Chapter 7
active; productive; alone
Depressed people are usually less _____________ and less _________________________. They spend more time _____________ and may stay in bed for long periods.
negative
Depressed people hold extremely _____________________ views of themselves. They consider themselves inadequate, undesirable, inferior, perhaps even evil (Scheffers et al., 2019). They also blame themselves for nearly every unfortunate event, even things that have nothing to do with them, and they rarely credit themselves for positive achievements.
slowly
Depressed people may also move, and even speak, more _____________
drive, initiative, and spontaneity.
Depressed people typically lose the desire to pursue their usual activities. Almost all report a lack of:
interpersonal psychotherapy (IPT); interpersonal loss, interpersonal role dispute, interpersonal role transition, and interpersonal deficits
Developed by clinical researchers Myrna Weissman and Gerald Klerman, _____________________ _________________________ holds that any of four interpersonal problem areas may lead to depression and must be addressed: (Lemmens et al., 2020; Swartz, 2019). Over the course of around 20 sessions, IPT therapists address these areas.
childhood traumas; inadequate parenting
Developmental psychopathology studies indicate, for example, that individuals who experience severe ____________________ ____________ or _________________________ _______________ often develop depression when they later encounter life stress, even if they have no genetic predisposition for the disorder
stressful events; 80
Episodes of unipolar depression often seem to be triggered by _____________________ ____________ in an individual's life (Krishnan, 2019). In fact, researchers have found that ______ percent of all severe episodes occur within a month or two of a significant negative event
artists; writers
a number of studies indicate that __________ and ___________ are somewhat more likely than others to suffer from certain mental disorders, particularly bipolar disorders
the individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways that lead them to feel depressed.
cognitive triad:
anhedonia
, an inability to experience any pleasure at all
Mania
, the opposite of depression, is a state of breathless euphoria, or at least frenzied energy, in which people may have an exaggerated belief that the world is theirs for the taking.
low; high; undersized; low; high; small
. Research suggests, for example, that among depressed people, activity and blood flow are unusually ________ in certain parts and unusually _________ in other parts of the prefrontal cortex; the hippocampus is ______________________ and its production of new neurons is _________; activity and blood flow are ________ in the amygdala; the subgenual cingulate is particularly ___________ and active; and the communication, or interconnectivity, between these various structures is often problematic
mania; motivational; active; cognitive; energetic
A person in the throes of ____________ has active, powerful emotions in search of an outlet. The mood of euphoric joy and well-being is out of all proportion to the actual happenings in the person's life. Not every person with mania is a picture of happiness, however. Some instead become very irritable and angry, especially when others get in the way of their exaggerated ambitions. In the ______________________ realm, people with mania seem to want constant excitement, involvement, and companionship. The behavior of people with mania is usually very _____________ They move quickly, as though there were not enough time to do everything they want to do. They may talk rapidly and loudly, their conversations filled with jokes and efforts to be clever or, conversely, with complaints and verbal outbursts. Flamboyance is not uncommon: dressing in flashy clothes, giving large sums of money to strangers, or even getting involved in dangerous activities. In the __________________ realm, people with mania usually show poor judgment and planning, as if they feel too good or move too fast to consider possible pitfalls. Finally, in the physical realm, people with mania feel remarkably ____________________. They typically get little sleep, yet feel and act wide awake
premenstrual dysphoric disorder
A third type of depressive disorder is _____________________ _________________ ___________________, a diagnosis given to certain women who repeatedly have clinically significant depressive and related symptoms during the week before menstruation
maladaptive attitudes, a cognitive triad, errors in thinking, and automatic thoughts
According to Beck.... combine to produce unipolar depression.
major depressive episode
According to DSM-5-TR, a ________________ _______________________ _________________ is a period of two or more weeks marked by at least five symptoms of depression, including sad mood and/or loss of pleasure (see Table 7-1). In extreme cases, the episode may include psychotic symptoms, ones marked by a loss of contact with reality, such as delusions — bizarre ideas without foundation — or hallucinations — perceptions of things that are not actually present.
