A clinical area of applied psychology Essay

‘Critically evaluate how psychological theories, concepts and explanations have been employed in one area of applied psychology covered on the module ‘

The main objective of this essay is to look at the way psychological theories have been employed in the development of causal explanations and subsequent treatments for the mental health disorder depression. It will focus largely upon two main theories; cognitive and biological, as these two are contrasting theories each offering radically different conceptions and treatments for depression. It will also be argued that although traditional psychology has much to offer to the understanding of depression, there are new theories emerging which take a critical position in the understanding of Depression as a mental disorder in today’s society.

Firstly, it is important to discuss what is meant when describing ‘depression’ in terms of this essay and as a mental health disorder in the wider context of society. The initial problem faced by those who try to understand depression is that the term is widely used in everyday contexts within society. Nemerott (1998:42) reflects this in his assertion that ‘clinical depression is quite different from the blues everyone feels at one time or another’. In fact, the comparison of the two can be seen to be trying to compare ‘a scratch and a compound fracture’ (Walker, 2008:5).

The reality is that clinical depression, the focus of this essay, is a mental illness that seriously effects the lives of the sufferers creating feelings of ‘over dullness and apathy: thoughts of suicide are common, as are crying spells’ (Wolpert, 1999: 1). This lack of distinction between feeling a bit ‘low’ and major depression has led to much of the stigma that surrounds the illness that effects the sufferers, but what is evident is that ‘major depression is not an emotion’ (Walker, 2008: 5), it is in fact an illness.

Its global prominence as an illness can be shown through the World Health Organisations prediction ‘that depression will be the second highest medical cause of global disability by the year 2030’ (Lam and Mok, 2008: 1) and by its huge drain on the economy, effecting the workforce in terms of medical costs, work absences and loss of productivity. All of this highlights its importance as an area of study within applied psychology; as a greater understanding of this illness is needed for any attempts to mitigate the suffering and disruption the disorder is causing.

It is now important to focus on theories that have emerged within traditional psychology regarding depression, and the subsequent applications of these theories in developing adequate treatments for this mental illness. It must be noted, however, that there are a multitude of theories surrounding depression and it still does not have a fully accepted aetiology (Walker, 2008: 7). For the purposes of this essay there will be two traditional theories that will be discussed and critiqued: cognitive and biological theories. These are prominent theories within this field and have both developed contrasting approaches in the treatment of depression.

The cognitive theory of depression was developed by Aaron Beck (1967), a leading mental health professional. His theory was developed from his own critique of the psychoanalytical school of thought’s theory on depression (a field Beck was originally associated with), as they believed that ‘the patient is under the control of concealed negative forces over which he or she has no control’ (Wolpert, 1999: 99). Beck, however, believed this did not take into account a person’s conscious thoughts, and so broke away from psychoanalysis to develop his own theory.

He believed that ‘negative pessimistic thinking is an important factor’ (Teasdale and Barnard, 1993: 3) within depression and these negative thinking patterns, also termed cognitions, are what produce a depressed emotional state. From this Beck (1979) went on to formalise three specific concepts used within his theory of depression: the cognitive triad, schemas and faulty information processing (Beck et al, 1979: 10-14). The cognitive triad ‘identified a pattern of reportable depressive thoughts’ (Teasdale and Barnard, 1993:6) in a person, these being a negative view of themselves, of the world and of the future. From this it is believed that other signs and symptoms derive from these negative cognitive patterns. Another prevalent concept within his work was ‘schemas’.

This concept was used to explain how depressed people maintain these negative attitudes they have concerning the three areas of the triad even when faced with evidence that these cognitions are invalid. The third concept, ‘faulty information processing’, was used to describe ‘systematic errors in the thinking of the depressed person’ (Beck et al, 1979: 14). This shows the underlying distinction between ‘primitive’ thinking , which is ways of thinking that tend to be negative and definitive , contrasting with ‘mature’ thinking which enables a person to think from a multitude of dimensions (Beck et al, 1979: 15). It is believed that within Beck’s theory a depressed person tends to draw upon primitive ways of thinking.

