comer, abnormal psychology, 8th edition_33558：来的人，心理异常，第八edition_33558

Comer, Abnormal Psychology, 8e,Mood Disorders,Chapter 8,Slides & Handouts by Karen Clay Rhines, Ph.D.Northampton Community College,2,Comer, Abnormal Psychology, 8e,Mood Disorders,Two key emotions :DepressionLow, sad state in which life seems dark and its challenges overwhelmingManiaState of breathless euphoria or frenzied energy,3,Comer, Abnormal Psychology, 8e,Mood Disorders,Most people with a mood disorder suffer only from depressionThis pattern is called unipolar depressionPerson has no history of mania Mood returns to normal when depression liftsOthers experience periods of mania that alternate with periods of depressionThis pattern is called bipolar disorderOne might logically expect a third pattern unipolar mania, in which people suffer from mania only but this pattern is uncommon,4,Comer, Abnormal Psychology, 8e,Mood Disorders,Mood disorders have always captured peoples interestMillions of people have mood disorders Economic costs of mood disorders amount to many billions of dollars each yearThe human suffering is beyond calculation,5,Comer, Abnormal Psychology, 8e,Unipolar Depression,The term “depression” is often used to describe general sadness or unhappinessThis loose use of the term confuses a normal mood swing with a clinical syndromeClinical depression can bring severe and long-lasting psychological pain that may intensify as time goes by,How Common Is Unipolar Depression?,Around 8% of adults in the U.S. suffer from severe unipolar depression in any given year As many as 5% suffer from mild formsAround 19% of all adults experience unipolar depression at some time in their livesThe prevalence is similar in Canada, England, France, and many other countriesThe rate of depression is higher among poor people than wealthier people,6,Comer, Abnormal Psychology, 8e,How Common Is Unipolar Depression?,People of any age may suffer from unipolar depressionWomen are at least twice as likely as men to experience severe unipolar depressionLifetime prevalence: 26% of women vs. 12% of menAmong children, the prevalence is similar among boys and girlsApproximately 85% of people with unipolar depression recover, some without treatmentAround 40% will experience another episode later in their lives,7,Comer, Abnormal Psychology, 8e,What Are the Symptoms of Unipolar Depression?,Symptoms may vary from person to personFive main areas of functioning may be affected:Emotional symptomsFeeling “miserable,” “empty,” “humiliated”Experiencing little pleasureMotivational symptomsLacking drive, initiative, spontaneityBetween 6% and 15% of those with severe depression die by suicide,8,Comer, Abnormal Psychology, 8e,What Are the Symptoms of Unipolar Depression?,Five main areas of functioning may be affected:Behavioral symptomsLess active, less productiveCognitive symptomsHold negative views of themselvesBlame themselves for unfortunate eventsPessimisticPhysical symptomsHeadaches, dizzy spells, general pain,9,Comer, Abnormal Psychology, 8e,Diagnosing Unipolar Depression,Criteria 1: Major depressive episodeMarked by five or more symptoms lasting two or more weeksIn extreme cases, symptoms are psychotic, including HallucinationsDelusionsCriteria 2: No history of mania,10,Comer, Abnormal Psychology, 8e,Diagnosing Unipolar Depression,Two diagnoses to consider:Major depressive disorderCriteria 1 and 2 are metDysthymic disorderSymptoms are “mild but chronic”Depression is longer lasting but less disablingConsistent symptoms for at least two yearsWhen dysthymic disorder leads to major depressive disorder, the sequence is called “double depression”,11,Comer, Abnormal Psychology, 8e,12,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?,Stress may be a trigger for depressionPeople with depression experience a greater number of stressful life events during the month just before the onset of their symptomsSome clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors,13,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?,Todays clinicians usually concentrate on recognizing both the situational and the internal aspects of any given caseThe current explanations of unipolar depression point to biological, psychological, and sociocultural factors,14,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Biological View,Genetic factorsFamily pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a biological predispositionResearchers have found that as many as 20% of relatives of those with depression are themselves depressed, compared with fewer than 10% of the general population,15,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Biological View,Genetic factorsTwin studies demonstrate a strong genetic component: Concordance rates for identical (MZ) twins = 46%Concordance rates for fraternal (DZ) twins = 20% Adoption studies also have implicated a genetic factor in cases of severe unipolar depressionUsing techniques from the field of molecular biology, researchers have found evidence that unipolar depression may be tied to specific genes,16,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Biological View,Biochemical factorsNTs: serotonin and norepinephrineIn the 1950s, medications for high blood pressure were found to cause depressionSome lowered serotonin, others lowered norepinephrineThe discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, confirmed