oral stage; introjection
According to the theorists sigmund freud and karl abraham, a series of unconscious processes is set in motion when a loved one dies. Unable to accept the loss, mourners at first regress to the __________ _______________ of development, the period of total dependency when infants cannot distinguish themselves from their parents. By regressing to this stage, the mourners merge their own identity with that of the person they have lost, and so symbolically regain the lost person. They direct all their feelings for the loved one, including sadness and anger, toward themselves. For most mourners, this reaction, called _____________________, is temporary. However, for some — particularly those whose various dependency needs were improperly met during infancy and early childhood — grief worsens over time, and they develop clinical depression
prefrontal cortex, hippocampus, amygdala, and subgenual cingulate
An array of brain-imaging studies point to several brain structures that are likely members of this depression-related brain circuit, including the:
pessimism
Another cognitive symptom of depression is _________________
half; tyramine; blood pressure
Approximately _________ of depressed patients who take MAO inhibitors are helped by them (Hirsch & Birnbaum, 2019a). There is, however, a potential danger with regard to these drugs. When people who take MAO inhibitors eat foods containing the chemical __________________ — including such common foods as cheeses, bananas, and certain wines — their ____________ ____________________ rises dangerously. Thus people on these drugs must stick to a rigid diet.
explanations that focus mostly on the behavioral realm, those that give primary attention to negative thinking, and ones that feature a complex interplay between cognitive and behavioral factors.
As with other kinds of psychological disorders, cognitive-behavioral theories contend that unipolar depression results from a combination of problematic behaviors and dysfunctional ways of thinking. These theories fall into three groups:
developmental psychopathology perspective; protective factors
As with their explanations of other psychological disorders, proponents of the _______________________________ _________________ ______________________ contend that unipolar depression is caused by a combination of the factors we have been examining throughout this chapter. Moreover, they believe that the factors unfold and intersect in a developmental sequence, with early negative factors generally setting the stage for later negative factors and ultimately for depression, but with later positive factors, called __________________ ______________ sometimes able to offset the lingering impact of early negative factors
deep brain stimulation (DBS).
As you have read, around 15 years ago researchers linked depression to high activity in the subgenual cingulate, a key member of the depression-related brain circuit. This finding led neurologist Helen Mayberg and her colleagues (2005) to administer a then-experimental treatment, DBS, to six severely depressed patients who had previously been unresponsive to all other forms of treatment. The Mayberg team drilled two tiny holes into the patient's skull and implanted electrodes in the subgenual cingulate. The electrodes were connected to a battery, or "pacemaker," that was implanted in the patient's chest (for men) or stomach (for women). The pacemaker powered the electrodes, sending a steady stream of low-voltage electricity to the brain structure. Mayberg's expectation was that this repeated stimulation would reduce activity in the structure to a normal level and help "recalibrate" the depression-related brain circuit.
— vagus nerve stimulation.
As you read in Chapter 3, in this procedure a surgeon implants a small device called a pulse generator under the skin of the chest. The surgeon then guides a wire, which extends from the pulse generator, up to the neck and attaches it to the vagus nerve (see Figure 7-3). Electrical signals travel from the pulse generator through the wire to the vagus nerve. The stimulated vagus nerve then delivers electrical signals to the brain. The pulse generator is typically programmed to provide 30 seconds of stimulation to the vagus nerve (and, in turn, the brain) every 5 minutes
consciousness; free associate; interpretations
Because they believe that unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people, psychodynamic therapists seek to help clients bring these underlying issues to _________________________ and work them through (Gabbard & DeJean, 2020; Busch et al., 2004). Using the arsenal of basic psychodynamic procedures, they encourage the depressed client to _________ ___________________ during therapy; suggest _________________________ of the client's associations, dreams, and displays of resistance and transference; and help the person review past events and feelings.
country to country
Beyond such core symptoms, however, research suggests that the precise picture of depression varies from ________________ to ___________________
hippocampus, basal ganglia, and cerebellum; gray matter; raphe nuclei, striatum, amygdala, and prefrontal cortex
Brain-imaging studies have identified a number of abnormal brain structures in people with bipolar disorders (Stovall, 2020; Dusi et al., 2019; Kato, 2019). For example, the...... of these individuals tend to be smaller than those of other people; they have lower amounts of __________ ____________ in the brain; and their..... have some structural abnormalities. It is not clear what role such abnormalities play in bipolar disorders. Some researchers believe that they collectively reflect dysfunction throughout a bipolar-related brain circuit (Gong et al., 2019). It may also be that they are related to the brain's depression-related circuit that you read about earlier
biological factors
But bipolar disorders appear to be best explained by a focus on one kind of variable —
electroconvulsive therapy (ECT).
