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Depression cognitive approach psychodynamic approach and behavioural approach

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Seligman (1973) termed depression as the ‘common cold’ of psychological problems (Gross,R.,Mcilveen,R.,2000). By using the term ‘common cold’ Seligman means that depression is the most common psychological disorder that people face.

Depression is a mood disorder. Most of us at some time in our lives may go through a period of time when we ‘feel down ‘ however to be clinically diagnosed with Depression we must present with a persistent low mood for at least two weeks and five of the following symptoms; markedly diminished interest or pleasure, feelings of worthlessness, significant weight gain or loss, insomnia or hypersomnia, fatigue, low concentration and psychomotor agitation, i.e. unusual habits. [1] The average duration of a major depression is 8-12 months (Blacker, 2000). There are 300,000 GPs in the UK, each of whom will see 250 patients with depression each year (Blacker, 2000) . Between 3000 and 7000 each year commit suicide whilst suffering from depression. (Blacker 2000) [2] .

There are three main psychological approaches to depression. The Psychodynamic Approach, developed by Freud believes that our experiences and behaviour are driven by our unconscious feelings. He believes the explanation of depression lies in the early relationship we have with our parents. Freud found a similarity between depression and grief in the way a person reacts such as loss of appetite, extreme sadness, insomnia and withdrawal from society. Freud described depression as “excessive and irrational grief” as a reaction to loss (Gross,R.,Mcilveen,R 2000). Freud believes that both “actual” loss such as the death of a loved one and “symbolic” such as loss of a job can cause depression. Freud believes that these losses cause us to re-experience parts of our childhood when we may have experienced loss of affection from an important person [3] . There have been studies which produce evidence to support this (Roy 1981). Roy found that that people who lost their parents in childhood were more likely to suffer depression whilst other studies (Lewinsohn & Hoberman, 1982) found no such link. (Gross,R.,Mcilveen,R.,2000). Freud argued that not only actual loss in childhood could cause depression as an adult but also imagined loss such as a bad relationship or unresolved hostilitiy towards a parent or an attachment figure. He believes that we turn this anger inwards and this creates feelings of guilt and despair causing depression.(Gross,R.,Mcilveen,R.,2000)

There have been studies to support the Psychodynamic Approach such as Waller et al (2000) who found that men who had lost their fathers during childhood scored higher on a depression scale than those whose fathers had not died and also Bifulco (1992) found evidence that suggested children who lost their mothers during childhood were more likely to suffer depression as an adult. [4] These studies give wider academic credibility to the idea that depression is caused by psychological factors [5] . However, Freud’s approach does have weaknesses. We could argue that this theory is unscientific and too difficult to measure and that we cannot generalise from case studies as no two people are the same or react in the same way to experiences. As Symbolic loss cannot be observed, we are unable to access this in an experiment or study. It is also true that not all depressed people have suffered loss of an adult in childhood (Lewinsohn & Hoberman 1982).

A different psychological approach to depression is the Cognitive Theory. Beck (1967) believes that depression is the result of self-defeating negative beliefs (Gross,R.,Mcilveen, R 2000). He called these cognitive errors [6] . He developed this idea which he called the cognitive triad .The idea is based on three negative thought processes made up of negative perspectives of The Self -“I am a bad person, The Future “things will not improve ” and Experiences “My life is terrible” [7] . Thinking in this way interferes with normal thoughts and causes problems with perception memory and problem solving so that the person becomes obsessed with negative thoughts and is trapped in a negative downward spiral which they will find difficult to break out of this is when we become susceptible to depression. A strength of this cognitive theory is that it has practical applications Butler &Beck (2000) found after reviewing analysis investigating the effectiveness of Beck’s cognitive therapy found that 80% of patients benefited from the therapy finding it more effective than drug therapy with a lower relapse rate. [8] Therefore if treatment based on the cognitive theory is working and improving the quality of peoples lives there must be relevance in the theory. However there are critics of the Cognitive Approach Lewinsohn (1981) carried out a study on depressed people and found they were no more likely to have depressed thoughts than those who did not develop depression. [9]

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This could suggest that the negative thoughts and Faulty thinking happens as a result of the depression rather than being the cause of it. It is also thought that the cognitive theory is reductionist a too simplistic way of explaining depression as it cannot explain why not everyone develops depression after a stressful event and also why people who have not experienced stressful events still develop depression.

The final theory to look at is the Behavioural Approach this approach looks at depression from two angles the first is the role played by reinforcement. When a person first becomes depressed they may withdraw and spend less time with friends and family the concern and sympathy shown at this stage reinforces the depressed behaviour the depressed person will enjoy the attention and carry on however as time passes and friends and family show less concern the reinforcement is reduced and this makes the depression worse Lewinsohn (1974).Lewinsohn (1974) also suggested that people who lack social skills are more likely to suffer depression as they are not receiving positive feed back from others. Another angle of the Behavioural Approach is that of Learned Behaviour when an individual gives up trying to influence their environment.

Due to circumstances where they have had no control for example constant failures such as being unable to get a job after going for lots of interviews and being turned down or after a series of broken relationships. These could be seen as constant failures and the person gives up. Seligman (1974) carried out an experiment using dogs, where by the dogs were restrained and given electric shocks as the dogs had no way of escaping they became passive and resigned to the shocks. However later the dogs were unrestrained and free to escape but still made no attempt to escape when given more electric shocks.

Seligman called this learned helplessness and believes that the behaviour shown by the dogs is similar to that of a depressed human. Seligman suggests that like the dogs humans learn after a series of bad experiences that they have no control and give up trying. When people feel helpless they almost switch

off and withdraw they see no way of solving the problem such as a woman trapped in an abusive relationship the result of this could be depression. We could criticise the research carried out using dogs as this may be too simplistic to compare to humans, maybe the dogs not trying to escape was for physical reasons rather psychological. An ethical objection to the research could be on the basis of animal rights. Did this research cause unnecessary cruelty to the dogs? The cognitive theory can be applied to reactive depression, when a person becomes depressed as a result of a particular event but does not explain endogenous depression when no actual cause for the depression can be found, nothing bad has happened to them.

When considering each approach individually to depression it is possible that we are being determinist and limiting our view and understanding. As each person is an individual exposed to completely different circumstances and experiences it is difficult to apply one theory as an overall explanation.

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