inability to experience any pleasure
MODULE 6| MOOD DISORDERS
I. UNDERSTANDING AND DEFINING MOOD
DISORDERS
A. MOOD vs. AFFECT vs. EMOTIONS
➢ MOOD
 A short-lived emotional state, usually of
low intensity.
 A disposition to respond emotionally in
a particular way that may last for hours,
days, or even weeks, perhaps at a low
level without the person knowing what
prompted the state.
➢ AFFECT
 A term that encompasses a broad
range of feelings that people can
experience.
 It embodies both mood and emotions.
➢ EMOTIONS
 An intense feeling that is short-term and
is typically directed at a source.
 Emotions often have indicative facial
expressions and body language as well.
B. AN OVERVIEW OF DEPRESSION AND
MANIA
➢ MAJOR DEPRESSIVE EPISODE
 An extremely depressed mood state
that lasts at least 2 weeks and includes
cognitive symptoms (such as feelings of
worthlessness and indecisiveness) and
disturbing physical functions (such as
altered sleeping patterns, significant
changes in appetite and weight, or a
notable loss of energy) to the point that
even the slightest activity or movement
requires an overwhelming effort.
 The episode is accompanied by a
general loss of interest in things and an
from life, including interactions with
family or friends or accomplishments at
work or at school
 The most central indicators of a full
major depressive episode are physical
changes (sometimes called somatic or
vegetative symptoms), along with the
behavioral and emotional “shutdown”,
as reflected by low behavioral
activation.
 ANHEDONIA (loss of energy and inability
to engage in pleasurable activities or
have any “fun”) is more characteristic
of these severe episodes of depression
than are, for example, reports of
sadness or distress.
o Reflects that these episodes
represent a state of low positive
affect and not just high negative
affect.
 The duration of a major depressive
episode, untreated, is approximately 4
to 9 months
➢ MANIC EPISODE
 Begins abruptly, gathering force within
days.
 Hallmark feature: Increased activity or
energy level, the person seems to be on
overdrive and have boundless energy.
 The person experiences a sudden
elevation or expansion of mood and
feels unusually cheerful, euphoric, or
optimistic.
 They may become extremely sociable
to the point of becoming overly
demanding and overbearing towards
others.
 Others recognize the sudden shift in
mood to be excessive in light of the
person’s life situation.
 Exhibit poor judgment and become
argumentative.
 Some become extremely generous,
have inflated self-esteem (extreme self-
confidence to delusions of grandeur).
 Tend to speak very rapidly with
pressured speech.
 Highly distractible, attention could be
easily diverted by irrelevant stimuli.
 They take on multiple tasks, more than
they can handle: Become disorganized
and are incapable of completing their
projects.
 Unable to sit still and have a decreased
need for sleep:
o Wake up early yet feel well-rested
and full of energy
o Sometimes go for days without sleep
but without feeling tired.
 Though they have abundant stores of
energy, they are unable to organize
their efforts constructively: Elation
impairs the ability to work and maintain
normal relationships.
 Severe cases: experience delusions
(“having a special relationship with
God”) and hallucinations.
 Fail to weigh the consequences of their
actions and get into trouble due to:
o Lavish spending
o Reckless driving
o Sexual escapades
 Some attempt suicide “on the way
down” from a manic phase.
 Individuals find extreme pleasure in
every activity.
 Some are extraordinarily active
(hyperactive), require little sleep, may
develop grandiose plans, believing they
can accomplish everything they desire.
 Observed persistent increased goal-
directed activity or energy.
 Speech is typically rapid and may
become incoherent because the
individual is attempting to express so
many exciting ideas at once referred to
as FLIGHT OF IDEAS.
 Duration: 1 week, less if the episode is
severe enough to require
hospitalization.
o HOSPITALIZATION occurs if the
individual is engaging in a self-
destructive buying spree, charging
thousands of his money in the
expectation of making more the
next day.
➢ HYPOMANIC EPISODE
 A less severe version of a manic
episode that does not cause marked
impairment in social or occupational
functioning and needs to last only 4
days rather than a full week.
 Not in itself necessarily problematic, but
its presence does contribute to the
definition of several mood disorders.
 Less severe than manic episodes and
not accompanied by the extreme
social or occupational problems
associated with full-blown mania.
 A person might feel unusually charged
with energy, show a heightened level of
activity, and inflated self-esteem.