Clinicians and patients alike vary greatly in their opinions of ___________________________ ________________ Some consider it a safe biological approach with minimal risks; others believe it to be an extreme measure that can cause troublesome memory loss and even neurological damage. Despite this controversy, __________ is used frequently, largely because it can be a very effective and relatively fast-acting intervention for unipolar depression.
social support
Consistent with these findings, depression has been tied repeatedly to the unavailability of ___________ _________________ such as that found in a happy marriage
interactions; glutamate; depression-related circuit
For years it was thought that low activity of either norepinephrine or serotonin directly produces depression, but theorists now believe that their relationship to depression is more complicated (Krishnan, 2019). Research indicates that depression is probably linked to ____________________ between serotonin and norepinephrine activity, or between them and additional key neurotransmitters, particularly ___________________, a neurotransmitter responsible for stimulating neurons and promoting connectivity and communication among neurons (Krystal et al., 2019). In addition, as you will read shortly, a number of studies suggest that the activity of these neurotransmitters may either reflect or help produce dysfunction of a ___________________-_______________ _____________ in the brain, dysfunction that may be the key to the development of depression.
culture-sensitive therapies
In Chapter 3, you read that _________________ _________________ _______________ are designed to address the unique issues faced by members of cultural minority groups (Comas-Díaz, 2019). For such approaches, therapists typically have cultural training and a heightened awareness of their clients' cultural values and the culture-related stressors, prejudices, and stereotypes that their clients face. They make an effort to help clients develop a comfortable (for them) bicultural balance and to recognize the impact of their own culture and the dominant culture on their views of themselves and on their behaviors.
behavioral activation; (1) reintroduce depressed clients to pleasurable events and activities, (2) consistently reward nondepressive behaviors and withhold rewards for depressive behaviors, and (3) help clients improve their social skills distance social skills.
In _____________________ ___________________, therapists work systematically to increase the number of constructive and rewarding activities and events in a client's life. The approach builds on the work of Peter Lewinsohn, the theorist who, as you'll recall, ties mood to the rewards one experiences in life. There are three key components to the approach. The therapists: Behavioral activation theorists argue that when people become depressed, their negative behaviors — crying, ruminating, complaining, or self-depreciation — keep others at a ____________________, reducing chances for rewarding experiences and interactions. To change this pattern, therapists guide clients to monitor their negative behaviors and to try new, more positive ones. Finally, behavior activation therapists train clients in effective ____________ ________
postpartum
In _____________________ depression, however, depressive symptoms continue and may last up to a year or more. The symptoms include extreme sadness, despair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, feelings of inability to cope, and suicidal thoughts
half
In fact, as many as _______ of all depressed clients may be in a dysfunctional relationship
individual, group, or family
In view of these problems, many clinicians now provide ___________________, ___________, or _____________ therapy as an adjunct to mood-stabilizing drugs (Post, 2019). Most often, therapists use these formats to emphasize the importance of continuing to take medications; to improve social skills and relationships that may be affected by bipolar episodes; to educate patients and families about bipolar disorders; to help patients solve the family, school, and occupational problems caused by their disorder; and to help prevent patients from attempting suicide.
treatment
It may be that minority groups in the United States are more vulnerable to repeated experiences of depression partly because many of their members have more limited ___________________ opportunities when they are depressed.
norepinephrine; serotonin
Low activity of two neurotransmitter chemicals, __________________________ and _______________, has been strongly linked to unipolar depression.
