Topic-3

Psychological
problems
Keerthy Anna Abraham
EXPLANATION
S OF
UNIPOLAR
DEPRESSION-
EXPLANATION
& TREATMENT

KEERTHY ANNA ABRAHAM

Genetic explanation of unipolar depression
• Higher risk of depression if
someone in your family has
been diagnosed
• Depression might be inherited
through genes
• Hyde et al. (2016)- 17 different
gene variations linked to
depression

Keerthy Anna Abraham

 Genetic explanation of unipolar depression
Twin studies
• Research comparing behavior in groups of
twins to see similarities
• Peter Mcgruffin et al.(1996)- if MZ twin
became depressed, 46% chance that
co-twin would be depressed
• 20% only in DZ twins
• Shows depression might be genetic

Keerthy Anna Abraham

 Genetic explanation of unipolar depression
• Not all family members of depressed
patients will become depressed; needs a
trigger from environment
• Those with genetic predisposition(biological
tendency to develop a particular behavior
as a result of genes) have higher risk
• Diathesis- stress model- an explanation for
depression which claims that people can
have genes that make them likely to develop
depression, but only if they face a stressful
situation that triggers depressive thoughts

Keerthy Anna Abraham

Strengths & weaknesses of genetic
explanation
Strengths
Takes away stigma of depression
diagnosis
Lot of research evidence
Eg: Caspi et al.(2003)- serotonin
transporter gene variation- react
negatively to stressful situation
Keerthy Anna Abraham
Weaknesses
Deterministic-doesn’t consider
free will; only genes
Reductionist-fails to take other
factors into consideration
Doesn’t consider situational
factors
 Cognitive theory as an explanation of
depression
• Behavior can be explained by looking at how
brain processes information
Beck’s cognitive triad
• Tried to explain depression through 3 negative
thought patterns
• Cognitive bias(bias in the way people think)-
see themselves negatively
• Negative triad- develops from bad experiences
from past. This leads to negative self schema.
This might make them prone to magnification
(seeing problem as far worse than reality)
Keerthy Anna Abraham
Ellis’s ABC model
• Different view from Beck
• 3 stages :

Keerthy Anna Abraham

Strengths & weaknesses of cognitive
explanation
Strengths
Takes the environmental factors
into consideration(not just
genetics)
Combination of nature and
nurture
Applied to therapy (CBT)
Has been found to reduce use of
antidepressants
Keerthy Anna Abraham
Weaknesses
Difficult to understand whether
irrational thought is cause or
symptom
Some activating events cannot be
easily explained by cognitive
approach
Eg: post-natal depression
Cognitive Behavioural Therapy (CBT) as a
treatment for depression
• CBT- used to treat many disorders
• Aim of CBT:
• Help patients change the way they think(cognitive part of therapy)
• Help patient change the way they act to improve symptoms they are having
(behavioural part of therapy)
How we think→ how we feel →how we behave
• Beck and Ellis both developed their versions of CBT; Ellis’s known as
REBT(Rational Emotive Behavioural Therapy)

Keerthy Anna Abraham

Steps in CBT
• Stage 1: patient should discuss all symptoms with therapist
• Eg: someone who lost their job
• Stage 2: challenging irrational ways of thinking
• Should replace irrational thoughts with rational positive ways of thinking
• Look at reason why they lost job

• Stage 3: many sessions of CBT; homework about how they are trying
to change behavior in their diary
CBT along with antidepressants is an effective treatment for depression

Keerthy Anna Abraham

Keerthy Anna Abraham
Strengths and weakness

Strengths Weaknesses

• Evidence suggests it is • Relies on patient’s want to

effective
• Longer lasting treatment
• Feeling of helplessness in
patients reduced
get better; 1 symptom of
depression- lack of
motivation
• Ethics- too much control for
therapist