 More alert, irritable, and restless than
usual.
 Work for long hours with little fatigue or
need for sleep.
C. THE STRUCTURE OF MOOD DISORDERS
➢ UNIPOLAR MOOD DISORDER
 Diagnosis is made on individuals who
experience either depression or mania
because their mood remains at one
“pole” of the usual depression-mania
continuum.
 Mania (UNIPOLAR MANIA), by itself,
probably does occur but seems to be
rare, because most people with a
unipolar mood disorder eventually
develop depression.
➢ BIPOLAR MOOD DISORDER
 Alternating between depression and
mania, traveling from one “pole” of the
 depression-elation continuum to the
other and back again.
➢ MIXED FEATURES
 Episode characterized by experiences
of manic symptoms but feel somewhat
depressed or anxious at the same time
or be depressed with few symptoms of
mania.
D. DEPRESSIVE DISORDERS
 These disorders differ from one another
in the frequency and severity with
which depressive symptoms occur and
the course of the symptoms (CHRONIC
– meaning almost continuous – or NON-
CHRONIC)
1. MAJOR DEPRESSIVE DISORDER
 Defined by the presence of depression
and the absence of manic, or
hypomanic episodes, before or during
the disorder.
 An occurrence of just one isolated
depressive episode in a lifetime is now
known to be relatively rare.
 RECURRENT:
o If two or more major depressive
disorders occurred and were
separated by at least 2 months
during which the individual was not
depressed.
➢ ADDITIONAL DEFINING CRITERIA FOR
DEPRESSIVE DISORDERS
PSYCHOTIC FEATURES SPECIFIERS
 Some individuals in the midst of a major
depressive (or manic) episode may
experience psychotic symptoms
specifically HALLUCINATIONS and
DELUSIONS.
 Patients may have:
 SOMATIC (PHYSICAL) DELUSIONS:
Believing for example that their bodies
are rotting internally and deteriorating
into nothingness.
 AUDITORY HALLUCINATIONS: Hearing
voices telling them how evil and sinful
they are.
 MOOD CONGRUENT HALLUCINATIONS
AND DELUSIONS
 DELUSIONS OF GRANDEUR: Believing
that they are supernatural or supremely
gifted that do not seem consistent with
the depressed mood.
 MOOD-INCONGRUENT HALLUCINATION
AND DELUSION
 Associated with a poor response to
treatment, greater impairment, and
fewer weeks with minimal symptoms,
compared with nonpsychotic
depressed patients over a 10-year
period.
ANXIOUS DISTRESS SPECIFIER
 The presence and severity of
accompanying anxiety, whether in the
form of comorbid anxiety disorders
(anxiety symptoms meeting the full
criteria for an anxiety disorder) or
anxiety symptoms that do not meet all
the criteria for disorders
 For all depressive and bipolar disorders,
the presence of anxiety indicates a
more severe condition, makes suicidal
thoughts and completed suicide more
likely, and predicts a poorer outcome
from treatment.
MIXED FEATURES SPECIFIER
 Predominantly depressive episodes that
have several (at least three) symptoms
of mania as described above would
meet this specifier, which applies to
major depressive episodes both within
major depressive disorder and persistent
depressive disorder.
MELANCHOLIC FEATURES SPECIFIER
 This specifier applies only if the full
criteria for a major depressive episode
have been met, whether in the context
of a persistent depressive disorder or
not.
 Include some of the more severe
somatic (physical) symptoms, such as
early-morning awakenings, weight loss,
loss of libido (sex drive), excessive or
inappropriate guilt, and anhedonia
(diminished interest or pleasure in
activities).
CATATONIC FEATURES SPECIFIER
 This specifier can be applied to major
depressive episodes whether they
occur in the context of a persistent
depressive disorder or not, and even to
manic episodes, although it is rare –
and rarer still in mania.
 Involves the absence of movement (a
stuporous state) or CATALEPSY, in which
the muscles are waxy and semirigid, so
a patient’s arms or legs remain in any
position in which they are placed.
 Involve excessive but random or
purposeless movement.
 This response may be a common “end
state” reaction to feelings of imminent
doom and is found in many animals
about to be attacked by a predator
ATYPICAL FEATURES SPECIFIER
 Applies to both depressive episodes,
whether in the context of persistent
depressive disorder or not.
