Major depressive disorder is a common psychological disorder characterized by a depressed mood lasting more than two weeks along with symptoms like loss of interest, sleep, and pleasure. It can be caused by genetic, biological, cognitive, social, and environmental factors. Treatment approaches include biomedical treatments using antidepressant drugs, individual cognitive therapies to change negative thoughts, and group therapies where people with similar issues provide support. The effectiveness of different treatment approaches is evaluated based on how long symptoms are relieved and whether observable behavior changes.

1. Abnormal psychology
Psychological disorders (148/152)
Introduction to psychological disorders:
In order to diagnosis the psychological disorder psychiatrists use symptomology and etiology.
Symptomology is the identification of the symptoms.
Etiology is why the patient suffers from the disorder.
The data assisting in the diagnosis:
Prevalence rate:the measure of the total number of cases of the disorder in a given population.
Lifetime prevalence: the percentage of the population that will experience the disorder at some time in their life.
Onset age: the average age at which the disorder is likely to appear.
Classification of abnormal behaviour:
Anxiety disorders: the central disturbance is an irrational fear.
Affective disorders: deals with dysfunctional moods.
Eating disorders: eating patterns which lead to insufficient or excessive food intake.
Affective disorders:
Major Depressive disorder:
Depression is a common psychological disorder especially among women and young adults. It can be diagnosed when
an individual experiences a depressed mood for more than two weeks, accompanied with loss of interest, sleep and
pleasure. The symptoms of depression are:
Affective: feeling guilt and sadness,lack of enjoyment and pleasure in familiar activities, low mood and low self-
esteem.
Behavioural: negative thinking, faulty attribution of guilt, irrational hopelessness and difficulties I making decisions.
Somatic: loss of energy , insomnia, weight loss/gain.
Etiology ofMajor Depressive Disorder:
Depression can be caused by biological factors,social pressure or cognitive factors. It is related to a number of factors
that include: genetic predisposition, personality, early history, cognitive style, coping skills, and the level of social
support available. So it is not caused by one factor but by a combination of some triggering factors.
A major unwanted quick change in an individual’s life can result in depression like a divorce, a death of a close person
or a serious accident. It can also be caused by long-term circumstances which are a constant source of disappointment
and stress.
The biological level ofanalysis: genetic and biochemical factors in depression:
An effective way to determine the effect of genetic predisposition on depression is twin studies. Nurnberg and
Gershon reviewed the results of seven twin studies and found out that the concordance rate of depressive disorder was

2. higher for MZ twins than DZ twins. This is seen as the support for the hypothesis that genetic factors have an effect on
the development of depression.
Genetic factors contribute in depression by:
 Affecting serotonin pathways.
 Moderating responses to environmental factors.
 Deficiency in neurobiological systems such as neurotransmitters and hormones.
 Low level of noradrenaline.
 Inbalance of severalneurotransmitters like dopamine, serotonin, acetylcholine.
Research in psychology: the impact ofpoverty on child depression
A recent study conducted by Fernald and Gunnar (2008) studied the effect of povertyon child depression. The
researchers surveyed 639 mexican mothers and their children.
They found that children of depressed mothers living in extreme poverty produced less cortisol (a hormone that help
us cope with stress everyday). Low level of cortisol makes children vulnerable not only to depression but also to
autoimmune diseases.
Children of poor familes will be under the impact of their parents’ depression and the living conditions.
Cognitive Level of Analysis: Cognitive factors in depression (153/157)
Cognitive theories suggest that depressed distortions and irrational beliefs produce the disturbances of mood.
Cognitive Style Theory by Ellis
People draw false conclusions about events, which lead to feelings of anger, anxiety or depression.
𝐼𝑟𝑟𝑎𝑡𝑖𝑜𝑛𝑎𝑙 𝑏𝑒𝑙𝑖𝑒𝑓 → 𝑙𝑒𝑎𝑑𝑠 𝑡𝑜 𝑓𝑎𝑙𝑠𝑒 𝑐𝑜𝑛𝑐𝑙𝑢𝑠𝑖𝑜𝑛 → 𝑛𝑒𝑔𝑎𝑡𝑖𝑣𝑒 𝑓𝑒𝑒𝑙𝑖𝑛𝑔
Depression Theory by Beck
Depressed people tend to construct negative cognitive triads, they are:
 Overgeneralisation based on negative events
 Non-logical interference about the self
 Dichotomous thinking which is the black and white thinking
The negative schemas are activated by stressful events. They distort truths in people’s minds and lead them to
depression. Most people who suffer from depression exhibit irrational beliefs and cognitive biases such as extreme
criticism and pessimism.
Perspective Study by Frude:
A perspective study is a study in which participants are chosen on a basis of a variable and then followed to see what
happens long term. There is a possible link between th cognitive style and the development of depression.
Social level ofanalysis: Social and cultural factors in depression
Brown and Harris found that 29 out of 32 women who became depressed experienced a severe life event. Previous
stressful events may lead to depression.
Brown suggested a vulnerability model of depression. It is consisted of the factors that may lead to depression:
 Lacking employment away from home
 Absence of social support
 Having severalyoung children at home

