1. Starter Biological explanation 1: genetic Biological explanation 2: neurotransmitters Biological explanation 3: hormones Biological treatment 1: Drugs Biological treatment 2: ECT

2. PSYCHOLOGICAL EXPLANATIONS AND TREATMENTS FOR DEPRESSION – COGNITIVE AND PSYCHODYNAMIC 1. Outline and evaluate psychological explanations of depression 2. Outline and evaluate psychological treatments for depression

3. COGNITIVE EXPLANATIONS OF DEPRESSION Outline and evaluate

4. Outline In groups: Thinking back to AS, try and give as much information as possible on the following: 1. Assumptions of the cognitive approach in relation to psychopathology. 2. Cognitive triad. 3. Extension: Strengths and weaknesses of the cognitive approach to explaining psychopathology

5. Cognitive explanation of depression: The cognitive triad Beck’s theory The self The future The world

6. Cognitive explanation of depression: Silent assumptions Beck believes the inner life of depressed people are dominated by a set of assumptions that shape conscious cognitions. Key: Extent to which people subscribe to them! I must do well in my masters or what is the point Task B: Individually, write three of you own silent assumptions.

7. Cognitive explanation of depression: Information processing Cognitive distortion Catastrophising: exaggerating a minor setback until it becomes a complete disaster Personalising: Taking responsibility and blame for all the bad things that happen. Overgeneralisation: Drawing sweeping conclusions based on a single incidence Black and white thinking: seeing everything in terms of success or failure Selective thinking: Focusing on negative details or events whilst ignoring the positive ones. Task: On the whiteboards, give examples for the one you have been given.

8. Read the case study on page 4 of your pack As a group answer the following questions Identify features of the patients thinking that illustrate the cognitive triad of depression Choose two of the information processing biases that have been explained and identify statements from the interview that illustrate the biases. Cognitive explanation of depression: Application: case study

9. Evaluation As a group… Think/discuss what the potential strengths and weaknesses of the cognitive explanation of depression. Mind-map these

10. Consider these evaluation points in groups, try to develop them further and explain why they are problematic for the cognitive explanation of depression 1. It is not clearly understood why negative thinking develops in the first place. 2. The explanation does not take into account biological factors. 3. The explanation focuses on the individual’s thought processes more than on social factors. 4. It tends to blame the individual for not thinking ‘correctly’.

11. Exam practice Outline at least one biological and at least one psychological explanation of depression (8 marks) Person A: Biological Person B: Psychological Evaluate biological and psychological explanations of depression (16 marks)

12. COGNITIVE TREATMENT FOR DEPRESSION Outline and evaluate

13. What do you know already from AS Discuss the following questions in groups and write up on big boards: 1. What is CBT? 2. What does it involve? How does it work? Swap boards and using the pack – assess how accurate the answers are.

14. Beck’s cognitive therapy Aim? Provides opportunities both inside and outside the therapy session that will change a client’s negative talk to something more positive. During a session a client’s negative talk (behaviour) is directly challenged in order to change the type of talk that is associated with destructive cognitions. How long does it last? Beck’s therapy involves 4 phases and is usually delivered over a period of 20 weeks.

15. What the therapy entails Stage 1: Clients are encouraged to draw up a schedule of activities and to become more active and confident. Stage 2: Encouraged to recognise their automatic, negative thoughts (e.g. I am a burden to my family and friends) and to record them and bring them to the sessions. The therapist then helps them to test the reality of their thoughts (e.g. write down examples of when you have been a burden, this would then be challenged further). Stage 3: The therapist helps the client to recognise the underlying illogical thinking processes that produce negative thinking. Stage 4: The therapist help clients to change their maladaptive attitudes, often by asking them to test them out in real life situations. They are also encouraged to keep actively engaged in pleasurable activities.

16. Outline Types of CBT: Beck’s cognitive therapy Activity: Using the handout, make notes on Beck’s cognitive therapy (p8 & p9) and complete the application task on p9.

17. Outline Types of CBT: Ellis’ rational emotive behavioural therapy (REBT) This is an ABC approach. The client and the therapist work together to identify situations (Activating Events) that cause or activate irrational thoughts. They then consider what the irrational thoughts are that are triggered (Beliefs) and what the Consequences of these are. During the therapy sessions the therapist helps the client rationalise the activating events, so more rational thoughts are triggered leading to better consequences. Ellis thought that clients should eventually be able to carry out REBT on themselves, so get rid of their own irrational beliefs and replace them with more rational ones.