hormonal; withdrawal; genetic predisposition; psychological; sociocultural
Many clinicians believe that the __________________ changes accompanying childbirth trigger postpartum depression. All women go through a kind of hormone "_____________________" after delivery, as estrogen and progesterone levels, which rise as much as 50 times above normal during pregnancy, now drop sharply to levels far below normal. Perhaps some women are particularly influenced by these dramatic hormone changes (Viguera, 2019b, 2018). Other theorists suggest that some women may have a ____________________ ___________________________ to postpartum depression (McEvoy et al., 2017). Women who suffered from depression previously in their lives are at particular risk for this kind of depression, but a woman with a family history of mood disorders also appears to have an elevated risk, even if she herself has not previously had a mood disorder At the same time, ________________________ and _____________________ factors may play important roles in the disorder (Hutchens & Kearney, 2020). The birth of a baby brings enormous psychological and social change. A woman typically faces changes in her marital relationship, daily routines, and social roles. Sleep and relaxation are likely to decrease, and financial pressures may increase. Perhaps she feels the added stress of giving up a career or of trying to maintain one. This pileup of stress may heighten the risk of depression.
inherit molecular biology; 13
Many theorists believe that people ___________ a biological predisposition to develop bipolar disorders Researchers have also used techniques from ___________________ ______________ to more directly examine possible genetic factors in large families. Their work has linked bipolar disorders to a variety of genes located on at least ______ different chromosomes (Stovall, 2020; Kato, 2019). Such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders.
eat; sleep; fatigued; excessively.
Most depressed people _______ less, __________ less, and feel more _______________ than they did prior to the disorder. Some, however, eat and sleep ______________________
symbolic,
Of course, many people become depressed without losing a loved one. To explain why, Freud proposed the concept of _______________ or imagined, loss, in which a person equates other kinds of events with the loss of a loved one.
the family-social perspective and the multicultural perspective.
Once again, there are two kinds of sociocultural views —
HPA; cortisol; depression-related circuit
Research indicates that the ________ axis of people with depression is also overly reactive in the face of stress, causing excessive releases of _______________ and related hormones at times of stress (Iob, Kirschbaum, & Steptoe, 2019). This relationship is not all that surprising, given that stressful events so often seem to trigger depression. Once again, it is possible that the HPA axis overreactivity and heightened hormone activity found in depressed people either reflect or help produce dysfunction in a _____________________ _________________ _____________ in the brain, the biological focus that we turn to next.
manic episode; hypomanic
People are considered to be in a full _______________ _______________ when for at least one week they display an abnormally high or irritable mood, increased activity or energy, and at least three other symptoms of mania (see Table 7-4). The episode may even include psychotic features such as delusions or hallucinations. When the symptoms of mania are less severe (causing little impairment), the person is said to be having a _____________________ episode.
headaches, indigestion, constipation, dizzy spells, and general pain Disturbances in appetite and sleep are particularly common
People who are depressed frequently have such physical ailments as:
major depressive disorder
People who go through a major depressive episode without having any history of mania receive a diagnosis of ____________ ______________________ _________________ (APA, 2022) (see Table 7-1 again).
persistent depressive disorder; persistent depressive disorder with major depressive episodes; persistent depressive disorder with dysthymic syndrome
People whose unipolar depression is chronic receive a diagnosis of ______________________ ____________________ ________________ (see Table 7-1 again). Some people with this chronic disorder have repeated major depressive episodes, a pattern technically called _____________________ _________________ __________________ _________ ________________ _____________________ ___________________ Others have less severe and less disabling symptoms, a pattern technically called _________________________ _________________ __________________ _______ ________________ ___________________
bipolar I disorder; bipolar II disorder
People with __________________ ____ __________________ have full manic and major depressive episodes. Most of them experience an alternation of the episodes; for example, weeks of mania followed by a period of wellness, followed in turn by an episode of depression. Some, however, have mixed features, in which they display both manic and depressive symptoms within the same episode — for example, having racing thoughts amidst feelings of extreme sadness. In _____________________ ____ _______________, hypomanic — that is, mildly manic — episodes alternate with major depressive episodes over the course of time. Some people with this pattern accomplish huge amounts of work during their mild manic periods
intellectual ability
People with depression frequently complain that their __________________________ _____________ is very poor (Lyness, 2019). They feel confused, unable to remember things, easily distracted, and unable to solve even the smallest problems.
unipolar depression
People with depressive disorders suffer only from depression, a pattern called _____________________ _________________________. They have no history of mania and return to a normal or nearly normal mood when their depression lifts.
