Discuss the relationship between etiology and therapeutic approach in relation to one disorder.

Biological etiology of depression

Genetic predisposition: can partly explain depression

Twin studies: Nurnberger and Gershon (1982)

reviewed the results of 7 twin studies and found that the concordance rate for major depressive disorder was consistently higher for MZ twins than for DZ twins

genetic factors might predispose people to depression

Average concordance rate for MZ twins was 65%, while for DZ twins it was 14%. The fact that the concordance rate is way below 100 indicates that depression may be the result of genetic predisposition/genetic vulnerability.



Duenwald (2003), Caspi et al

short variant of the 5-HTT gene may be associated with higher risk of depression. This gene plays a role in serotonin pathways which scientists think are involved in controlling mood, emotions, aggression, sleep, and anxiety.



Biological etiology of Anorexia




Research suggests that a genetic predisposition to anorexia may run in families. If a girl has a sibling with anorexia, she is 10 to 20 times more likely than the general population to develop anorexia herself. Brain chemistry also appears to play a significant role. People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, and decreased levels of serotonin and norepinephrine, which are associated with feelings of well-being.

Studies at the University of Pittsburgh found that unusually high levels of serotonin in the brains of anorexics. It seems strange at first because normal levels of serotonin are associated with happiness and a sense of well-being. High levels of serotonin, however, may be linked to anxiety and obsessional thinking. These are typical traits of anorexics.



Biological treatment of depression

The biological depression treatments are familiar to many people in that they usually include antidepressant medications and ECT (electroconvulsive therapy) or shock treatments. Antidepressant medications have grown significantly in their level of effectiveness and have an improved side effect profile over the earlier medication treatments. The earliest antidepressants included tricyclic antidepressants which are now increasingly being replaced by the SSRI's (selective serotonin reuptake inhibitors) which include Prozac, Paxil and Zoloft. These medications are reviewed extensively on separate pages of this web site.
One of the most controversial forms of depression treatment is electroconvulsive therapy or ECT. These treatments for depression have been around for several decades but have improved significantly over the years in terms of both safety and effectiveness. These depression treatments will also be reviewed extensively on other pages of this web site.

For Major Depression
Name and year of study
Kirsch et al (2002)
Aim
To find out whether new generation anti-depressants Selective Seratonine Reuptake Inhibitors (SSRI) is effective in treating depression or not.
Research method
Experimental
Procedure
Using the Hamilton Scale for Depression on patients of different severity of depression taking the SSRI and placebo to see if the SSRI is effective or not.
Findings
The effects on the SSRI did not seem effective on patients with mild and moderate symptoms of depression; only severe depression patients experience some positive effects.
Conclusion
Methodological strength
- Make people more aware of the real effects of the new generation drugs.
- Ecological validity is high as drugs are being tested for their real effects.
Methodological weakness
- Employed too many participants of the milder depression with fewer participants with severe depression. Creates a bias. (Low generalizability.
- Some drugs experimented were still in the experimental phase, and not yet approved by the FDA.
Ethical considerations
- Requires human testing on drugs, but consent forms are given.




Cognitive etiology of Anorexia Nervousa
- People with Anorexia have distorted image of themselves
- Emotional disorder focused on food
- Cognitive mind: trying to deal with perfectionism, control things by strictly controlling amount of food intake and weight
- Self esteem is tied to their weight (how thin they are)
- Could be caused by emotional stress or severe trauma (sexual abuse, death of loved ones) during times before or during puberty
- It is an Attentional biases and cognitive styles that distort reality/body image
- “Body-image distortion hypothesis” : 1962, Brucg
o Overestimation of body size
o 1994, Slade and Brodie : those who suffer from an eating disorder are UNCERTAIN about the size /shape of their body
  • Make judgment in which results in overestimation of body size