Beck’s model has had significant influence within the field of cognitive psychology yet does not escape criticism, a key concern being with its fluidity as a model over time (Ernst et al, 1991: 215). Beck (1979: 386), himself, is also cautious with his own findings, observing that ‘negative cognitions, although present in association with a depressed mood, may simply be a secondary effect of the mood itself’. Teasdale and Barnard (1993: 10) also described this theory as an ‘intra-psychic’ view and therefore fails to take into account social and environmental factors and their influence on the aetiology of depression, as Walker (2008: 11) also draws attention to the fact that ‘depression is first and foremost a biopsychosocial disorder’ and therefore an approach needs to encompass all these areas.

However, this theory’s application to the treatment of depression has had significant influence and cognitive therapy has been described as ‘one of the most promising innovations for the treatment of depression’ (Shelton and Loosen, 1991: 88). The therapy entails helping the client to re evaluate their negative automatic thoughts and through this evaluation highlights the need to examine evidence for and against the irrational thoughts, in the hope to therefore substitute the irrationality for more reality orientated interpretations for their biased cognitions. Beck et al (1979: 4) described the therapists role being concerned with aiding the patient ‘to think and act more realistically and adaptively’ hoping to then reduce the effects of their depressive symptoms. This therapy has shown to be effective through many empirical studies.

For instance, Shipley and Fazios’ (1973, cited in Beck et al, 1979: 387) research showed when using this therapy there were a significant improvements in depressed student volunteers than an interest-support control group. However, much debate still arises from the use of ‘talking therapies’ in relation to the use of physical intervention. Shelton and Loosen (1991: 88-) looked into the comparisons of effectiveness of these two treatment approaches and concluded that cognitive therapy is promising but is still not an ‘adequately tested alternative to antidepressant medication in the treatment of outpatient depression’. It is important to also point to the fact that even though it has shown significant effect on managing and treating depression, it must be considered that ‘any therapy is only as good as the practitioner’ (Solomon, 2002: 109).

Another area within psychology that has had an influence on the causal explanations and subsequent treatments of depression has been within the field of biology. Psychology has offered many explanations of the mind and its link to depression, but it is important to recognise that ‘the mind does not exist without the brain’ (Nemerott, 1998: 42). Ultimately, depression can be linked to biochemical changes in the brain, yet the brain is a complex matter and there still remains a large amount of scope for the unknown to be discovered. However, over the past few decades neurobiologists have made some extraordinary discoveries which Nemerott (1998: 42) believes ‘is fuelling optimism that the major biological determinants of depression can be understood in detail’. It can be seen now that adequate diagnoses, treatments and preventions of the condition have started to be developed within this area.

One such area which has made huge developments within applying biological theories to the development of treatments has been concerned with the ‘deficiency of neurotransmitters like nordrenaline and serotonin in the brain’ (Wolpert, 1999: 109). These particular neurotransmitters fall under the Monoamine class and Monoamines and their subsequent link to depression became apparent in the 1950’s, when a group of physicians who were treating hypertension using the drug Reserpine, discovered that this drug caused a depletion of monoamines within the brain. From this it was seen that up to 15 percent of the patients being treated by this drug suffered from severe depression (Nemerott, 1998: 44). These findings led to the realisation that low levels of monoamines in the brain circuit could cause depression and thus led to the subsequent development of Monoamine Oxidase Inhibitors, the first form of anti depressant drugs.

Since then, research has developed focusing on the two main neurotransmitters within the Monoamine class thought to be linked with depression, Noradrenaline and Serotonin.It is believed that a depletion of either of these two neurotransmitters in the brain could lead to the onset of depression. The application of these theories has led to the further development of anti-depressant drugs and the principle behind these is modifying levels of certain substances in the brain can lead to changes in the way a patient feels or acts (Solomon, 2002: 111).

The research surrounding Serotonin has become critical to the study of Monoamines and causes of depression in neurobiology over the past few years. This has in part been due to the success of the antidepressant drug Prozac, which falls under Selective Serotonin Reuptake Inhibitors (SSRI’s). This drug manipulates serotonin levels within the brain and was believed to be revolutionary in comparison to past treatments as it had much milder side effects (Nemerott, 1998: 45).

The main concern with using anti depressants as method of treatment for depression is the side effects that can occur when using the drugs. Wolpert (1999: 133) highlighted this by pointing to the fact that companies who market the drugs ‘will never know the full effectiveness of their drug, and most important, all the side effects, until it has been marketed and used by large number of patients’. However, even though there are risks posed by taking some of the drugs available for the treatment of depression, for the sufferer of this particular illness Solomon (2002: 133) believes that ‘it is not weak to take medications’ but instead describes it as being ‘courageous’.