rewards and punishments; depression; social
Peter Lewinsohn was one of the first theorists to link depression to significant changes in the number of __________________ _________ _____________________ people receive in their lives (Lewinsohn et al., 1990, 1984). He suggested that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors. Although many people manage to fill their lives with other forms of gratification, some become particularly disheartened. The positive features of their lives decrease even more, and the decline in rewards leads them to perform still fewer constructive behaviors. In this manner, they spiral toward _____________________ Lewinsohn and other theorists have further proposed that __________ rewards are particularly important in the downward spiral of depression
physical exercise; dietary supplements (also known as nutraceuticals)
Two of the most common CAM interventions are _____________________ __________________ and __________________ ____________________
selective serotonin reuptake inhibitors (SSRIs); serotonin; selective norepinephrine reuptake inhibitors; norepinephrine; serotonin-norepinephrine reuptake inhibitors; serotonin; norepinephrine
Second-generation antidepressants, the third group of effective drugs for depression, are structurally different from the MAO inhibitors and tricyclics. Developed over the past three decades, most of these drugs are called _________________ ____________________ ________________ _________________ because they increase ______________ activity specifically, without affecting norepinephrine or other neurotransmitters. The SSRIs include fluoxetine (trade name Prozac), sertraline (Zoloft), and escitalopram (Lexapro). Other second-generation antidepressants are ________________ ______________________ ________________ _________________ (such as atomoxetine, or Strattera), which increase __________________ activity only, and ______________________ _____________________________ _____________ __________________ (such as venlafaxine, or Effexor), which increase both ________________ and ________________________ activity
(1) they no longer have control over the reinforcements (the rewards and punishments) in their lives, and (2) they themselves are responsible for this helpless state.
Since the mid-1960s Seligman has been developing the learned helplessness theory of depression. It holds that people become depressed when they think that:
social context
Sociocultural theorists propose that unipolar depression is strongly influenced by the ___________ ______________ that surrounds people.
exogenous; endogenous
Some clinicians consider it important to distinguish a reactive ____________________ depression, which follows clear-cut stressful events, from an __________________________ depression, which seems to be a response to internal factors.
cyclothymic disorder
Some people have numerous periods of hypomanic symptoms and mild depressive symptoms, a pattern that is called ________________________ ________________ in DSM-5-TR. The symptoms of this milder form of bipolar disorder continue for 2 or more years, interrupted occasionally by normal moods that may last for only days or weeks
resilience
Studies have found, for example, that individuals who experience moderate and manageable adversities throughout their childhood often develop _________________ — an important protective factor — and become better able to withstand the depressive effects of life stress in adulthood
lower
Studies indicate that under usual circumstances the neurotransmitters serotonin and norepinephrine are both plentiful and active in this brain circuit. It appears, however, that among depressed people, the activity of serotonin and norepinephrine in this circuit is distinctly ____________ than among other people
seasonal; catatonic; peripartum; melancholic
The MDD disorder may be additionally further described as _______________ if it changes with the seasons (for example, if the depression recurs each winter), ________________ if it is marked by either immobility or excessive activity, ___________________ if it occurs during pregnancy or within 4 weeks of giving birth (see PsychWatch), or _____________________ if the person is almost totally unaffected by pleasurable events.
drug therapy
The choice of treatment for bipolar disorders is narrow and simple: ________ ___________________, perhaps accompanied by psychotherapy, is the single most successful approach
two-way street
The connection between declining social rewards and depression is a _______-_______ _____________ (Hammen, 2018, 2016). On the one hand, researchers have found that depressed people often display weak social skills and communicate poorly. They seek repeated reassurances from others, and they typically speak more slowly and quietly than nondepressed people, pause longer between words, and take longer to respond to others. Such social deficits make other people uncomfortable and may cause them to avoid the depressed individuals. As a result, the social contacts and rewards of depressed people decrease, and, as they participate in fewer and fewer social interactions, their social skills deteriorate still further.