the NT roleDepression likely involves not just serotonin nor norepinephrine a complicated interaction is at work, and other NTs may be involved,17,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Biological View,Biochemical factorsEndocrine system / hormone releasePeople with depression have been found to have abnormal levels of cortisolReleased by the adrenal glands during times of stressPeople with depression have been found to have abnormal melatonin secretion“Dracula hormone”Other researchers are investigating deficiencies of important proteins within neurons as tied to depression,18,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Biological View,Biochemical factorsModel has produced much enthusiasm but has certain limitations: Relies on analogue studies: depression-like symptoms created in lab animalsDo these symptoms correlate with human emotions?Measuring brain activity has been difficult and indirectCurrent studies using newer technology are attempting to address this issue,19,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Biological View,Brain anatomy and brain circuitsBiological researchers have determined that emotional reactions of various kinds are tied to brain circuitsThese are networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reactionIt appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCDAlthough research is far from complete, a circuit responsible for unipolar depression has begun to emergeLikely brain areas in the circuit include the prefrontal cortex, hippocampus, amygdala, and Brodmann Area 25,20,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Biological View,Immune SystemThis system is the bodys network of activities and cells that fight off bacteria and other foreign invadersWhen stressed, the immune system may become dysregulated, which some believe may help produce depressionSupport for this explanation is circumstantial but compelling,21,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Three main models:Psychodynamic modelNo strong research supportBehavioral modelModest research supportCognitive viewsConsiderable research support,22,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Psychodynamic viewLink between depression and griefWhen a loved one dies, an unconscious process begins and the mourner regresses to the oral stage and experiences introjection a directing of feelings for the loved one onto oneselfFor most people, introjection is temporaryFor some, grief worsens over time; if grief is severe and long-lasting, depression resultsThose with oral stage issues (unmet or excessively met needs) are at greater risk for developing depressionInstead of actual loss, some people experience “symbolic” (or imagined) loss insteadNewer psychoanalysts (object relations theorists) propose that depression results when peoples relationships leave them feeling unsafe and insecure,23,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Psychodynamic viewStrengths:Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss (e.g., anaclitic depression)Research supports the theory that early losses set the stage for later depressionResearch also suggests that people whose childhood needs were improperly met are more likely to become depressed after experiencing a loss,24,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Psychodynamic viewLimitations:Early losses and inadequate parenting sometimes lead to depression but may not be typically responsible for development of the disorderMany research findings are inconsistentCertain features of the model are nearly impossible to test,25,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Behavioral viewDepression results from changes in rewards and punishments people receive in their livesLewinsohn suggests that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer csonstructive behaviors, and they spiral toward depressionResearch supports the relationship between the number of rewards received and the presence or absence of depressionSocial rewards are especially important,26,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Behavioral viewStrengths:Researchers have compiled significant data to support this theoryLimitations:Research has relied heavily on the self-reports of depressed subjectsBehavioral studies are largely correlational and do not establish that decreases in rewards are the initial cause of depression,27,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsTwo main theories:Negative thinkingLearned helplessness,28,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsNegative thinkingBeck theorizes four interrelated cognitive components combine to produce unipolar depression:Maladaptive attitudesSelf-defeating attitudes are developed during childhoodBeck suggests that upsetting situations later in life can trigger an extended round of negative thinking,29,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsThis negative thinking typically takes three forms, called the cognitive triad:Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression,30,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsNegative thinkingDepressed people also make errors in their thinking, including:Arbitrary inferencesMinimization of the positive and magnification of the negativeDepressed people also experience automatic thoughtsA steady train of unpleasant