Psychological Problems

Chapter 3 – Psychological Problems

Depression

Unipolar depression: Mood is pulled in one direction. An extreme lowering of mood that is persistent which affects day to day functioning.

Key symptoms from International Classification of Diseases version 10 (ICD-10)

Persistent sadness or low mood
Loss of interests or motivation
Fatigue or low energy
Disturbed sleep
Poor concentration or indecisiveness
Low self-confidence
Poor or increased appetite
Suicidal thoughts or acts
Guilt or self-blame
Agitation or slowing of movements

For a diagnosis, at least one has to be experienced for most days for most of the time for at least 2 weeks. In addition, one another needs to be present at some point during that time.

Features of unipolar depression

Episode	Symptoms	Features
Mild	Four symptoms displayed	Patient might find their symptoms upsetting but they will probably be able to carry on with most day-to-day activities
Moderate	Five or six symptoms displayed	Patient might have serious problems doing day-to-day activities
Severe	Seven or more symptoms (plus general feeling of worthlessness)	Patient may have suicidal thoughts or engage in self-harm to cope with their feelings

Incidences of Depression over time

Martin Seligman (1988) reported that in the 1980s people were 10 times more likely to be diagnosed with depression than in the 1940s. A report by the King’s Fund (2008) on mental health in England estimates that by 2026, 1.45 million people will be diagnosed with depression in comparison to 1.24 million in 2007. Brandon Hidaka (2012) suggests that “modern living” is more stressful and includes many risk factors such as sleep deprivation, poor diet and increased social isolation. Jean Twenge et al. (2010) found that young adults in 2007 were more likely to be diagnosed with depression than in 1938. Liu yi lin et al. (2016) links high level of social media usage to higher risk of depression in young American participants.

How depression affects individuals and society

Depression can lead to higher suicide rates as people feeling worthless and sad want a “way out”. Patients also miss time at work. The Health and Safety Executive (hse.gov.uk) estimated that in 2014-15, 9.9 million days of work were missed due to stress, depression or anxiety associated with work. With an increase in depression rates (shown in the statistics above), the cost to provide treatment increases. If used antidepressants are expensive to prescribe and other therapies like counselling need trained therapists. Depression cost the National Health Society (NHS) an estimate of £1.7 billion in 2007. This could cause a strain on the services provided by the NHS.

Genetic Explanation of Depression

Depression is carried in our DNA, passed on from parents and more likely to run in the family. Craig Hyde et al. (2016) found that 17 different gene variations were linked to developing depression.

Genetic Predisposition – Tendency to become depressed as a result of their genes

Diathesis-stress Model – People have gene but is only triggered by a stressful event

Studied using twin studies, family studies and adoption studies

Twin Studies – Peter McGuffin et al. (1996) found that if one monozygotic twin (genetically identically) became depressed, there was a 46% chance the other would too. However, if a dizygotic twin became depressed, there’s only a 20% chance their twin would too. This supports genetic predisposition and the diathesis-stress model.

Strengths –

Lots of research evidence
We can explain depression by looking at genes people might inherit
Free will – choose whether or not to ‘let yourself’ become depressed

Weaknesses –

Reductionist – fails to take in to account other factors that can explain why someone may develop depression
The theory is deterministic – assumes that if you have certain genes you are likely to become depressed

Cognitive Explanation of Depression

Cognitive theory looks at how the brain processes information.

Aaron Beck – Cognitive triad

Explained by three negative thought patterns (Cognitive biases)
Develops from bad experiences in someone’s past.
Leads to negative self-schema – whole belief system is covered in negativity and therefore view every situation as worse than it is.

Albert Ellis’s ABC model – three stages that can cause us to develop negative thought processes/ depression

Strengths –

Takes into account the events in the person’s life
The Cognitive Theory explanation has been applied to CBT

Weaknesses –

It is difficult to tell whether irrational thoughts are a cause or a symptom of depression
Some types of depression may not be so easily explained by thought possesses.