 Individuals with this specifier consistently
oversleep and overeat during their
depression and therefore gain weight,
leading to a higher incidence of
diabetes
 Although they have considerable
anxiety, they can react with interest or
pleasure to some things, unlike most
depressed individuals.
 Has more symptoms, more severe
symptoms, more suicide attempts, and
higher rates of comorbid disorders
including alcohol abuse.
PERIPARTUM ONSET SPECIFIER
 PERIPARTUM: The period of time just
before and just after the birth of a child.
 Can apply to both major depressive
and manic episodes.
 New mothers have difficulty
understanding why she is depressed
because they assume this is a joyous
time.
 Women with a history of peripartum
depression meeting full criteria for an
episode of major depression may be
affected differently by the rapid
decline in reproductive hormones that
occurs after delivery or may have
elevated corticotrophin-releasing
hormone in the placenta and these
factors may contribute to peripartum
depression.
POSTPARTUM DEPRESSION
 Women experience a major depressive
episode within 4 weeks of delivery.
 In some cases, the depressive episode
begins before delivery and continues
into the postpartum period.
 Usually last for a few days but may
persist for months or even a year or
more.
 Maybe a normal response to hormonal
changes associated with childbirth.
 Accompanied by disturbances in
appetite and sleep, low self-esteem,
and difficulties in maintaining
concentration or attention.
 Risk Factors:
o History of mood disorders or
depressive episodes during
pregnancy
o Being a single or first-time mother
o Financial problems or a troubled
marriage
o Domestic violence
o Lacking social support from partners
and family members
o Having unwanted, sick, or
temperamentally difficult infants
o Genetic factors
 PPD is distinct from POSTPARTUM
PSYCHOSIS (a form of Brief Delusional
Disorder):
o Mother loses touch with reality
o Experiences delusions,
hallucinations, and irrational
thinking.
SEASONAL PATTERN SPECIFIER
 Applies to recurrent major depressive
disorder (and also to bipolar disorders).
 Accompanies episodes that occur
during certain seasons.
 The most usual pattern is a depressive
episode that begins late fall and ends
with the beginning of spring.
 In bipolar disorder, individuals may
become depressed during the winter
and manic during the summer.
 These episodes must have occurred for
at least two years with no evidence of
nonseasonal major depressive episodes
occurring during that period of time.
SEASONAL AFFECTIVE DISORDER
 Seasonal changes in light may alter the
body’s underlying biological rhythms
that regulate processes such as body
temperature and sleep-wake cycles.
 Seasonal changes might affect the
availability of Serotonin.
 May be related to daily and seasonal
changes in the production
of MELATONIN, a hormone secreted by
the pineal gland.
 Because exposure to light suppresses
melatonin production, it is produced
only at night. Melatonin production
tends to increase in winter when there is
less sunlight.
 Increased production of melatonin
might trigger depression in vulnerable
people.
PHASE SHIFT HYPOTHESIS
 SAD is a result of phase-delayed
circadian misalignment, meaning that
the patient’s circadian rhythm is
misaligned with the environmental day-
night cycle.
 Women with SAD reported more
autonomous negative thoughts
throughout the year and greater
emotional reactivity to light in the
laboratory, with low light associated
with lower mood.
TREATMENT
 PHOTOTHERAPY:
o Most patients are exposed to 2 hours
of bright light immediately on
awakening.
 o If the light exposure is effective, the
patient begins to notice a lifting of
mood within 3-4 days and a
remission of winter depression in 1-2
weeks.
2. PERSISTENT DEPRESSIVE DISORDER
(DYSTHYMIA)
 Shares many of the symptoms of the
major depressive disorder but differs in
its course.
 Depressed mood that continues at least
2 years, during which the patient
cannot be symptom-free for more than
2 months at a time even though they
may not experience all of the symptoms
of a major depressive episode.
 Differs from a major depressive disorder
in the number of symptoms required,
but mostly it is in chronicity.
 Considered more severe, since patients
with persistent depression present with
higher rates of comorbidity with other
mental disorders, are less responsive to
treatment, and show a lower rate of
improvement over time.
➢ DOUBLE DEPRESSION
 22% of people suffering from persistent
depression with fewer symptoms
(specified as “with pure dysthymic
syndrome”) eventually experience a
major depressive episode (Klein et al.,
2006).
