Moving Forward

Moving Forward-A therapeutic approach: Case notesSarah K.Introduction:Sarah is 42, she suffers with clinical depression, this is mood disorder that can last a very long time and affects many aspects of everyday life. There are psychological, physical and social symptoms. Sarah suffers with low self-esteem and low self-image, she has also had suicidal thoughts and attempted suicide twice these are psychological symptoms. Statistics show that in 2017 there were around 6,000 suicides in the UK and Republic of Ireland. The causes of depression are not extremely clear and can be quite complex, in some cases there is a trigger for depression, for Sarah, she was emotionally and physically abused as a child, resulting in her negative self-schema. There are many types of depression proposed by the diagnostic and statistical manual (DSM), major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder and premenstrual dysphoric disorder. Sarah most likely suffers with persistent depressive disorder as her depression is ongoing and has occurred since she was younger. For support, Sarah attends a community psychiatric clinic, Psychiatrists diagnose, treat and prevent mental health conditions. They are medically qualified doctors meaning they can prescribe medication if they need to as well as other solutions unlike other mental health professionals. Case Report:There are three main psychological perspectives that describe the development and treatment of depression. The cognitive approach looks at depression and explains both causes and treatments, cognitive views look at individual’s way of thinking. One psychologist looking into depression is Aaron Beck, he explains that depressed individuals make errors in logic, he then further developed three key ideas of the acquisition of depression. Faulty information processing is one, he argues that people selectively attend the negatives of situations and ignore all positives, they blow small problems out of proportion. Another idea is the development of negative self-schemas. Schemas are a set of ideas of some information that advances more and more with experience, self-schemas are the ideas we have about ourselves, depressed individuals can develop negative self-schemas where they interpret any information about themselves in a negative way, and this further explains why Sarah has such a low self-image and low self-esteem. Beck then went on to develop his explanations further and suggested that individuals are trapped in a cycle of negative thoughts and they form a negative cognitive triad, they have negative automatic thoughts of themselves, the world and the future, these interfere with normal cognitive processing and can affect factors such as memory, ability to problem solve and they become obsessed with the negative side of every situation, explaining why she may have days where it does not seem worth living, she will become obsessed with the negative thoughts and may think that suicide is the only solution. This view of depression has supporting evidence and can be used as a basis for cognitive behavioural therapy (CBT) and all aspects of depression can be challenged with CBT. However Beck does not fully explain the wide variety of symptoms people with depression face and is limited in that aspect.Another cognitive psychologist, Albert Ellis, argues that irrational thoughts are the cause of depression or any other mental health problem. These irrational thoughts interfere with us being happy. He identified a factor to the development of depression through irrational thoughts. The ABC model describes the impact that irrational thoughts have on behaviour and emotional state there are stages A is the activating event, this is whatever started it all off, in Sarah’s case, her physical and emotional abuse when she was growing up led to her developing depression. B is beliefs, the thoughts that are triggered due to this activating event, Sarah has faced low self-esteem and a low self-image since she was younger, and these are the self-defeating beliefs that increased her chance of eventually developing depression. C are the consequences that the beliefs develop, irrational beliefs can lead to unhealthy ones and eventually depression. A strength of the cognitive explanation to depression would be the development of cognitive behavioural therapy which has become one of the leading treatments of depression. However the cognitive approach could be viewed as blaming the patient and that they should simply change the way they think and they would no longer suffer with depression. There is also a biological view of depression and why it develops in certain individuals, it can be viewed as a chemical imbalance in the brain but there are also more complexities that work alongside this. Neurotransmitters play a large role in depression, these are the chemical signals and messages that are released and received in the brain through neurons. This communication system is crucial for effective brain functioning. An example of synaptic transmission would be, a