Depression - Comparing treatments [Biological, behavioural and cognitive]

Depression is an affective (mood) disorder which affects approximately one in 5 older people, and thus being able to treat depression is obviously very important. 

The biological approach to treating depression

The biological approach assumes that all behaviour has a biological cause, and thus it targets biology when attempting to treat depression. As many biological psychologists believe that depression is caused by neurotransmitter dysfunction, the treatment for depression aims to target this through a form of therapy called drug therapy. 

Drug therapy is specific to the type of disorder that is being treated; anti-psychotics for psychotic disorders, anti-anxiety medication for anxiety disorders, and anti-depressants for affective disorders. 

Anti-depressants aim to treat depression by raising levels of certain neurotransmitters such as serotonin, as low levels of serotonin have been associated with depressed mental states. 

Study: Karp and Frank (1995) carried out a review article on the effectiveness of drug therapy in treating depressed women. Meta-analysis  (combined analysis) of nine pieces of research featuring a total of 520 women with depression showed that adding cognitive therapy to drug therapy was no more effective than merely prescribing anti-depressants. This suggests that drug therapy for depression is sufficient treatment for depression without other components. 

The behavioural approach to treating depression

The behaviourist approach works on the basis that if behaviour is learned, it can also be unlearned, often through the use of Cognitive Behavioural Therapy (or CBT).

The cognitive element of CBT essentially asks the client undergoing therapy to keep a diary of thoughts and beliefs, and then the therapist will work through them in order to challenge negative thought patterns. The behavioural element, focussed on behavioural activation, features the client and therapist planning pleasurable activities (working on the basis of classical conditioning) and providing rewards for non-depressed activities such as being sociable and active (working on the basis of operant conditioning). Thus, the client learns to associate "non-depressed" activities with pleasure and will therefore be more likely to continue in order to get the positive reinforcement of pleasurable activities and feelings. 

Study: Lewinson (1990) refers to the CBT programme of "coping with depression", a skills based programme where people with depression work together in small-groups to relieve their depression through learning skills such as assertiveness, mood monitoring, relaxation and conflict resolution. It used a sample of 69 depressed self-selected adolescents from Oregon, US, who were split into 3 conditions: only adolescent received training, both adolescent and parents received training, and a control group who were put onto a waiting list for therapy. Note that whilst the adolescents received the "coping with depression" course, parents were taught about positive reinforcement for non-depressed activities and positive changes in their children. By the end of the treatment, group 1 had a 43% reduction in depression, group 2 showed a 47% reduction, whilst the control group showed only 5%. All follow up interviews showed depression rates continued to drop over time, suggesting that CBT is valuable in reducing depression in the short and long term, and that positive reinforcement training for parents is also significant.

The cognitive approach to treating depression

The cognitive approach assumes that it is necessary to recognise the importance of internal mental processes such as thought and perception in determining behaviour. In terms of depression, this approach attempts to identify cognitive distortions through therapy, and to challenge them.

One common type of cognitive therapy used to treat depression is Rational Emotive therapy (RET). It was devised by Albert Ellis and aims to target the irrational beliefs that cause depression. It focuses on depressed people's tendency to think catastrophically (worst case scenario) and then challenging the irrational assumptions underlying this tendency. His model is often referred to as the ABC model:

A: Activation (event which triggers depressive thought/depression)

B: belief (main target of therapy; irrational thought/assumption)

C: consequence (what happens as a result; depression)

Study: Beck et al (1978) is one study which looked at cognitive therapies such as RET, comparing their effectiveness to drug therapy. 44 patients diagnosed with depression undergoing therapy (either drug or cognitive) for 12 weeks were monitored. Whilst both groups showed marked improvements, self-report measures and observations made by psychologists suggested that cognitive therapy was substantially more effective in reducing depression and also seemed to be linked to greater adherence (shown by less attrition in the cognitive group).

Similarities:

Both the behavioural and cognitive approaches use face-to-face therapy and recognise the importance of interaction and cognitive elements in treating depression.

None of the approaches are instantaneous; they require a course across several weeks to be effective. 

Differences:

Drug therapy doesn't require much patient-client interaction, nor does it require much effort on the part of the client - this might be more appropriate as lack of energy or concentration is often part of depression. The other two require more effort.

The behavioural approach is the most holistic as it includes both a cognitive and behavioural element, and aims to treat both the depressed person and change their social environment by changing their parents' behaviour. The other two are quite reductionist as they believe depression is simply dispositional in terms of cognition or biology. 

Reductionism

Reductionism is a really key issue in psychology because to some extent it can be applied to every theory, and every approach or paradigm. 

Reductionism refers to the breaking down of complex phenomenon into smaller components. It's the opposite of holism, where complex phenomena are looked at in their entirety.