 MAJOR DEPRESSIVE EPISODES +
PERSISTENT DEPRESSION WITH FEWER
SYMPTOMS
E. OTHER DEPRESSIVE DISORDERS
1. PREMENSTRUAL DYSPHORIC DISORDER
 The problem of mood swings is
associated with the premenstrual
period.
 A more severe form of Premenstrual
Syndrome (PMS).
 Diagnosis applied to women who
experience a range of significant
psychological symptoms in the week
before menses.
 Symptoms of PMDD:
 Mood swings
 Sudden tearfulness or feelings of
sadness
 Depressed mood
 Feelings of hopelessness
 Irritability or anger
 Feelings of anxiety, tension, or feeling
on the edge
 Greater sensitivity to cues of rejection
 Negative thoughts about oneself
➢ ETIOLOGY:
 Biological: Interaction of hormones and
neurotransmitters
 Psychological: Attitude towards
menstruation
2. DISRUPTIVE MOOD DYSREGULATION
DISORDER
 In children: characterized by irritability
and increasingly difficult to get along
with at home, engage in intense
arguments at the slightest provocation.
 Adults with a history of disruptive mood
dysregulation are at increased risk for
developing mood and anxiety disorders
as well as many other adverse health
outcomes.
F. BIPOLAR DISORDER
 Characterized by extreme mood swings
and changes in energy and activity
levels.
 Mood swings shift between heights of
elation and depths of depression.
 Some experience mixed states
characterized by both mania and
depression.
 MIXED STATES: Rapid shift between
mania and depression.
 Develops around the age of 20 in both
men and women and tends to become
a chronic, recurring condition requiring
long-term treatment.
➢ RAPID CYCLING:
 Experience of 2 or more full cycles of
mania and depression within a year
without intervening normal periods.
 Occurs more often in women than in
men
 Limited to a year or less
 Associated with a more severe form of
the disorder and with more serious
suicide attempts.
A. BIPOLAR I DISORDER
 Applies to people who have at least
one fully manic episode.
 Involves extreme mood swings between
manic episodes and major depression
with intervening periods of normal
mood.
 It may be applied to a person who
does not have a history of a major
depressive episode, major depression
may have been overlooked in the past
or will develop in the future.
 Onset in men: begins with a manic
episode
 Onset in women: begins with a major
depressive episode
B. BIPOLAR II DISORDER
 Hypomanic episode + 1 major
depressive episode
** BIPOLAR DISORDER AND CREATIVITY **
 Many distinguished writers, composers,
and artists seem to have suffered from
major depression or bipolar disorder.
 Perhaps in some cases, creative people
channel their seemingly boundless
energy and rapid stream of thoughts
associated with mania into creative
expressions.
C. CYCLOTHYMIC DISORDER
(CYCLOTHYMIA)
 Derived from the Greek
word, kylos (“circle”)
and thymos (“spirit”).
 A chronic cyclical pattern of mood
disturbance characterized by mild
mood swings lasting at least two years
(one year for children and
adolescents).
 Begins in late adolescence or early
adulthood and persists for years.
 Few, if any, periods of normal mood last
for more than a month or two.
 Periods of elevated or depressed mood
are not severe enough to warrant a
diagnosis of bipolar disorder.
 Most common of the bipolar disorders.
 Milder than bipolar disorder but can
significantly impair a person’s daily
functioning.
 Boundaries with bipolar disorder are not
clearly established
 FEATURES:
 Numerous episodes of hypomanic
symptoms are not severe enough to
meet the criteria for a hypomanic
episode.
 Numerous periods of mild depressive
symptoms do not measure up to a
depressive episode.
 Fluctuates between periods of mildly
high “highs” and mildly low “lows”
 When they are “UP”: elevated activity
levels are directed at accomplishing
various personal or professional
projects.
 Mildly depressed state:
o Unfinished projects
o Feel lethargic and depressed but
not to the extent typical of a major
depressive episode.
 Shifting moods may strain social
relationships, work may suffer, sexual
interest waxes and wanes with the
person’s moods
II. ETIOLOGY: MAJOR DEPRESSIVE DISORDER
A. BIOLOGICAL FACTORS
1. GENETIC FACTORS
 Interactions of genetic and
environmental factors in major
depression and other mood disorders.
 High genetic risk: greater effect of life
stressors on the development of
depression.
 Two people may share the same
genetic risk factor but may develop
very different disorders depending on
their particular life experiences or other
factors.