neurotransmitter is released from a neuron, this then travels through the tiny space named a synapse to the next neurone, and it is then received through a receptor on the surface. According to the biological approach, imbalances in the neurotransmitters serotonin, dopamine can lead to depression. Serotonin regulates many internal functions such as mood, therefore an imbalance can cause many behavioural characteristics for example being stuck in a mood state that eventually leads to depression or even suicidal thoughts, Sarah has faced these thoughts and attempted it multiple times, she may be lacking serotonin. Dopamine is another neurotransmitter but this regulates our drives, especially when in search of rewards, if there is an imbalance individuals will not feel the same drives. This can explain why depressed individuals do not experience the same pleasure from some activities that other people do. Sarah has days where she doesn’t see the point in living, she doesn’t seek the pleasure or rewards from her every day activities anymore and has limited motivation. The biological approach also developed the view that depression is linked to genetics and can be passed throughout the family, this could have led to Sarah’s early symptoms and diagnosis. The psychodynamic approach, created by Sigmund Freud, looks at childhood experiences and the impact they have on future development. Looking at the unconscious and conscious mind, One model looking at depression is the Biopsychosocial Model, this model takes the biological, psychological and social factors into consideration and further studies how they are linked relating to mental health. A further explaining could generate from the diathesis stress model. Discussion: The cognitive approach developed treatments for depression, one is cognitive behavioural therapy (CBT) the use of both cognitive and behavioural techniques to treat a range of mental disorders. The patient must understand the link between thought, emotions and actions, this therapy is a talking therapy that aims to change the way individuals think and behave. Linking to the cognitive approach, Beck and Ellis both developed forms or cognitive behavioural therapy.Ellis-REBTSimon W.Introduction:Simon is 56 years old, he has a severe phobia of spiders, named arachnophobia. He attends clinic at the local NHS trust for help on how to overcome his fear. Simon faces Emotional characteristics and has had several anxiety attacks in public before due to the severity of the phobia, he also avoids any situation involving spiders, this a behavioural characteristic, for example he cannot sing nursery rhymes or read stories to his daughter if they have spiders in, Halloween also encourages this fear and he cannot walk past the local toy shop when decorated for the occasion as there are plastic spiders on display. Case Report:The behavioural approach looks into the acquisition of phobias and fears through the role of conditioning. The two-process model was developed by Mowrer (1947) to explain how phobias are acquired and maintained. The phobia is initially learned through classical conditioning, individuals may create a phobia if they associate something with a traumatic event, for example Simon may have been bitten by a spider when he was younger and has since associated all spiders with that traumatic experience, generating his extreme phobia. The model then states that phobias are maintained through operant conditioning and positive reinforcement, in Simon’s case this is his avoidance, when he avoids certain situations involving spiders such as the shop windows on Halloween he is rewarded with the relief and comfort that he isn’t going to see any spiders, this then reinforces his behaviour of avoiding all situations with spiders and the phobia is maintained as he will not face spiders, he would rather have the comfort when avoiding than the fear when confronting. A strength of the behaviourist approach when looking at phobias is that there is real life application as the view has led to many effective behavioural treatments for phobias. There is also supporting evidence of the two-process model as individuals often remember a traumatic event that has led to them developing their phobia, however this is not always the case as people may have repressed the experience or simply do not remember because they were too young. There is also the idea that different phobias have different processes and could have developed through observing others, this is the social learning theory of phobias. The social learning theory is the learning through role models and imitating others behaviour. Phobias can be passed through families simply because the children internalise and imitate their role models’ phobias, the children are also more likely to imitate the behaviour of a same-sex parent. Simon may have had a male role model with a severe fear of spiders and that has impacted his view of spiders. However it may work the other way also, he may pass it on to his children, he is showing them his severe phobia of spiders and