TREATMENTS FOR UNIPOLAR DEPRESSION

DRUG THERAPY: Antidepressants increase the levels or length of effect of neurotransmitters like serotonin and noradrenaline, useful for relapsing patients.
- Selective Serotonin Reuptake Inhibitors (SSRIs) block the reuptake of serotonin, most commonly used antidepressant.
- Serotonin And Noradrenaline Reuptake Inhibitors (SNRIs) block the reuptake of both neurotransmitters.
- Monoamine Oxidase Inhibitors (MAOIs) prevent the enzyme monoamine oxidase from breaking down serotonin and noradrenaline.
- Tricyclics (TCAs) block reuptake of neurotransmitters, used since 1950s.
STRENGTHS: prevents lack of motivation for CBT, and placebo pills are less effective.
WEAKNESSES: ignores the cause for depression, and relapse is more likely than with CBT as antidepressants lose their effect when it leaves the body.
COGNITIVE BEHAVIOR THERAPY (CBT): helps the patient change the way they think and how they act to improve their symptoms.
- Patients discuss their symptoms and explain how they feel and what makes them feel that way to a therapist.
- Then the therapist helps the patient challenge irrational thoughts about an event and replace them with more rational and positive thoughts.
- Patients will have series of sessions and will try to change the way they think and write about how they feel in a diary, and discuss this with their therapist.
STRENGTHS: patients treated with CBT improved more than those who weren’t, and the feelings of helplessness are reduced as patients know they can change their state.
WEAKNESSES: the lack of motivation can make CBT ineffective, and therapists can abuse their power by making patients become what they feel is appropriate.

Avshalom Caspi et al. (2003) Influence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT gene

Background – Stressful life events have been found to cause depression but not everyone who experiences a stressful life event becomes depressed. This study looks at whether a gene (5-HTT) linked to the neurotransmitter serotonin makes some people more likely to be depressed after stressful life events than others.

Aim – To investigate why do stressful life events seem to lead to depression in some people and not others.

Procedure – There were 847 participants split into three groups depending on the length of their gene. It was a longitudinal study as participants were researched from an early age

Group one: 2 copies of the short allele
Group two: one short and one long allele
Group three: two copies of the long allele

Participants were asked to complete two questionnaires

Stressful life events between 21-26 years old.
Symptoms of depression before one year prior to their 26th birthday

Results – Participants with at least one short version of the 5-HTT gene who experienced stressful life events were more likely to be diagnosed with (symptoms of) depression and were more likely to report suicidal thoughts.

Conclusion – There is an interaction between life events and genetic influences in cause depression.

Strengths –

Having 847 participants increases the generalisability of the results because a large sample is more likely to represent the wider population
Caspi used a standardised procedure as the same questionnaires were given to participants which means the research is reliable.
The findings can be applied to real life situations. E.g. It could be useful for doctors as it tells them that someone with depression could have different causes for their depression. Doctors can look at the different factors that influence depression and check for the short version of the 5-HTT gene.
Consent was given from participants which makes the research ethical.

Weaknesses –

People may have lied on the questionnaire which reduces the validity of the results
Could be upsetting for participants if they discover they have the short version of the gene which is unethical for the participants.

Addiction

Addiction – people need to have or do a particular thing – a substance or activity – in order to be able to go about their normal routine.

E.g.: drugs/ alcohol/gambling/shopping

Withdrawal – a set of unpleasant physical or psychological symptoms someone gets when they are trying to quit or cannot satisfy their addiction

Dependence disorder – dependent on a substance such as alcohol and cocaine

Behavioural addiction – dependent on an activity such as gambling

To be diagnosed, at least three of the symptoms needs to be present at the same time for 1 month in total, or for repeated occasions over a year.