Cognitive etiology of Major Depression
A depressed mood may lead to depressed thoughts
Depressed cognitions, cognitive distortions, and irrational beliefs produce disturbances in mood
Ellis 1992 “cognitive style theory”
Depression from illogical and irrational thinking
On doubtful evidence about the meaning of an event, people draw false conclusion which could cause depression
E.g. “My report must be perfect” “I did not get an A” leads to self-defeating conclusion “I am a failure, I am very stupid, I will fail at life”
Beck 1976 “cognitive distortion theory of depression”
Schema processing : store schemas about the self interfere with information processing
By observing depressive patients he found out that patients receives a negative cognitive triad characterized by
1. Overgeneralization : based on negative evens
2. Non-logical interference :about self
3. Dichotomous thinking: “black and white thinking”, only recalling the negative consequences
- Negative cognitive schemas are activated by stressful events and patients overreact
- If a person has negative expectations about the future then the depression will go in a cycle
- *Most people who suffer from depression have irrational beliefs and cognitive biases such as harsh self-criticism and pessimism

Sociocultural etiology of anorexia nervosa
  • More common in western society, but it is increasing in the eastern societies because of globalization
  • Media exposure
  • Social learning that people mimicking the action of their parents and low self-esteem
  • Family interaction
  • Places(social or environment) where they take the importance on physical appearance
  • Places where people who area thin achieve success

Cognitive Treatment of Depression:
- Beck’s cognitive therapy
- Beck states: depressed people acquired negative schema of the world in childhood and adolescence through negative events
- When those people faces situation that represents the original condition of the learned schema/negative schema activated (read more above)
- Beck’s cognitive triad (patients have negative thoughts of) : SELF, WORLD, FUTURE
Way to treat :
- COGNITIVE RECONSTRUCTURING
- Replace wrong thoughts with accurate and beneficial ones
- Gain awareness of bad thought habits challenge the habits change life enhancing thoughts and beliefs
- E.g. “I failed my test” “I will do better next time,” “I can definitely pull my grades up.” “I hated the class anyway, now I know what course to take next year”

STUDY:
Goldapple (2004)
Aim: To investigate how cognitive therapy affects brain changes
Research method: Experiment
Procedure: PET scans were used to document brain activity before and after 15 to 20 therapies of cognitive therapy over seven weeks in 14 patients. PET scans from a previous study on participants taking antidepressants were used as a control group. Participants were screened to ensure that they had no substance problems or antidepressant treatment one month prior to the study. Some of the participants reported reported previous negative experiences with drug therapy
Findings: there were significant changes in glucose metabolism in prefrontal-hippocampal pathways. The changes on the brain were the same as with antidepressants.
Lyon & Woods (1991)
Compared 70 Cognitive Therapy outcone studies with behavior therapy and other psychotherapies.
Cognitive therapy demonstrated better improvement than other groups
Effect size was related to therapist experience and duration of therapy
There were some methodological flaws: attribution rates (some participants dropped out) and lack of follow updata.
These studies show that cognitive factors influence abnormal behavior because they can affect a persons thoughts or cognition.
They're mood changes after the therapy, which aims to change their thought patterns.
Since their moods have improved after therapy, we can assume that their mood is affected by negative thoughts
Weakness: It ignores the other factors and only focuses on one factor. Does not take into account the biological and sociocultural factors
Strengths: It is testable and applicable- it is supported by case studies.

Lyon & Woods (1991)
Compared 70 Cognitive Therapy outcome studies with behavior therapy and other psychotherapies.
Cognitive therapy demonstrated better improvement than other groups
Effect size was related to therapist experience and duration of therapy
There were some methodological flaws: attribution rates (some participants dropped out) and lack of follow-up data.
These studies show that cognitive factors influence abnormal behavior because they can affect a persons thoughts or cognition.
They're mood changes after the therapy, which aims to change their thought patterns.
Since their moods have improved after therapy, we can assume that their mood is affected by negative thoughts
Weakness: It ignores the other factors and only focuses on one factor. Does not take into account the biological and sociocultural factors
Strengths: It is testable and applicable- it is supported by case studies.