18. Outline Types of CBT: Ellis’ rational emotive behavioural therapy (REBT) Using the information in the pack (p10), complete the application activity on p10 & 11 http://www.youtube.com/watch?v=GqW8p9WPweQ&play next_from=TL&videos=lZBQq6IFFwM http://www.youtube.com/watch?v=GqW8p9WPweQ&play next_from=TL&videos=lZBQq6IFFwM http://www.youtube.com/watch?v=JZHcWIJ_KzE&feature =related http://www.youtube.com/watch?v=JZHcWIJ_KzE&feature =related

19. Evaluation of CBT Activity: Read the statements on p12, then label with an E or A in terms of which ones relate to appropriateness and which relate to effectiveness. Note: some points are questions which need answering Extension: Some of these evaluation points could be extended e.g. by comparing with another treatment and saying why CBT is more appropriate

20. Exam practice Evaluate one psychological treatment for depression (16 marks) Plan which points you would use and in what order for the above question. Remember you can add additional evaluation to your essay e.g. comparisons with bio treatments

21. PSYCHODYNAMIC EXPLANATION OF DEPRESSION Outline and evaluate

22. Psychodynamic explanations What do you already know about the psychodynamic approach?

23. How could you explain Tom’s depression? Tom’s parents were very driven parents, with high expectations for their son. They both studied at Oxford university and are now both doctors. They wanted their son to achieve in life as they did. Tom was sent to the best schools as a child and received extra tuition outside of school. Tom struggled through his education, which frustrated his parents but he continued to work hard as his parents wanted him to become a doctor. Unfortunately Tom did not get high enough grades to study medicine at any of his university choices. Tom’s parents were very disappointed at him. Tom became so down that he was diagnosed with depression. TASK: Read the explanation in the pack and use it to help you explain Tom’s depression

24. How could you explain Tom’s depression? Tom’s parents were very driven parents, with high expectations for their son. They both studied at Oxford university and are now both doctors. They wanted their son to achieve in life as they did. Tom was sent to the best schools as a child and received extra tuition outside of school. Tom struggled through his education, which frustrated his parents but he continued to work hard as his parents wanted him to become a doctor. Unfortunately Tom did not get high enough grades to study medicine at any of his university choices. Tom’s parents were very disappointed at him. Tom became so down that he was diagnosed with depression.

25. Green et al Areas of the brain related to guilt and knowing how to behave were strongly linked in the control group (no history of depression), in comparison those areas of the brain were disconnected in those with history of depression. This offers partial support to the psychodynamic explanation as it suggests that people suffering from major depression do tend to experience more guilt and self-blame which may have been triggered from an unconscious conflict in early life. However, it could be that these differences in the brain of depressed patients means there is a biological, rather than a psychological underpinning for depression

26. General S&W’s of explanation Strengths Awareness of root cause of depression (potential for comparison with another explanation) Psychoanalytic theories of depression have had a profound impact on contemporary theories of depressions. For example, Beck's (1983) model of depression was influenced by psychoanalytic ideas such as the loss of self-esteem (re: Beck's negative view of self Weaknesses Unfalsifiable – not scientific (potential for comparison with another explanation) Emphasis on the unconscious and early experiences can be limiting – could overlook additional aspects of depression

27. PSYCHODYNAMIC TREATMENT FOR DEPRESSION Outline and evaluate

28. Outline Aim: To bring to consciousness repressed and painful memories from childhood making the client aware of the cause for depression. This should make the person cope better with their inner conflicts that are causing the depression. Experiences of childhood loss and rejection are concentrated on as they are key to the development of depression Ways of uncovering unconscious: Transference and free association This insight enables the client to deal with loss more effectively, become less dependent on others, and make appropriate changes to their everyday life. This should end the client’s depression.

29. Evaluate: Appropriateness and Effectiveness of Psychoanalysis p14&15: Read the evaluation points on psychodynamic treatment and as a group discuss and answer the questions. Note: You will need to elaborate on the first 2 appropriateness points (e.g. in what way do they effect the how appropriate the treatment is or how do they show it is more appropriate than other treatments).

30. Psychodynamic therapy Aim: To bring to consciousness repressed and painful memories from childhood making the client aware of the cause for depression. This should make the person cope better with their inner conflicts that are causing the depression. Experiences of childhood loss and rejection are concentrated on as they are key to the development of depression Ways of uncovering unconscious: Transference and free association This insight enables the client to deal with loss more effectively, become less dependent on others, and make appropriate changes to their everyday life. This should end the client’s depression. CBT (cognitive behavioural therapy) It aims to change the way that people think. Encourages the client to consider the beliefs and expectations that are at the root of their depression and to replace their irrational, negative thoughts with more positive, adaptive (helpful) ones. Focus is on both cognitive (focusing on thoughts) and behavioural (focusing on action) elements. Basic stages: awareness, challenge, role play Once the client develops more rational, positive beliefs their depression should end. An example of cognitive therapy: Ellis’s rational emotive- behavioural therapy (REBT) – uses ABC model