thoughts that suggest inadequacy and hopelessness,31,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsStrengths:Many studies have produced evidence in support of Becks explanation:High correlation between the level of depression and the number of maladaptive attitudes heldBoth the cognitive triad and errors in logic are seen in people with depressionAutomatic thinking has been linked to depressionLimitations:Research fails to show that such cognitive patterns are the cause and core of unipolar depression,32,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsLearned helplessness This theory asserts that people become depressed when they think that:They no longer have control over the reinforcements (rewards and punishments) in their livesThey themselves are responsible for this helpless state,33,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsLearned helplessness Theory is based on Seligmans work with laboratory dogsDogs subjected to uncontrollable shock were later placed in a shuttle box Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do soSeligman theorized that the dogs had “learned” to be “helpless” to do anything to change negative situations, and drew parallels to human depression,34,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsLearned helplessness There has been significant research support for this modelHuman subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trialsAnimal subjects lose interest in sex and social activitiesIn rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain,35,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsLearned helplessness Recent versions of the theory focus on attributionsInternal attributions that are global and stable lead to greater feelings of helplessness and possibly depression Example: “Its all my fault” internal. “I ruin everything I touch” global “and I always will” stable.If people make other kinds of attributions, this reaction is unlikelyExample: “She had a role in this also” external, “the way Ive behaved the past couple weeks blew this relationship” specific. “I dont know what got into me I dont usually act like that” unstable.,36,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsLearned helplessness Some theorists have refined the helplessness model yet again in recent years; they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual,37,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Psychological Views,Cognitive viewsLearned helplessness Strengths:Hundreds of studies have supported the relationship between styles of attribution, helplessness, and depressionLimitations:Laboratory helplessness does not parallel depression in every wayMuch of the research relies on animal subjectsThe attributional component of the theory raises particularly difficult questions in terms of animal models of depression,38,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?Sociocultural Views,Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds peopleThis belief is supported by the finding that depression is often triggered by outside stressorsThere are two kinds of sociocultural views:The family-social perspectiveThe multicultural perspective,39,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Sociocultural View,The Family-Social PerspectiveThe connection between declining social rewards and depression (as discussed by the behaviorists) is a two-way streetDepressed people often display social deficits that make other people uncomfortable and may cause them to avoid the depressed individualsThis leads to decreased social contact and a further deterioration of social skills,40,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Sociocultural View,The Family-Social PerspectiveConsistent with these findings, depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriagePeople who are separated or divorced display three times the depression rate of married or widowed persons and double the rate of people who have never been marriedThere also is a high correlation between level of marital conflict and degree of sadness that is particularly strong among those who are clinically depressedIt also appears that people who are isolated and without intimacy are particularly likely to become depressed in times of stress,41,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Sociocultural View,The Multicultural PerspectiveTwo kinds of relationships have captured the interest of multicultural theorists:Gender and depressionA strong link exists between gender and depressionWomen cross-culturally are twice as likely as men to receive a diagnosis of unipolar depressionWomen also appear to be younger, have more frequent and longer-lasting bouts, and to respond less successfully to treatment,42,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Sociocultural View,The Multicultural PerspectiveA variety of theories has been offered:The artifact theory holds that women and men are equally prone to depression, but that clinicians often fail to detect depression in menThe hormone explanation holds that hormone changes trigger depression in many womenThe life stress theory suggests that women in our society experience more stress than men,43,Comer, Abnormal Psychology, 8e,What Causes Unipolar Depression?The Sociocultural View,The Multicultural PerspectiveA variety of theories has been offered:The body dissatisfaction the