This essay so far has looked into traditional psychological theories in relation to depression. However, it is also important to acknowledge that there has been a quiet revolution within the Social Sciences (Hepburn and Wiggins. 2007: 1) over the past twenty years leading to the development of theories such as Discursive psychology and Critical psychology. These new theories that have emerged have been described by Burr (2003: 2) as all sharing a sort of ‘family resemblance’ and are all under the ‘umbrella’ of Social Constructionism, which takes an anti-essentialism view of the world. It seeks to question reality as we know it and announces that knowledge that is produced, even within the social sciences, must itself be historically and culturally specific. If we are to look at depression in terms of a social constructionist’s view point, we see that one must be critical of past assumptions made by traditional psychology, and that to understand depression we should focus on the cultural and historical period we are concerned with.

Marsella et al (1985: 300) highlighted this is in their work surrounding cross cultural studies of depression regarding our conceptions to be often ‘highly ethnocentric’, and showed the importance of studying cultural factors to gain an understanding of the depressive experience, as they believed that those factors must be considered, ‘if an accurate understanding of depression is to be achieved’. Walker (2008) also highlights the importance of gaining an understanding of depression by positioning it in context to major political and social developments in his book Depression and Globalization, where he believes that ‘radical change in political ethos is a fundamental driving force behind the structural changes that have led to the tangible increase in depression over the last thirty years’ (Walker, 2008: 135).

This all shows the need to not just take biological or cognitive factors into account when focusing on depression but to go beyond the body and look to issues of culture and its historical relevance. Social Constructionist’s believe that the focus of positivist research that has developed around depression has ‘fostered a view of knowledge as detached from the influence of prevailing cultural values’ which has lead to ‘the role played by language in shaping the meaning of concepts’ (Stoppard, 2000: 69) being neglected.

This essay has shown that the theories which have been discussed must be considered when attempting to understand and develop treatments for depression. However, future discoveries surrounding this particular illness will need to both build on and challenge the assertions and assumptions made by these theories before there will be a fully accepted aetiology of depression. What is clear is that these psychological theories and their application to depression have had a great influence upon developing interventions that are currently being used to lessen the pain of those suffering.

Reference List

Beck, A., Rush, A., Shaw, B. and G. Emery. 1979. Cognitive Therapy of Depression. New York: Guildford Press

Burr, V. 2003. Social Constructionism. 2nd ed. Hove: Routledge

Ernst, D., Haaga, D., M. Dyck. 1991. Empirical Status of Cognitive theory of Depression. Psychological Bulletin 110 (2): 215-236

Hepburn, A and S. Wiggins. 2007. Discursive Research: Themes and Debates. In: Discursive Research in Practice: New approaches to Psychology and Interaction, edited by A. Hepburn and S. Wiggins. Cambridge: Cambridge University Press

Lam, R and H. Mok. 2008. Depression. Oxford: Oxford University Press

Marsella, A., Saritorius, N., Jablenstay A. and F. Fenton. 1985. Cross Cultural studies of Depressive Disorders: An Overview. In: Culture and Depression: Studies in the Anthropology and cross cultural Psychiatry of affect and disorder, edited by A. Kleinman and B. Good. London: University of California Press

Nemerott, C. 1998. The neurobiology of Depression. Scientific American 278 (6): 42-50

Shelton, R and Loosen, P. 1991. Cognitive Therapy and Pharmacotherapy of Depression. Journal of Consulting and Clinical Psychology 39 (1): 88-99

Solomon, A. 2001. The Noonday Demon: An anatomy of Depression. London: Vintage

Stoppard, J. 2000. Understanding Depression: Feminist Social Constructionist approaches. London: Routledge

Teasdale, J and P. Barnard. 1993. Affect, cognition and change: Re-modelling Depressive thought. Hove: Lawrence Erlbaum Associates Ltd

Walker, C. 2008. Depression and Globalization: The politics of Mental Health in the twenty first century. New York: Springer Science and Business Media LLC

Wolpert, L. 1999. Malignant Sadness: The anatomy of Depression. London: Faber and Faber Ltd