Reductionism/holism is a continuum rather than an either/or description of a theory or approach. Some of the more reductionist approaches are behaviourism and the biological approach, whilst the more holistic approaches are humanistic psychology, the individual differences approach and social psychology.

Essentially, the more simplistically a behaviour is explained, the more reductionist the theory. 

What is Reliability?

Reliability is probably one of the most difficult concepts to get a handle on that you have to understand at A-level psychology. So I'll ease you in gently.

Reliability refers to the extent to which something is consistent. It does not imply validity, as something may consistently give incorrect measures, though both can be affected by factors such as participant variables, observer bias, subjectivity and standardisation. 

You can be asked to assess reliability of a number of things, most commonly:

- reliability of a measure
- reliability of research
- reliability of a method

There are two main types of reliability: external reliability and internal reliability. Internal reliability refers to the extent to which a measure is consistent within itself whilst external reliability is consistency over time (i.e. it is externally reliable if the measure taken in similar circumstances would produce similar results).

Generally, the factors that affect reliability are:
- the level of control over confounding variables. The higher the control, the less chance there is of inconsistencies over time and thus the more externally reliable it is likely to be
- standardisation. If research into an area tends to use experiments with standardised procedures, or a manual is used, it's more likely that reliability will be high.
- population and ecological validity (research). If a study has poor generalisability due to an ethnocentric or biased sample, or poor mundane realism (as in the case of many lab experiments) findings when applied to real life cannot be expected to be consistent with that of the research.
-subjectivity. If a measure or study relies on subjectivity to give results, as with all qualitative data, self-reports or observations and much research done in cognitive/psychodynamic psychology, it's unlikely to produce consistent results and will probably lack in internal reliability because interpretation becomes a confounding variable and thus may change from measure to measure.

Tackling part a) questions

You've got to answer 4 part a) questions for the G543 paper, and it's important to get them right because it's a lot easier to get top marks in this part than part b). 

If you're struggling on how to go about it, here's how I answer part a):

• Is it asking about a theory or research? Some sections don't really have "theories" as such, like the stress subsection, but you'll need a bit of an intro. If they're asking about a theory, it won't hurt to make the last paragraph a bit of a study to help illustrate your point. It's generally what they're looking for.
• Identify what the question is asking you, and actually answer it. Pre-learned part a)s won't be the most effective way of gaining marks; you need to apply your knowledge of studies and theories to the actual question.  
• Keep referring back to the question.

Generally, this is my structure:

1. Set the scene. If it's a question on the behavioural approach to managing stress, briefly define stress and outline the assumption of the behaviourist approach. You might also want to list that there are many approaches to managing stress, but it's not necessary. 

e.g. Stress is the body's response to either physical, emotional or mental demands that are perceived to stretch an individual in some way (often because they may feel they are unable to deal with it). Some stress is good, like stress that makes you want to revise, but some stress is unnecessary and has a strong aversive effect on overall health. There are many proposed ways to manage stress. The behavioural approach to psychology believes that all behaviour, including stress is learned, and thus assumes that you can learn to manage stress.

2. The theory. Start with the basic explanation, as simple as you can. Then you can expand on it and show what you know, giving the example of a specific or main theory. 

e.g. The behavioural approach to managing stress often includes teaching stressed clients to be aware of their central nervous system and their stress, and then learning how to reduce the stress. This is often also combined with positive reinforcements. One key behavioural technique of managing stress emphasises the role of biofeedback. It involves being taught relaxation techniques, whilst being made aware of the effect on the body that they have, and then receiving feedback on their progress, through the use of biodots, or heart rate monitors which show the physical reduction of stress. This use of double positive reinforcement in the form of relaxation and biofeedback is supposed to help the client feel in control of their stress.

3. The study. Even if the question doesn't ask for it, I would rarely recommend skipping this step. It helps to illustrate your understanding and get you those full marks.

e.g. One study which illustrates how the behaviourist approach uses biofeedback to manage stress was conducted by Budzynski et al. It was a field experiment involving 18 volunteers with tension headaches who were split into three conditions. Group 1 received relaxation training for 2 weekly sessions for 8 weeks, during which they had their muscle tension measured by an EMG. They were informed of the biofeedback in the form of clicks as their positive reinforcement; more clicks meant higher tension, and thus they were encouraged to relax. Group 2 had the same relaxation training but didn't have accurate biofeedback, and Group 3 was a control group with neither. Both experimental groups showed improvement in tension headaches and other stress-related illnesses such as hysteria and depression, but Group 1 showed the most improvement. This suggests that biofeedback is one technique in which stress can be managed. 

If there's a question you'd like me to go over, leave a comment and I'll take a look.