2. BIOCHEMICAL FACTORS & BRAIN
ABNORMALITIES
 Irregularities in how serotonin is used in
the brain
 Antidepressants:
o Relieve depression by altering the
number or density of these receptors
or their sensitivity to
neurotransmitters.
3. BIPOLAR DISORDER
 Cognitive deficits in recognizing facial
cues of emotions in others.
 Abnormality in the prefrontal cortex and
limbic system.
 Genetic factors: play an even stronger
role in bipolar disorder than it does in
major depressive disorder
B. PSYCHODYNAMIC THEORIES
1. PSYCHOANALYSIS AND DEPRESSION
 According to Freud, depression is anger
directed inward rather than against
significant others following either the
actual or threatened loss of significant
others.
PATHOLOGICAL MOURNING:
 Fosters lingering depression.
 Occur in people who hold powerful
ambivalent feelings (love and anger or
hostility) toward the departed or whose
departure is feared.
INTROJECTION
 Loss or fear of losing a person whom
one feels ambivalent about, anger turns
into rage triggers guilt.
 A form of preservation of psychological
connection to the lost object/ person
brings inward the mental representation
of the object.
 Anger is then turned inward, against the
part of the self which is the mental
representation of the person.
 Self-hate leads to depression
2. PSYCHOANALYSIS AND BIPOLAR
DISORDER
 Bipolar disorder represents the shifting of
dominance between the ego and the
superego.
 Depressive phase:
o Superego dominant
o Exaggerated notions of wrongdoings
o Flooding the individual with feelings
of guilt and worthlessness
 Manic phase:
o Ego rebounds and assumes
supremacy
 o Feelings of elation and self-
confidence
o Excessive display of ego triggers guilt
that once again plunges an
individual into depression.
3. SELF-FOCUS MODEL
 Focus on the individual’s self-esteem
and sense of self-worth.
 Considers how people allocate their
attentional processes after a loss.
 Depressed people have difficulty
thinking about anything other than
themselves and the loss they
experienced.
C. DIATHESIS-STRESS MODEL
 Stressful life events: INCREASE THE RISK
FOR MOOD DISORDERS
 SOURCES OF LIFE STRESSES:
o Loss of a loved one
o The breakup of a romantic relationship
o Prolonged unemployment and
economic hardship
o Serious physical illness
o Marital or relationship problems
o Separation or divorce
o Exposure to racism and discrimination
o Living in unsafe, distressed
neighborhoods
 Stressful life events can contribute to
depression whereas depressive
symptoms can be stressful in themselves
or lead to other sources of stress
➢ PROTECTIVE FACTORS AGAINST
DEPRESSION:
 Coping skills
 Genetic endowment
 Availability of social support
 Strong marital relationships
➢ RISK FACTORS
 Gene-environment interactions: genetic
susceptibility to develop depression with
a history of very stressful life events
 Lack of secure attachments to parents
during infancy or childhood
 Adverse experiences in early life:
parental divorce or physical abuse.
 Insufficient marital supportive
relationships
➢ BIPOLAR DISORDER
 Stressful life changes and underlying
biological influences may interact with
a genetic predisposition to increase a
person’s vulnerability to bipolar disorder.
 Stressful life events can trigger mood
episodes in people with bipolar
disorder.
 Negative life events may precede
depressive episodes, whereas both
negative and positive life events may
precede a hypomanic or manic
episode.
 PSYCHOSOCIAL FACTORS
 Social support from family members or
friends can enhance the level of
functioning of bipolar patients by
providing them with a buffer against
the negative effects of stress.
 Availability of social support: play a role
in helping speed recovery from mood
episodes and reducing the likelihood of
recurrent episodes.
D. BEHAVIORAL THEORIES
1. ROLE OF REINFORCEMENTS (P.
Lewinsohn, 1974)
 Depression is the result of an imbalance
between behavior and reinforcements.
 Low levels of positive reinforcements
lead to:
o Reduced motivation
o Induce feelings of depression
 o Exacerbate withdrawal
 Secondary Reinforcement: Low rate of
activity of depressed individuals
o Sympathy: releases depressed
individuals from their responsibilities
and maintains depressed behavior
 Reinforcement reduction:
o Recovery from serious physical illness
o Loss of loved ones
o Changes in life circumstance
 INTERVENTION:
o Encourage participation in
rewarding activities and goal-
oriented behaviors
o Encourage regular physical activities
2. INTERACTIONAL THEORY (J. COYNE,
1976)
 The adjustment to living with a
depressed person can become so
stressful that the partner or family
member becomes progressively less
reinforcing.