the extreme lengths he goes to, to simply avoid them, this may impact his children and they could eventually develop the same fear at the same severity. Cognitive approach- mental processes.4377690-175260Fear Hierarchy example.https://www.simplypsychology.org/a-level-psychopathology.html#beh00Fear Hierarchy example.https://www.simplypsychology.org/a-level-psychopathology.html#behDiscussion:395986016764000There are multiple treatments to help phobias, many approaches developed alternative methods. Systematic desensitisation is one of the treatments developed by the behaviourist approach, this method based on classical conditioning, aims to counter-condition by replacing the fear response with a relaxation response. There are steps to this process, firstly the patient is taught how to have control over breathing, muscle tensioning or meditation. Secondly the patient would build a fear hierarchy, at the top would be the stimuli that creates the least amount of fear, this would then gradually build to the stimuli they most fear and thirdly the individual would work through their hierarchy starting with the stimuli that causes the least fear, once the individual does not feel the fear anymore they move onto the next stage in the hierarchy, if they do however feel uncomfortable again they can just go back through the stages and practice relaxation techniques. . Simon would create a hierarchy based on his fear of spiders, the hierarchy may include the hurdles he faces such as reading a story with a spider in or looking at the decorations on Halloween, this treatment is a gradual process that eases people into the transition of overcoming phobias. This therapy is effective for example Barlow et al (2002) discovered that there was a success rate of between 60 and 90 per cent for specific types of phobias when individuals stayed focused, actually committed to the phobias and stuck to the system, showing the effectiveness in real life situations. This therapy can also be used on children whereas other therapies may be too intense or traumatic. The behaviourist approach developed another form of behavioural therapy named flooding, this however is very intense and the opposite to systematic desensitisation. This therapy aims to overwhelm the individual’s senses with their phobia to show them that they cause no harm to them. This is a repetitive process and extremely intense, no build up or gradual processing. This technique is a very quick and effective process, individuals aim towards ‘extinction’ the learning that the stimulus they are scared of is harmless. Simon’s senses would be ‘flooded’ if he was to use this method, he would be shown images and videos of spiders, look at and hold spiders straight away and all at once. Number of sessions of these types of treatments varies based on the severity of the phobia and is complete once the individual’s needs and therapeutic needs are met. This treatment has been proven effective, it does have negative views. Firstly, it can be extremely traumatic for some patients and may even worsen in some cases, another negative would be that it cannot treat all phobias, some are too complex or for example, the phobia may have cognitive aspects rather than just behavioural.There are also negative aspects to the use of behavioural therapies as a whole, one would be ‘Symptom substitution’ may occur, because the behavioural therapies focus on the symptom over the cause of the phobia, they just want to change the individuals behaviour, this however could lead to the development of a different disorder, the psychoanalytical approach criticise the behavioural techniques for disregarding the unconscious mind and the repressed memories that may be the original cause Cognitive behavioural therapy can also be used, a talking therapy to try and change the way people think and behave.Book References: AQA Psychology for A level Year 1 and AS (07/03/2019)Bibliography:https://www.nhs.uk/conditions/clinical-depression/ (07/03/2019)https://www.nice.org.uk/guidance/cg28/evidence/evidence-update-pdf-193484989 (evidence of treatment-use later) https://www.nhs.uk/conditions/psychiatry/ (11/03/2019)https://www.samaritans.org/about-us/our-research/facts-and-figures-about-suicide (15/03/2019)https://www.simplypsychology.org/depression.html (19/03/2019)https://www.mentalhelp.net/articles/biology-of-depression-neurotransmitters/ (25/03/2019)https://www.mentalhelp.net/articles/psychology-of-depression-psychodynamic-theories/ (28/03/2019)https://www.mentalhelp.net/articles/current-understandings-of-major-depression-biopsychosocial-model/ (29/03/2019)https://www.simplypsychology.org/defense-mechanisms.html (01/04/2019)https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/ (03/04/2019)https://prezi.com/sbuvnui2k6ob/social-learning-theory-and-phobias/ (28/03/2019)https://www.simplypsychology.org/a-level-psychopathology.html#beh (02/04/2019)https://psychologyhub.co.uk/the-behavioural-approach-to-treating-phobias-systematic-desensitisation-including-relaxation-and-the-use-of-hierarchy-flooding/ (03/04/2019)