tricyclics; schizophrenia; three-ring; synapses
The discovery of ___________________ in the 1950s was also accidental. Researchers who were looking for a new drug to combat _________________________ ran some tests on a drug called imipramine (Kuhn, 1958). They discovered that imipramine was of no help in cases of schizophrenia, but it did relieve unipolar depression in many people. The new drug (trade name Tofranil) and related ones became known as tricyclic antidepressants because they all share a ____________-__________ molecular structure. Tricyclics inhibit this overly vigorous reuptake process, allowing serotonin and norepinephrine to remain in their __________________ longer, thus increasing their stimulation of receiving neurons
MAO inhibitors; monoamine oxidase (MAO)
The effectiveness of ___________ ______________________ as a treatment for unipolar depression was discovered accidentally back in 1952. Physicians noted that iproniazid, a drug being tested on patients with tuberculosis, had an interesting effect: it seemed to make the patients happier (Bloom, 2020). It was found to have the same effect on depressed patients (Kline, 1958). What this and several related drugs had in common biochemically was that they slowed the body's production of the enzyme _____________________ _______________. Thus they were called MAO inhibitors. By inhibiting (that is, blocking) the production of MAO, these drugs ultimately increased the activity level of the neurotransmitters serotonin and norepinephrine throughout the brain.
ketamine-based drugs
The fourth group of antidepressants are ____________________ ___________ ____________. In recent years, researchers have learned that the drug ketamine brings significant relief to many people with depression
glutamate
The ketamine-based treatments appear to alleviate the symptoms of depression by increasing the activity of the neurotransmitter ___________________ in the brain, in contrast to the increases in serotonin and norepinephrine produced by the other antidepressant drugs (Krystal et al., 2019). Thus many clinical theorists now suspect that low glutamate activity may be equally or even more important than low serotonin or norepinephrine activity in depression, or that low activity of all of these transmitters collectively helps produce the disorder.
interpersonal psychotherapy and couple therapy.
The most effective family-social approaches are.....
quickly; unresponsive; suicidal
The virtues of ketamine are that it often alleviates depression very _________________, helps people who are ____________________ to other kinds of treatments and those who are _______________, and combines effectively with other antidepressant drugs and psychotherapies Early tests of ketamine, which were administered intravenously, produced extraordinary results — as many as 70 percent of persons with treatment-resistant depression showed immediate improvement and their symptoms decreased within hours, in contrast to the weeks or months needed for other drugs to work. In 2019, the FDA approved esketamine (trade name Spravato), a more accessible version of ketamine that is taken by ______________ _________ rather than intravenously
integrative behavioral couples therapy
Therapists who offer ____________________ __________________ ____________ _______________ combine cognitive-behavioral and sociocultural techniques to teach couples specific communication and problem-solving skills, guide them to recognize that their problematic interactions often reflect basic differences between them, and steer them to become more accepting and supportive of each other
monoamine oxidase (MAO) inhibitors, tricyclics, the second-generation antidepressants, and ketamine-based drugs
There are four kinds of drugs available to reduce the symptoms of depression:
acceptance and commitment therapy (ACT)
These therapists, the new-wave cognitive-behavioral therapists about whom you read in Chapters 3 and 5, including those who practice ________________________ ________ _____________________ __________________, use mindfulness training and other cognitive-behavioral techniques to help depressed clients recognize and accept their negative cognitions simply as unimportant streams of thinking that flow through their minds. As the clients increasingly accept their negative thoughts for what they are, rather than use them as guides for behaviors and decisions, the individuals learn to work around them in life. Research suggests that thought acceptance of this kind helps prevent recurrences of depression after individuals have recovered
lithium; lamotrigine (Lamictal), carbamazepine (Tegretol), and valproate (Depakote); antipsychotic
This gloomy picture changed dramatically in 1970 when the FDA approved the use of ___________, a silvery-white element found in various simple mineral salts throughout the natural world, as a treatment for bipolar disorder. It was lithium that first brought hope to those suffering from bipolar disorder Effective alternative mood stabilizers include..... — antiseizure drugs that originally were used to treat brain seizure disorder (epilepsy). Such drugs do not require the frequent patient monitoring that lithium does. Additionally, certain __________________________ drugs, originally developed to treat schizophrenia, are often included in the mix to help stabilize the moods of persons with bipolar disorders. The effects of these antipsychotics drugs tend to unfold sooner than those of the other mood-stabilizing drugs, although, as you will see in Chapter 14, the antipsychotics pose serious health risks of their own.
family pedigree, twin, and gene studies
Three kinds of research — — suggest that some people inherit a predisposition to unipolar depression.