Keerthy Anna Abraham

 Drug therapy
for depression
• Antidepressants- medicines
given to reduce symptoms of
depression
• It works by raising levels of
neurotransmitters such as
serotonin, noradrenaline etc
 Types of antidepressants
• Selective serotonin reuptake inhibitor (SSRIs)-
• Blocks reuptake of serotonin & increases its level in
brain, thus improving mood
• Serotonin and noradrenaline reuptake inhibitors(SNRIs)-
• Blocks reuptake of serotonin & noradrenaline, thus
improving mood
• Monoamine Oxidase inhibitors(MAOIs)-
• Prevents the enzyme MAO from its function(MAO- break
down serotonin & noradrenaline);
• Thus, MAOIs keep higher dose of neurotransmitters in
brain
• Tricyclics(TCAs)
• Used since 1950s
• Prevents absorption of serotonin & norepinephrine
Keerthy Anna Abraham
Keerthy Anna Abraham
 Strengths
• Improve symptoms so that they can
go for other treatments- by improving
motivation
• Useful for depression with moderate
to severe symptoms
Weaknesses
• Unpleasant side effects
• MAOIs- dangerous when
consumed with some food
• Antidepressants can make you
drowsy, nauseous & dizzy &
disturb sleep
• Can also lead to diabetes and
suicidal feelings
• Decreases quality of life for some
• Tricyclics- dangerous if too many
consumed
• Only tackle symptoms & not cause
• Long term effect is lesser- likely to
relapse
Addiction: Symptoms, features,
incidence and influence
Addiction- a mental health problem where people
need a substance or activity in order to be able to go
about their normal routine

Can be with substance such as alcohol or tobacco

ICD-10 calls addiction a dependence disorder

People with addiction often show withdrawal

symptoms(a set of unpleasant physical or
psychological symptoms someone gets when trying
to quit or cannot satisfy addiction)
Symptoms of addiction
Features of • Records state that in 2014-15- 141,646 adults are treated
addiction for substance misuse; most treated for addiction to
opiates & alcohol
• Difficult to understand number of people affected
with addiction as they might not be aware
• NHS(National Health Service) reports that almost 2
million people suffer and so addiction is not a rare
problem
• ICD-10(International Classification of Diseases)- does
not currently recognize internet addiction as a mental
health problem; almost 6% of people have addiction to
internet
• Highest rate of internet addiction in Middle East(10.9 %
of population) lowest rate in Northern & Western
Europe
• 2014 survey- 18–24-year-olds using almost for 15
How does incidences of addiction change over time?
• Addiction now includes internet addiction
& video game addiction
• Change in use of drugs also. Earlier
opiates were used as medicines
• Newspapers are reporting more cases of
drinking and it is now considered a social
issue
• The sources of addiction are becoming
cheaper each day; 2008 survey, 27 %
agreed to using illegal drugs
• 2014 study- 31% agreed to using illegal
drugs
How does addiction affect
individuals & society
• Ignore family, work & school
• Spend their money on addictive
substance; quality of life & health is
affected
• Impact on society by influencing
workplace
• Every year substance misuse costs
488 million pounds, including
rehabilitation
• Addictions can turn to criminal
behaviour, NHS claims drug related
crimes cost 13.9 million pounds
Explanations of addiction
 • Addiction can be due to genetic factors
• Carmelli et al.(1992) found that a MZ twin of a
smoker have higher chance of smoking than a DZ
twin

Genetic • Goodwin et al.(1973) – adopted children with atleast

1 biological parent showing addiction are likely to be
addicts
explanation • Cadoret et al.(1987)- supported the findings of
Goodwin study and found that when 1 adoptive
of parent is addict, the chances are higher
• DDR2 gene and it’s variant A1 gene found to be

addiction responsible for addictions - affects the way brain

reacts to pleasure(requires higher “buzz” than
normal people)
• Martinez et al (2004)- heavy cocaine users were
more likely to have a particular variation of
dopamine receptor D2
Strengths and weaknesses
Strengths Weaknesses

• Lot of scientific evidence- • Reductionist approach- fails

many twin and adoptive to account for social factors
research- thus more • Not able to find a single
reliable gene relating to addiction-
• Helps understand why only DDR2 found to be linked
some people get addicted with autism as well

Keerthy Anna Abraham

Learning theory as an explanation
• Classical conditioning
• Learning through associations
• Eg: feeling sick after eating a food can cause you to experience negative
feelings the next time also
• Operant conditioning
• Behavior repeated through positive consequences
• Eg: positive reinforcements(rewards) such as feeling good while drinking
alcohol can get you addicted
• Social learning
• Behavior learned through observation of others
• Eg: growing up with a parent who smokes
Treatments of addiction
CBT as a treatment
for addiction
• Initially started as a method for
depression but now used for many
disorders
• Occurs in 2 key stages when treating
addicts
• Functional analysis
• Skills training

Particularly useful when used

alongside other treatments such as
drug therapy (in case of heroin
addiction) or nicotine gums (for
smoking)
 Strengths Weaknesses

• Aims to give patient • Addict has to be motivated

control to overcome to change behavior; relies
Strengths addictions. on addict using the skills
• Supported by learned & whether patient
and research evidence. wants to overcome
weaknesses Eg: Young’s study on addiction
internet addiction • Addicts can learn better
coping skills but might not
reduce addiction. Eg:
Morgenstern and
Longabaugh(2000) study

