the UK 13.9 billion a year. Genetic explanation of addiction - Addiction being genetic explains why some people become addicts and others don’t (when partaking in the same activity) 6  - There is a high likelihood that if one monozygotic twin is addicted that the other twin will be an addict as well. - This likelihood is higher than if the twins were dizygotic. - Adopted children with one biological parent with an addiction are highly likely to become addicts themselves. - Adopted children also have a higher risk of addiction if their adoptive family were addicted, demonstrating environmental influence. - The DDR2 gene is linked to addiction as it affects the way the brain reacts to pleasure. Strengths and weaknesses of the genetic explanation - Strengths: - There is a lot of scientific evidence to support the genetic explanation: - Twin and adoption studies show the most likely explanation comes from genes. The research is reliable. - It would explain why people are more prone to becoming addicts whilst others take part in addictive behaviours. - Weaknesses: - The theory is reductionist as it does not take social factors into account. - Addiction running in families could be explained by them sharing the same home environment. - The research has not been able to find a single gene that explains where addiction comes from. - The DDR2 gene has also been linked to autism which has very different symptoms. Learning theory as an explanation of addiction - Learning theory: Believes that behaviour is learned through association and experiences. Classical conditioning and addiction - Behaviour is learned through association. - When two things happen at the same time, they become connected to each other. - People become addicted to a substance or activity due to the positive feelings associated with the activity and will continue doing it as they associate it with the positive outcome. Operant conditioning and addiction - Operant conditioning involves learning via consequences of actions. - When a behaviour is rewarded with a good feeling after engaging in an addictive behaviour, the positive feeling will reinforce the behaviour and make them want to do it again. 7  - The addict may also continue as they want to avoid the negative feelings from the withdrawal which would also act as a reinforcement. Social learning theory and addiction - Social learning theory believes that behaviour is learned as a result of observing other people (especially role models). - If the role model engages in addictive behaviour, the person is more likely to imitate the behaviour and become an addict themselves. Strengths and Weaknesses of learning theory as an explanation of addiction - Strengths: - The theory helps in treating addiction as it believes that addiction is treatable and the consequences can be re-learned. - Classical conditioning can explain why addicts relapse after stopping. - They may return to the addiction when they find themselves in the associated situation. - Weaknesses: - The theory ignores the role of biological factors. - Conditioning theories do not explain why only some people become addicts whereas most are not despite engaging in the same activities. - Some People who do the actions/activities don’t become addicted to them even though they did and others got addicted. - Social learning theory may explain it as their role models may/ may not be addicted influencing the person. Stages of CBT as treatment for addiction - Functional analysis: - Identify the triggers of the addiction. - Skills training: - The therapist will help the addict develop skills: - How to cope with cravings - Assertiveness training to prevent others from encouraging them - Improving motivation to stop the addictive behaviour. - The patient will keep a diary to make notes - CBT can be combined with other therapies such as drug therapy (which reduces withdrawal symptoms) Strengths and Weaknesses of using CBT to treat addiction - Strengths: - It gives the patient control over stopping their own addiction. - There is evidence of the effectiveness of CBT: - It is supported by Young (2007) showing long-term treatment. 8  - Weaknesses: - The addict has to be motivated to change. - One of the symptoms of addiction is that the addict will find stopping difficult. - There is evidence that even though addicts can learn how to cope, it does not mean they will stop the addictive behaviour. - This is shown by Longabaugh (2000). Drug therapy as a treatment for addiction: Drug addiction - Detoxification: When an addict tries to stop taking a substance they are addicted to. - Medicine can reduce the effects of withdrawal. Withdrawal - When a person stops using a substance they are addicted to they can face physical symptoms of withdrawal as the substance leaves their system. - Drugs can be given to reduce these effects. - This reduces the chance of a relapse. Reducing cravings - Patients will tend to crave the substance when they stop using it. - This is because their nervous system has become used to the effects. - Medication can be given to control these symptoms: - Methadone acts in the same way as heroin and can be given to heroin addicts. - Smokers can use chewing gum. - Naltrexone stops cravings for alcohol. Treating other underlying mental health problems - People with addiction may have other mental health problems such as depression or anxiety. - Drugs can be given to reduce the symptoms of these mental health problems to prevent relapse. Behavioural addiction - Behavioural addictions (such as gambling, sex, internet) can be treated with drugs. - Naltrexone is prescribed for patients with severe gambling addiction. - This lessens their cravings, helping them stop. - SSRIs increase the amount of serotonin. - This has been shown to help patients control their urges through the research by Belinda Winder et al. (2014) 9 Strengths and Weaknesses of drug therapy as a treatment for addiction - Strengths: - There is research evidence that drug therapy is effective. - Suck Won Kim et al. (2001) supports this. - Drug therapy may help the patient access other types of therapy (such as CBT) by dealing with the short-term symptoms of withdrawal. - Weaknesses: - There is mixed evidence on the effectiveness of drug therapy. - John Krystal et al. (2001) finds no significant