Symptoms of dependence disorder –

Need to take substance
Stopping or reducing the use of the substance is very difficult
Physical withdrawal symptoms (such as shaking, sweating) when substance isn’t used for a period of time
Tolerance for substance increases
Replacing normal activities with taking substance or recovering from it
Ignoring evidence that the use of the substance is harmful

Symptoms of behavioural addiction –

Need to do activity regularly
Stopping or reducing the activity is very difficult
Have to do the activity more often or something riskier to get the same “buzz”
Replacing normal activities with doing this activity
Ignoring arguments that the activity is harmful

Genetic Explanation for Addiction

Dorit Carmelli et al. (1992) found that if one identical twin was a smoker, there was a higher chance the other smoked too compared to non-identical twins. Donald Goodwin et al. (1973) found that adopted children who had at least one biological parent with alcohol addiction were highly likely to show signs of alcohol addiction themselves. Diana Marinez et al. (2004) found that heavy users of cocaine were more likely to have a particular version of a dopamine receptor gene. Remi Cadoret et al. (1987) found that adopted children who shared a biological link with someone with alcohol problems were more likely to have problems with alcohol themselves.

Strengths –

There is a lot of scientific evidence to support the genetic explanation for addiction
Twin studies and adoption studies act as a control for possible factors that could explain addiction
There is evidence that family members might share genes that would explain why addictions run in families (but the results could also be explained by other shared factors)

Weaknesses –

Some people seem naturally more likely to develop addictions, while others might take part in many potentially addictive behaviours but find it easy to stop and start
The genetic explanation is reductionist because it fails to take social factors into account
Research has not been able to find a single gene that explains where addiction comes from. This makes it difficult to pinpoint exactly what is causing the addiction.
One of the genes that has been linked to addictions (DDR2 A1 gene) has been linked to autism. Autism and addiction have very different symptoms and features, and so it is not clear how exactly the gene relates to addiction.
Explains why only some people are prone to becoming addicts.

Learning Theory of Addiction

Classical Conditioning –

Behaviour is learned through associations – two or more things happen around the same time they become linked.
So, when we experience one thing, the other thing becomes automatically triggered.
If a substance or activity is associated with positive feelings in some way, the person learns to associate it with the positive feeling.

Operant Conditioning –

Behaviour are repeated when they lead to positive consequences (form of reinforcement such as rewards).
Positively reinforced behaviour increases the chances of doing it again.
Negative reinforcement/ consequence to our behaviour, that behaviour is avoided
If the thing they are addicted to makes them feel good, it reinforces the behaviour and makes them do it again.

Social Learning Theory –

Behaviour is learned as a result of observing other people – role models – and modelling their behaviour.
May copy someone they look up to with an addiction. E.g. imitating a parent who is smoking.

Strengths –

Assumes behaviours can be unlearned. This means we can use the theories to develop treatments for addiction
OC does take into account that some biological factors. The brain rewards taking drugs by releasing ‘feel good’ chemicals. This suggests an interaction between internal and external factors of addiction
CC – helps explain why some people relapse even years after they have stopped. E.g. A smoker may have the urge to smoke in a situation associated with smoking.

Weaknesses –

In the main the theory ignores the roles of biological factors
Does not explain why lots of people try drugs, alcohol and gambling but only a small number become addicted.
If we learn from associations and consequences, then anyone with an experience of these should become addicted.
SLT if someone sees a role model try drugs, alcohol and gambling but does not become addicted, they may not continue with an addiction

TREATMENTS FOR ADDICTION:

DRUG THERAPY:

DRUG ADDICTION: medication can help with the effects of detoxification (stopping the use of a substance)
- WITHDRAWAL: sweating, shaking, lack of appetite, headaches and irritability can be reduced by taking drugs to combat them,
- REDUCING CRAVINGS: methadone used for opiates, nicotine patches or gums for smokers, and nalxetrone for alcoholics.
- ANTIDEPRESSANTS: can be used to treat underlying issues like depression.
BEHAVIORAL ADDICTION: although not typically treated by drugs, evidence proves that it is effective.
- NALXETRONE: reduces cravings for gambling addiction
- SSRIs: seem to help patients control the urges to participate in behaviors
STRENGTHS: research evidence supports its effectiveness, and helps deal with the short term problems of addiction
WEAKNESSES: no significant differences in cases with a placebo pill instead of nalxetrone, and addicts may become dependent on this medication.