3.  Loss of mother at young age
 History of childhood abuse
Collectivist countries have lower level of depression compared to individualist countries. Each culture has its own
patterns of depression.
Gender consideration in major depressive disorder:
Women are two to three times more likely to become clinically depressed than women because women are more
emotionally than men.
Research in psychology
The theory of social factors in depression (Brown and Harris)
Abnormal psychology (157-161)
Anxiety disorders: post-traumatic stress disorder
PTSD lasts for more than 30 days. It is developed by a specific stressor. According to recent studies, PTSD affects 15-
24% of individuals who are exposed to traumatic events.
PTSD frequently occurs in conjunction with depression, social life problems like divorce or deaths, substance abuse,
problems of memory and cognition beside physical and mental health problems.
Symptomology
 Affective: anhedonia and emotional numbing.
 Behavioural: hyper vigilance, passivity, nightmares, flashbacks.
 Cognitive: Intrusive memories, inability to concentrate, hyper arousal.
 Somatic: lower back pain, headaches, stomach ache and digestion problems, insomnia, regression.
Etiology of PTSD
Biological level of analysis
Twin studies showed a possible genetic predisposition for PTSD, but most of biological studies focus on the role of
neurotransmitters on developing PTSD.
People with PTSD have high levels of noradrenaline which make them express emotions more than normal.
Cognitive level of analysis
PTSD patients tend to think that they don’t have control over their lives. They experience feelings of guilt and
intrusive memories.
Development of PTSD is associated with a tendency to take personal responsibility for failures and to cope with stress
by focusing on the emotion rather than the problem.
Sociocultural level of analysis
Experiencing racism, threat of death and oppression can be a trigger of PTSD.
Cultural considerations in PTSD
The ways people experience PTSD differ from a culture to another.
Gender consideration in PTSD
Studies have shown that women have a risk up to 5 times greater than males to develop PTSD after a violent or
traumatic event.

4. Symptoms can also differ between males and females. Men experience substance abuse, violent behaviour, irritability
and impulsiveness whereas women experience numbing, avoidance, anxiety and affective disorders.
Research in psychology
PTSD in post-genocidal societies: the case of Rwanda
Right after the genocide, the experiment was conducted on participants who continued to live in the same area where
the atrocities took place.
The survey was conducted by UNICEF on 3000 children of age 8-19 years:
 95% had witnessed violence.
 80% had suffered from a death of a close relative.
 62% had been threatened with death.
Symptomology:
 Diminished expectations.
 60% didn’t care if they grew up.
 Intrusive memories.
 Traumas.
Etiology:
 Exposition to triggers.
 Inability to give meanings to dangerous experiences in the presence of an overwhelming arousal.
 Less care towards child’s needs.
Abnormal psychology (166-171)
Possible relationship between etiology and treatment
The purpose of the diagnosis is to find the suitable treatment for the patient. The treatment of the psychological
disorder is linked to the etiology.
Contemporary abnormal psychology adopts a number of approaches to treatment depending on the disorder.
Biopsychological treatment is the most efficient. It includes drug treatment, individual therapy, or group therapy.
The biomedical approaches are based on the assumption that biological factors are involved in the psychological
disorder. A number of drugs are used to treat various disorders based on the brain chemistry. Drugs help in changing
the person’s mood in a positive direction.
In individual therapies, a therapist works one on one with a client. They include some kind of cognitive therapy by
changing negative thoughts.
In group therapies, individuals who suffer from the same problems meet together and get therapy. Sharing experience
and talking to each other help in improvement.
Cultural considerations in treatment
In therapy cultural differences should be taken in consideration. In Malaysia for example religion takes part in therapy.
The setting of social life takes part in the therapy to help people feel emotional connection.
The use of electric approaches
Electric therapy recognises the strengths and the limitations of the various therapies, they also take a short time.