difference in relapse rates. - Drug therapy may make people’s problems worse in the long-term as they may become dependent on the medication, substituting their addiction. STUDIES Caspi et al. (2003) Influence of Life stress on depression: Moderation by a polymorphism in the 5-HTT gene Background to the study - There is research evidence that stressful life events cause depression. - If a gene causes low levels of serotonin than others it can explain why some are more likely to be depressed than others. Aims - To investigate why stressful life events seem to cause depression in some and not others. - Are people with a certain variation of the 5-HTT gene are more likely to lead to depression. Procedure - 847 people were studied - They were divided into three groups based on the version of the 5-HTT gene. - The study was a longitudinal study - It used two questionnaires: - Asking for events between their 21st and 26th birthdays (problems with money, health and relationships) - Asking for any symptoms of depression before their 26th birthday. Results - Participants with at least one version of the short 5-HTT gene and stressful life events showed significant increase in symptoms of depression. - Participants with a short version of the 5-HTT gene and who experienced stressful life events were more likely to be diagnosed with depression than those with 2 long versions of the gene. 10  - Those with the short version of the gene were more likely to develop suicidal thoughts. - Those with two short versions of the 5-HTT gene were more likely to report severe depressive symptoms if they faced more than 3 stressful life events. Conclusions - There is an interaction between life events and genetic influences causing depression. - Both nature and nurture work together. Strengths and Weaknesses of the study - Strengths: - The large sample size of 847 people increases the generalisability of the results. - The information has practical applications for doctors as it shows that people can have different causes for depression. - Weaknesses: - There is a chance that people put themselves in stressful situations. - The short version of the 5-HTT gene may cause people to be prone to stressful situations. - Evidence from questionnaires is self-report data which may not be reliable. - Some people may exaggerate their symptoms of depression - Others may downplay their depression. Young (2007) Cognitive behaviour therapy with internet addicts: treatment outcomes and implications Background to the study - Internet addiction has only recently been seen as a mental health problem. Aims - To investigate the effectiveness of CBT to treat a group of patients diagnosed with internet addiction and see how they improved over time during and after therapy. Procedure - 114 participants were recruited - All participants had completed the Internet addiction test. - All participants were given a course of online CBT sessions. - Participants fill in a questionnaire during the 3rd, 8th and 12th online therapy session. - They answered 12 questions where participants rated their behaviour on a 5 point Likert-type scale. Result - Slightly more males than females were included in the study. 11  - Many of the participants were educated to university level. - There were differences in what online apps participants were addicted to. - 30% of males were addicted to online pornography - 30% of females were addicted to chat rooms - Almost all participants 96% said their biggest problem caused by their addiction was the time taken. - Over 12 sessions of CBT, the average rating of the quality of the CBT sessions improved. - There was no significant drop in ratings of these goals 6 months after therapy ended. Conclusion - CBT can be an effective treatment for internet addiction as clients reported an increased ability to control their addiction. Strengths and Weaknesses of the study - Strengths: - It shows that online CBT sessions are useful for treating internet addiction. - This encourages people to access treatment for addiction. - Using the same questions and 5 point scale, allows for the behaviours to be assessed in the same way so it is consistent and standardised. - Weaknesses: - The clients filled their own questionnaire making the data less valid. - They might lie on the questionnaire. - Different types of internet addiction were identified however the study only shows the overall treatment outcomes with no breakdown for the type of internet addiction. ISSUES AND DEBATES Nature and nurture debate Nature - Nature refers to the biological factors that can influence a person’s behaviour. - It accepts that we will all be physically different because of different genes. - Genes determine how our body will develop. Nurture - Nurture refers to the environmental factors that can influence a person’s behaviour. - People are born as a ‘blank slate’ and that all our experiences influence our behaviour. The nature and nurture debate and mental health problems - Explanations claim that genes have a strong influence, supporting nature. - Caspi et al (2003) found evidence that the short version of the 5-HTT gene makes a person more likely to develop depression 12  - The influence of genes explains why some people don’t develop psychological problems. - If genes influence behaviour, then it would be difficult to stop addiction as we cannot change a person’s genetic make-up. - Depression is likely to return to a person even after treatment as they still have the gene which will trigger a relapse. - Explanations also support nurture. - Cognitive explanation for depression - Learning theory for addiction - Both explanations assume that problems are learned as a result of events / a person's environment. - Therefore, these behaviours can be unlearned/ new behaviours can be learned. - Cognitive behavioural therapy can be used for both addiction and depression. - The therapy is shown to be effective supporting the argument that nurture causes mental health problems. - Other explanations claim there is an interaction between nature and nurture - Caspi et al. (2003) found that a combination of the short version of the 5-HTT gene and a stressful live event increased the likelihood of depression. - The gene makes people prone to developing depression. - The stressful event triggers the symptoms 13