 RECIPROCAL INTERACTION
o Our behavior influences how other
people respond to us and how they
respond to us influences how we in
turn respond to them.
 Depression-prone people react to stress
by seeking or demanding reassurance
and support from their partners and
significant others.
 Persistent demands for emotional
support may begin to elicit more anger
and annoyance than expression of
support.
 Depressed people:
o May react to cues of rejection with
deeper feelings of depression and
by making greater demands for
reassurance, triggering a vicious
cycle of rejection and more
profound depression.
o May feel guilty about causing
distress in the family which can
exacerbate their negative feelings
about themselves.
o Family members may find it stressful
to adjust to the depressed person’s
behavior (withdrawal, lethargy,
despair, and constant demand for
reassurance)
o Unresponsive, uninvolved, and even
impolite when they interact with
others
o Dwell on negative feelings while
interacting with strangers.
 Depressed individuals’ excessive need
for reassurance leads to rejection by
the very people from whom they seek
reassurance and support due to their
lack of social skills
 Partners who fail to meet each other’s
psychological needs or are critical or
hurtful toward each other can affect
each other’s emotional well-being.
E. COGNITIVE THEORIES
1. COGNITIVE TRIAD OF DEPRESSION (A.
BECK, 1979)
 Negative concepts of the self and the
world as mental templates are adopted
in childhood on the basis of early
learning experiences.
2. COGNITIVE DISTORTIONS (D. BURNS,
1980)
 Tend to occur automatically.
 Automatic Thoughts: likely to be
accepted as statements of facts rather
than as opinions or habitual ways of
interpreting events.
a. ALL-OR-NOTHING THINKING
 Seeing events as either all good or all
bad, or either as white or black with no
shades of gray
 e.g.: Perfectionism is connected with an
increased vulnerability to depression as
well as poor treatment outcomes.
b. OVERGENERALIZATION
 Believing that if a negative event
occurs, it is likely to occur again in
similar situations in the future.
 One may interpret a single negative
event as foreshadowing an endless
series of negative events.
c. MENTAL FILTER
 Focusing only on negative details of
events, thereby rejecting the positive
features of one’s experiences.
 Selective Abstraction: an individual
selectively abstracts the negative
details from events and ignores the
events’ positive features.
 Bases one’s self-esteem on perceived
weaknesses and failures, rather than
one positive feature or on a balance of
accomplishments and shortcomings.
d. DISQUALIFYING THE POSITIVE
 The tendency to snatch defeat from
the jaws of victory by neutralizing or
denying one’s accomplishments.
 Taking credit where credit is due may
help people overcome depression by
increasing their belief that they can
make changes that will lead to a
positive future.
e. JUMPING TO CONCLUSIONS
 Forming a negative interpretation of
events, despite a lack of evidence.
 MIND READING: a person arbitrarily
jumps to conclusion that others do not
like or respect him or her, as in
interpreting a friend’s not calling for a
while as rejection.
 FORTUNE TELLER ERROR: the prediction
that something bad is always about to
happen; the person believes the
prediction of calamity is factually
based, even though there is no
evidence to support it.
f. MAGNIFICATION AND MINIMIZATION
 Tendency to make mountains out of
molehills.
 CATASTROPHIZING: Exaggeration of the
importance of negative events,
personal flaws, fears, or mistakes.
 MINIMIZATION: Minimizes or
underestimates one’s good points.
g. EMOTIONAL REASONING
 Interprets feelings and events on the
basis of emotions rather than on fair
consideration of the evidence.
h. “SHOULD” STATEMENTS
 Creating personal imperatives or self-
commandments “shoulds” or “musts”
 Creating unrealistic expectations
i. LABELING AND MISLABELING
 Explaining behavior by attaching
negative labels to oneself and others.
 Labeling: “stupid” or “insensitive” can
engender hostility towards the person.
 Mislabeling: use of emotionally charged
labels and inaccurate, calling oneself
as a “pig” due to a minor deviation
from one’s diet.
j. PERSONALIZATION
 Assuming that one is responsible for
other people’s problems and behavior.
3. COGNITIVE-SPECIFICITY HYPOTHESIS
 Proposes that different disorders are
characterized by different types of
automatic thoughts.