5. A growing number of studies is showing that cognitive therapies are more effective than drug treatment especially at
preventing relapse or recurrence of symptoms.
Measuring the effectiveness of the therapy
It is found that even is an individual didn’t receive a therapy he would still improve due to a natural process of
recovery.
Here are the criteria considered when evaluating the effectiveness of a therapy:
 For how long a person showed a relief from his symptoms?
 Is a total absence of symptoms the only criterion that should be used?
 Should only observable behaviour change be used to assess success?
 Is it possible to gather quantitative data on the effectiveness of therapy, or only qualitative data?
 Another key question is who decided?
 Other issues that include the self-reporting of the client.
Other psychologists use outcome studies which focuses on whether the client showed improvement or no. however,
these types of studies have shortcomings.
Abnormal psychology p 171/176
Biomedical approaches to the treatment of depression
It is based on the assumption that if the problem is based on biological factors then drugs should be used to restore the
biological system.
Drugs typically operate by affecting transmission in the nervous system of neurotransmitters. The basic idea is to
restore the balance of neurotransmitters.
Antidepressant drugs are used to elevate the mood of people suffering from depression.
Evaluation of drug therapy
They are generally effective; however they are not suitable for all cases. A controversial study conducted by Kirsch
and Sapirstein analysed the results from 19 studies, covering 2318 patients. They found that the antidepressant weren’t
that much effective as they are believed to be. On the other hand, drugs offer long-term treatment for mood disorders,
especially with preventing suicides.
The side effects of drugs are red flags that raise many ethical issues. It cannot be given without a patient’s consent.
Another problem is that drugs reduce symptoms but they don’t cure the disorder.
Individual approaches to the treatment of depression
One of the symptoms of depression is distorted cognitions. Thus replacing negative thoughts by positive ones will
help the depressed person.
Principles of Aaron Beck’s theory:
 Identify negative thoughts
 Determine the connection between the negative thoughts and depression
 Investigate if negative thoughts can be supported
 Replace negative thoughts with realistic ones.
Therefore, improving the schema used by the individual is the main method to defeat depression.
Cognitive-behavioural therapy

6. CBT is a brief from of psychotherapy used to the treatment of adults and children with depression. It is focused on the
current issues and symptoms exhibited by the patient. There are around 12-20 weekly sessions combined with daily
practise to develop personal skills. The aim of the therapy is to identify and correct faulty thoughts though cognitive
reconstructing.
The six patterns of faulty thinking:
 Arbitrary reference: drawing wrong conclusions by invalid connections.
 Selective abstraction: drawing conclusions by focusing a single åart of a whole.
 Overgeneralization: applying single incident to all similar incidents.
 Exaggeration: overestimating the significance of negative events.
 Personalization: assuming that the others’ behaviour is done with the intention to hurt or humiliate you.
 Dichotomous thinking: black or with thinking.
People with psychological disorders tend to think negatively, and focus on failaures more than successes.
CBT also aims to encourage people to increase gradually any activities that could be rewarding to boost their self-
esteem. It also helps them monitor thought processes and then test them against reality.