cognitive therapy PHASE 1: INCREASING ACTIVITIES AND ELEVATING MOOD PHASE 2: CHALLENGING AUTOMATIC THOUGHTS PHASE 3: IDENTIFYING NEGATIVE THINKING AND BIASES PHASE 4: CHANGING PRIMARY ATTITUDES
To help depressed clients overcome their negative thinking, Aaron Beck has developed a treatment approach that he calls _____________________ ______________. He uses this label because the approach focuses largely on guiding clients to recognize and change negative cognitive processes. The approach follows four pases:
(1) links between gender and depression, and (2) ties between cultural and ethnic background and depression
Two kinds of relationships have captured the interest of multicultural theorists:
two-thirds
Using such techniques, researchers have found evidence that unipolar depression may be tied to genes on at least _______-___________ of the body's 23 chromosomes
second messengers; antidepressant; mood stabilizers
When a neurotransmitter binds to a receptor on the receiving neuron, a series of changes occur within the receiving neuron to set the stage for firing. The substances in the neuron that carry out those changes are often called __________________ _________________________ because they relay the original message from the receptor site to the firing mechanism of the neuron. (The neurotransmitter itself is considered the first messenger.) Whereas _____________________ drugs affect a neuron's initial reception of neurotransmitters, ____________ _____________________ appear to affect a neuron's second messengers.
antipsychotic
When antidepressants fail, psychiatrists or family physicians often augment treatment by adding certain _______________________ medications (Fornaro et al., 2019; Gerhard et al., 2018).
rapid cycling
Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder. If a person has four or more episodes within a one-year period, their disorder is considered to be ________________ _____________
disruptive mood dysregulation disorder
Yet another kind of depressive disorder, ______________________ ___________ ______________________ __________________, is characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper. This disorder emerges during mid-childhood or adolescence
ions; mania; depression
_________ seem to play a critical role in relaying messages within a neuron. That is, ions help transmit messages down the neuron's axon to the nerve endings. Positively charged sodium ions (Na+) sit on both sides of a neuron's cell membrane. When the neuron is at rest, more sodium ions sit outside the membrane. When the neuron receives an incoming message at its receptor sites, pores in the cell membrane open, allowing the sodium ions to flow to the inside of the membrane, thus increasing the positive charge inside the neuron. This starts a wave of electrical activity that travels down the length of the neuron and results in its "firing." If messages are to be relayed effectively down the axon, the sodium ions and nearby ions must be able to travel easily between the outside and the inside of the neural membrane. Some studies suggest that, among bipolar individuals, irregularities in the transport of these ions may cause neurons to fire too easily (resulting in ___________) or to stubbornly resist firing (resulting in _____________________)
brain stimulation; electroconvulsive therapy (ECT); — vagus nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation.
___________ ____________________, refers to interventions that directly or indirectly stimulate certain areas of the brain. The oldest — and most controversial — such approach is ______________________________ ______________. In recent years, three additional kinds of brain stimulation have been developed for the treatment of depressive disorders:
object relations theorists
_______________ _________________ ______________ (the psychodynamic theorists who emphasize relationships) propose that depression results when people's relationships — especially their early relationships — leave them feeling unsafe, insecure, and dependent on others
psychotherapy; mood-stabilizing drugs; cyclothymic disorder
_________________________ alone is rarely helpful for persons with bipolar disorders. At the same time, clinicians have learned that _____________-__________________ ___________ alone are not always sufficient either Psychotherapy commonly plays a more central role in the treatment of _____________________ _____________. In fact, patients with cyclothymic disorder typically receive psychotherapy, alone or in combination with mood stabilizers.