COGNITIVE BEHAVIORAL THERAPY:

When treating addicts, CBT has 2 key stages:
- FUNCTIONAL ANALYSIS: The therapist helps the patient understand the sources of the addiction, and tells them what places, people, or feelings to avoid in order to stop the addiction.
- SKILLS TRAINING: The therapist then helps the patient learn skills they can use in avoiding addiction, such as coping with cravings, assertiveness, and improving motivation.
- The patient also keeps a diary of their feelings in between sessions of CBT to discuss with the therapist
STRENGTHS: it gives the patient control to stop their own behavior, and is supported by research evidence.
WEAKNESSES: CBT only works if the patient wishes to stop their behavior, and may also not use the skills they have learnt to avoid the addiction.

The Nature and Nurture Debate for Mental Health Problems

Caspi et. al (2003) found that having a specific version of the 5-HTT gene could influence the likelihood of someone having depression after a stressful life event. Nativist theories explain why some people are more likely to have psychological problems – because we inherit different genes – but if genes affect these problems, then patients will find it extremely difficult to change their behaviour. E.g.: if a patient has the short version of the 5-HTT gene that predisposes them to depression after a life event, the depression might be more likely to return even after treatment because they still have that version of the gene and any future life event could trigger a relapse.

The cognitive explanation of depression and learning theory of addiction assume that psychological problems are learned as a result of events that happen in a person’s environment. Other ways of behaving could replace the learned behaviour and this forms the basis of the treatment. This explains why CBT can be used to treat addiction and depression. The fact that it is effective for both these psychological problems would support the claim they caused by nurture and not nature.

Other explanations claim that there is an interaction between nature and nurture factors that causes symptoms. Caspi et. al (2003) found that a combination of the short version of the 5-HTT gene AND a stressful life event increased the risk of developing depression. The genes make some people more prone to developing a problem and a stressful event from the environment will trigger the symptoms.

Caspi et. al (2003) Influence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT Gene

Background and Aims: To investigate why stressful life events seem to lead to depression in some people and not others and whether these events were more likely to lead to depression in people with a certainvariation of the 5-HTT gene. Procedure: 847 members of a group of children studied since birth were divided into groups based on 3 variations of the 5-HTT gene (2 short copies, a short and long copy, and 2 long copies). They did a questionnaire on their 21^st and 26^th birthdays that measured events in their life and were assessed for depression a year before the 26^th.

Results: People with a short copy and stressful life events showed an increase in depressive symptoms after the event, and were more likely to be depressed and suicidal than people with 2 long copies. People with 2 short copies had a significantly higher number of reports of severe depressive symptoms and suicidal thoughts. Conclusion: The evidence suggests an interaction between life events and genetic influences to cause depression, needing the specific gene and stressful life events.

Strengths: A large sample is used, increasing generalizability. Information is useful for doctors. Weaknesses: There is a chance the gene influenced them faking into stressful life events rather than depression directly, and the data is self-reported, which may not be reliable.

Young (2007) Cognitive Behavior Therapy with Internet Addicts: Treatment Outcomes and Implications

Background and Aims: To investigate the effect of using CBT to treat a group of patients diagnosed with internet addiction and how problem behaviors improved over time both during therapy and after therapy sessions ended. Procedure: 114 people from the Center for Online Addiction diagnosed with only internet addiction were given online CBT sessions for addiction. Participants answered the Client Outcome Questionnaire, designed to measure how effective CBT was on the 3^rd, 8^th and 12^th session and 6 months after therapy. There were 12 questions answered on a 5-point Likert-type scale (where they rate their level of agreement to a statement).

Results: Participants were 58% males and 42% females, and 61% were educated to university. The average rating of each outcome improved over the course of CBT. Conclusion: CBT is effective in treating internet addiction

Strengths: Encourages addicts to use CBT, and a reliable, standardized questionnaire was used. Weaknesses: Data was self-reported and could be biased, reducing validity, and different types of internet addiction was treated, and it is not clear how CBT affected each type in the end.