 People with diagnosable depression
more often reported automatic
thoughts concerning themes of loss,
self-deprecation, and pessimism.
 People with anxiety disorders more
often reported automatic thoughts
concerning physical danger and other
threats.
F. HUMANISTIC THEORIES
 Depression: caused by an inability to
imbue a person’s existence with
meaning and make authentic choices
that lead to self-fulfillment.
 Focus on the loss of self-esteem that
can occur when people lose friends or
family members or suffer occupational
setbacks.
 Sense of self-worth and self-esteem is
associated with social and
occupational roles, loss of these
identities could facilitate depression.
G. LEARNED HELPLESSNESS (ATTRIBUTIONAL)
THEORY (M. SELIGMAN, 1973, 1975)
 People may become depressed
because they learn to view themselves
as helpless to change their lives for the
better.
 Situational factors foster attitudes that
lead to depression.
 Learned helplessness effect:
 Failing to learn to escape when escape
became possible.
 Showed behaviors similar to those of
depressed people including lethargy,
lack of motivation and difficulty
acquiring new skills.
 Some forms of depression in humans
might result from exposure to
apparently uncontrollable situations.
 Outcomes are beyond one’s ability to
control
 ATTRIBUTIONAL STYLE:
o A personal style of explanation
o Disappointments or failures:
 Internal Attribution: Blame
ourselves.
 External Attribution: Blame
circumstances we face
 Stable Attribution: Bad
experiences as typical events
 Unstable Attribution: Isolated
events
 Global Attribution: Evidence of
broader problems
 Specific Attribution: Evidence of
precise and limited shortcomings
➢ THREE TYPES OF ATTRIBUTION MOST
VULNERABLE TO DEPRESSION:
 INTERNAL FACTORS: beliefs that failures
reflect their personal inadequacies,
rather than external factors, or beliefs
that failures are caused by
environmental factors.
 GLOBAL FACTORS: beliefs that failures
reflect sweeping flaws in personality
rather than specific factors, or beliefs
that failures reflect limited areas of
functioning.
 STABLE FACTORS: beliefs that failures
reflect fixed personality factors rather
than unstable factors, or beliefs that the
factors leading to failures are
changeable.
III. TREATMENT AND INTERVENTION FOR
MOOD DISORDERS
A. BIOMEDICAL APPROACH
1. DEPRESSION
a. ANTIDEPRESSANT DRUGS
 Increase the availability of
neurotransmitters
 TRICYCLICS:  Dramatic effects on relieving suicidal
o Imipramine (Tofranil), Amitriptyline ideation
(Elavil), Desipramine (Norpramin),
and Doxepin (Sineqan) 2. BIPOLAR DISORDER
o Increase brain levels of
a. LITHIUM AND MOOD STABILIZERS
neurotransmitters norepinephrine
and serotonin by interfering with the
 Lithium Carbonate
process of the reuptake of these
 Helps reduce mania and stabilize
chemical messengers.
moods in bipolar patients and reduces
the risk of relapse
 MONOAMINE OXIDASE (MAO)
 Some patients may fail to respond to
INHIBITORS:
the drug or cannot tolerate it
o Phenelzine (Nardil)
 May lead to mild memory problems
o Increase availability of
 Side Effects:
neurotransmitters by inhibiting MAO
o Weight gain
o Less widely used due to possible
o Lethargy and grogginess
interactions to food and alcoholic
o General slowing down of motor
beverages.
functioning
o Long-term use: gastrointestinal
 SELECTIVE SEROTONIN-REUPTAKE
INHIBITORS (SSRI) distress and lead to liver problems
o Fluoxetine (Prozac) & Sertraline
b. ANTICONVULSANT DRUGS
(Zoloft)
o Interfere with serotonin reuptake
 Carbamazepine (Tegretrol), Divalproex
(Depakote) and Lamotrigine (Lamictal)
 SELECTIVE NOREPINEPHRINE-REUPTAKE
 Help reduce manic symptoms and
INHIBITORS (SNRI)
stabilize moods in people with bipolar
o Venlafaxine (Effexor)
disorder
o Selectively reuptake of both
 Help people with bipolar disorder who
norepinephrine and serotonin
fail to respond to lithium or cannot
increases levels of the same
tolerate its side effects
neurotransmitters in the brain.