"Complementary and Alternative Medicine (CAM)
____________________________ ________ ___________________ ________________ is the popular term for interventions that fall outside of conventional Western treatments.
emotional, motivational, behavioral, cognitive, and physical.
depression has many symptoms other than sadness. The symptoms, which often exacerbate one another, span five areas of functioning:
genetically inherited predisposition
developmental psychopathologists believe that the road to unipolar depression often begins with a _______________________ _____________________ _________________________ — a predisposition that is characterized by low activity of key neurotransmitters (serotonin, norepinephrine, or glutamate) in key brain structures, an overly reactive brain-body stress route (the HPA axis), and a dysfunctional depression-related brain circuit (see pages 192-194) (Lippard & Nemeroff, 2020; Bagot et al., 2016). Researchers from this perspective have found that such biological predispositions will most likely result in later depression if the individual is also subjected to significant losses or other traumas early in life and/or inadequate parenting, such as parenting that is disrupted, depressive in style, inconsistent, or rejecting (Dittrich et al., 2018; Wang et al., 2018). Still other studies indicate that this combination of biological and childhood factors often leads to a low self-concept, a temperament marked by guilt, a negative style of thinking, general feelings of helplessness, and interpersonal dependence — variables that are themselves each linked to depression
The artifact theory; hormone explanation; The life stress theory; The body dissatisfaction explanation; The lack-of-control theory; rumination theory
holds that women and men are equally prone to depression but that clinicians often fail to detect depression in men. Perhaps depressed women display more emotional symptoms, such as sadness and crying, which are easily diagnosed, while depressed men mask their depression behind traditionally "masculine" symptoms such as anger The ____________________ _____________________ holds that hormone changes trigger depression in many women, particularly during puberty, pregnancy, and menopause. suggests that women in our society are subject to more stress than men. states that females in Western society are taught, almost from birth, but particularly during adolescence, to seek a low body weight and slender body shape — goals that are unreasonable, unhealthy, and often unattainable. , which draws on the learned helplessness research, proposes that women may be more prone to depression because they feel less control than men over their lives. A final explanation for the gender differences found in depression is the ___________________ _______________. As you read earlier, rumination is related to depression. Research reveals that women are more likely than men to ruminate when their mood darkens, perhaps making them more vulnerable to the onset of clinical depression.
Depression
is a low, sad state in which life seems dark and its challenges overwhelming.
couple therapy
many cases of depression have been treated by _________________ ______________, the approach in which a therapist works with two people who share a long-term relationship.
brain-derived neurotrophic factor (BDNF) functioning; communications
mood-stabilizing drugs also increase the production of a protein called ___________ ____________________ ___________________ _____________ and other proteins within certain neurons whose job it is to prevent cell death. Finally, it may be that effective mood stabilizers reduce bipolar symptoms by improving the _____________________ of or _________________________ between key structures in the brain.
interpersonal role dispute
occur when two people have different expectations of their relationship and of the role each should play.
norepinephrine, serotonin, glutamate, and dopamine; unconvinced
over the years, a number of studies have found abnormal activity of neurotransmitters — — in the brains of people with bipolar disorders (Kato, 2019; Purse, 2019). But the kind of abnormal neurotransmitter activity has varied from study to study (sometimes high and sometimes low, sometimes one neurotransmitter and sometimes another), leaving most of today's theorists ______________________ that neurotransmitters directly cause bipolar disorders.
ruminative responses
people who generally make ___________________ ___________________ during their depressed moods — that is, repeatedly dwell mentally on their mood without acting to change it — feel dejection longer and are more likely to develop clinical depression later in life than people who avoid such ruminations
Publication bias
refers to the tendency of professional journals to accept for publication mainly those studies that have positive findings.
Suicide
represents the ultimate escape from life's challenges. As you will see in Chapter 8, many depressed people become uninterested in life or wish to die; others wish they could kill themselves, and some actually do
immune system; lymphocytes; cytokines
the _________________ _________________ is the body's network of activities and body cells that fight off bacteria, viruses, and other foreign invaders. When people are under intense stress for a while, their immune systems may become dysregulated, leading to slower functioning of important white blood cells called ___________________________ and to increased production of pro-inflammatory ___________________, proteins that spread throughout the body and cause inflammation and various illnesses (see page 279). There is a growing belief among some researchers that immune system dysregulation of this kind helps produce depression
attribution-helplessness theory
the _______________________-___________________________ _____________, when people view events as beyond their control, they ask themselves why this is so (Cherry, 2020a; Abramson et al., 2002, 1989, 1978). If they attribute their present lack of control to some internal cause that is both global and stable ("I am inadequate at everything and I always will be"), they may well feel helpless to prevent future negative outcomes and they may experience depression
bipolar disorders
those with ____________________ _________________ have periods of mania that alternate with periods of depression.