Keerthy Anna Abraham

Drug therapy as a treatment for addiction
• Treatment depends on what type of addiction & severity
Drug addiction
• Medication can help cope with symptoms of withdrawal during
detoxification(when addict stops taking substance they are addicted to)
Reducing cravings
• Many addicts have craving once they stop using the substance
• Their nervous system has become used to the effects of the substance
• Medication can help control the cravings
• Methadone for addiction of opiates etc
• Smokers- nicotine patches, chewing gum etc
Drug therapy as a treatment for addiction
Treating other underlying mental health problems
• Some addiction associated with other disorders like depression, anxiety
etc
• Anti-depressants and anti-anxiety medication can be given along
substance addiction medication
Behavioral addiction
• Medication given for behavioral addiction also
• Naltrexone- used for gambling also as it helps reduce cravings
• Anti-depressants such as SSRI is also used; still unclear how it effects addiction
• Winder et al. (2014)- SSRI helps reduce thoughts about sex in sex addicts
Drug therapy as a treatment for addiction
Strengths and weaknesses
Strengths
• Research supported
• Kim et al.(2001)- found that 75% showed improvement in gambling when
treated with naltrexone
• Helps them access other therapies that last longer; initially controls
symptoms
Weaknesses
• Research evidence is mixed
• Patients might become dependent on medication
 Caspi et al.(2003)- Influence of Life Stress on Depression:
Moderation by a Polymorphism in the 5-HTT Gene
Background of the study
• Not everyone gets depressed through stressful life events
• The study tries to find whether a gene linked with neurotransmitter
serotonin can cause depression
Aims
• To investigate why stressful life events lead some to depression and not
others
• To study whether stressful life events lead to depression in people with
gene variation of 5-HTT gene(a gene linked to serotonin levels in brain)
Procedure
• Dunedin multidisciplinary health
and development study(group of
children studied since birth)
• 847 participants divided to 3 groups
• longitudinal study- completed
questionnaire about life events that
occurred between 21st to 26th
birthdays
• Money, health & relationships
problems
• Another questionnaire used to
assess whether they had depression
before 26 years
Results
• Participants with at least 1 short version of 5-HTT gene along with
stressful life events before ages 21 and 26 years showed significant
increase in symptoms of depression
• Participants with short version of 5-HTT gene and who experienced
stressful life events were more likely to be diagnosed with depression
than those with 2 long versions
• Short version gene- more suicidal thoughts
• 2 short version gene- report severe depression
Conclusion
• Suggest that there is some interaction between life events and
genetic influence
• Both nature and nurture work together to increase likelihood of
depression
Strengths and weaknesses
Strengths Weaknesses

• Large sample- 847 participants • Some people were naturally more

• The information from this study can likely to put themselves in stressful
be useful for doctors situations
• Self-report data and can be biased
Young (2007) Cognitive Behavior Therapy with Internet
Addicts: Treatment outcomes and implications
Background to the study
• Internet addiction has been seen as mental health disorder only
recently; thus treatment methods are also less known
• Young wanted to assess whether CBT can be effective for internet
addiction also
Aims
• To investigate the effects of using CBT to treat internet addicts & to
assess how their problem behaviours improved
Procedure
• 114 participants; completed Internet Addiction Test(IAT) & has been
diagnosed addicts; those with any other psychological problems were
not chosen as participants
• Online CBT sessions given
• Functional analysis
• Skills training
• Participants filled questionnaires on 3rd, 8th & 12th online therapy
session & again at 6 months after treatment
• Client outcome questionnaire- used to assess whether CBT was
effective; included 12 questions; used 5-point likert scale(1- not at all
to 5- extremely good)
Results
• Males (58 %) and Females(42 %) used in
study
• 30% males addicted to pornography; 30%
females addicted to online chat rooms
• 96% said their biggest problem was time
taken up by using online apps
• Client’ attitude towards CBT was also
measured
Conclusion
• CBT can be effective treatment for internet
addiction as clients can control their
problem behavior
• CBT gives long term effects
Strengths & weaknesses
Strengths
• Easy access to treatment as it
can be done online
• Same questions & rating scales
used at 3rd, 8th, 12th session &
after 6 months – increases
reliability
Weaknesses
• Self-report scale & thus might
not be reliable
• Different types of online
addictions(online gambling,
pornography, internet chatrooms
etc) were identified; but not
clear whether all types received
same effects from treatment.
Issues &
debates