B. PSYCHODYNAMIC APPROACH
b. ELECTROCONVULSIVE THERAPY (ECT)
 Help depressed people understand
 Safe and effective treatment for severe
underlying ambivalent feelings toward
depression and shows it can help
important people in their lives whom
relieve major depression even in cases
they have lost or whose loss was
in which drug treatments have failed.
threatened.
 An electrical current of 70 – 130 volts is
 Focus on unconscious conflicts but are
applied to the head to induce
more direct, relatively brief, and focus
convulsions.
on the present as well as past
 Administered in a series of 6-12
conflicted relationships.
treatments given three times per week
 Some use behavioral methods to
over several weeks.
acquire the social skills needed to
 Given to a majority of people with
develop a broader social network.
major depression who had failed to
respond to antidepressant medication.
➢ INTERPERSONAL PSYCHOTHERAPY
 Relatively brief therapy that emphasizes
the role of interpersonal issues in
depression and helps clients make
healthy changes in their relationships.
 Focus on the client’s current
relationships rather than on unconscious
internal conflicts of childhood origin.
 Helps client deal with unresolved or
delayed grief reactions following the
death of a loved one as well as with
role conflicts in present relationships.
 Effective treatment for major depression
and shows promise in treating other
psychological disorders as well
including dysthymia, bulimia, and
posttraumatic stress disorder.
C. BEHAVIORAL APPROACH
 Focus on helping depressed patients
develop more effective social or
interpersonal skills.
 Increasing their participation in
pleasurable or rewarding activities.
BEHAVIORAL ACTIVATION
 Encourages patients to increase the
frequency of rewarding or enjoyable
activities
 Produce substantial effects in treating
depression
D. COGNITIVE-BEHAVIORAL THERAPY
 Believe that distorted thinking plays a
key role in the development of
depression.
 Focus on helping people recognize and
correct dysfunctional thought patterns.
 Help clients identify and change
dysfunctional thoughts and develop
more adaptive behaviors.
 Brief lasting for 14 – 16 weekly sessions.
 Produce impressive results in treating
major depression and reducing risks of
recurrent episodes.
 Greater protection against relapse than
antidepressant medication
IV. SUICIDE IN ADULTS
o Often a feature or symptom of an
underlying psychological disorder.
o Older adults: higher suicide rates aged
65 and above.
o Gender: more women attempt but
more men succeed.
o Reasons behind suicide:
o Higher among people with severe
mood disorders, greater risk for
repeated episodes of major depression.
o Associated with other psychological
disorders: alcoholism and drug
dependence, anxiety disorders,
anorexia, schizophrenia, panic disorder,
personality disorders, posttraumatic
stress disorder, and borderline
personality disorder.
o Past suicide attempts.
o “Rational Suicide”: belief that they are
based on a rational decision that life is
no longer worth living in light of
continual suffering.
 Motivated by the desire to escape from
unbearable emotional pain.
 Prevented if people with suicidal
feelings received treatment for
underlying disorders, including
depression, bipolar disorder,
schizophrenia, and alcohol and
substance abuse.
A. THEORETICAL PERSPECTIVES ON SUICIDE
1. BIOLOGICAL FACTORS
 Genetics
 Neurotransmitter
imbalance: SEROTONIN
o Decreased serotonin levels lead to
disinhibition or release of impulsive
behavior that takes the form of a
suicidal act in vulnerable individuals
2. CLASSIC PSYCHODYNAMIC MODEL

 Inward-directed anger that turns

murderous.
 Vent their rage against the internalized
representation of the love object,
destroy themselves in the process

3. SOCIOLOGICAL PERSPECTIVE

 ANOMIE (E. DURKHEIM, 1897/ 1958)

o Feeling lost, without identity, rootless

 Social isolation
 Family support is available but not
helpful

4. BEHAVIORAL THEORIES

 Lack of problem-solving skills for

handling significant life stress
 Schneidman (1985):
o Those who attempt suicide wish to
escape unbearable psychological
pain and may perceive no other
way out.

 People who threaten or attempt suicide

may receive sympathy and support
from loved ones and others perhaps
making future and more lethal attempts
more likely.

5. SOCIAL-COGNITIVE THEORY

 Suicide may be motivated by personal

expectancies, such as beliefs that one
will be missed by others or that survivors
feel guilty for having mistreated the
person
 Suicide will solve one’s own problems or
even other people’s problems
 Potential modeling effects of observing
suicidal behavior in others
 Social Contagion