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Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
Chapter 7 — Mood Disorders
Slides, handouts, and answers keys created by Karen Clay Rhines, Ph.D., Seton Hall University
Handout 3: Mood Disorders
Most people with a mood disorder experience only depression

This pattern is called unipolar depression
Person is no history of mania


Mood returns to normal when depression lifts
Some people experience periods of depression that alternate with periods of
mania

This pattern is called bipolar disorder
Handout 7: How Common Is Unipolar Depression?
In almost all countries, women are twice as likely as men to experience severe
unipolar depression

Lifetime prevalence: 26% of women vs. 12% of men
These rates hold true across socioeconomic classes and ethnic groups
~50% recover within 6 weeks, some without treatment

Most will experience another episode at some point
Handout 10: Diagnosing Unipolar Depression
Criteria 1: Major depressive episode

Marked by five or more symptoms lasting two or more weeks
In extreme cases, symptoms are psychotic
Hallucinations
Delusions
Criteria 2: No history of mania
Handout 11: Diagnosing Unipolar Depression

Two diagnoses to consider:
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Major depressive disorder


Criteria 1 and 2 are met
Dysthymic disorder

Symptoms are “mild but chronic”
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Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
Experience longer-lasting but less disabling depression
Consistent symptoms for at least two years

When dysthymic disorder leads to major depressive disorder, the sequence is called
“double depression”
Handout 12: Stress and Unipolar Depression
Stress may be a trigger for depression

People with depression experience a greater number of stressful life events during the
month just prior to the onset of their symptoms

Some clinicians distinguish reactive (exogenous) depression from endogenous
depression
Handout 14: Biological Model of Unipolar Depression
Genetic factors

Family pedigree, twin, and adoption studies suggest that some people inherit a
biological predisposition
Relatives of those with depression have higher rates of depression than members of the general
population
Twin studies demonstrate a strong genetic component:
Rates for identical (MZ) twins = 46%
Rates for fraternal (DZ) twins = 20%
Adoption studies have also implicated a genetic factor in cases of severe unipolar depression
Handout 15: Biological Model of Unipolar Depression

Biochemical factors
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NTs: serotonin and norepinephrine
In the 1950s, medications for high blood pressure were found to increase depression
Some lowered serotonin, others lowered norepinephrine
Led to “discovery” of effective antidepressant medications
It is likely not just one NT or the other – a complex interaction is at work
Handout 16: Biological Model of Unipolar Depression
Biochemical factors

Endocrine system hormone release
People with depression have been found to have abnormal levels of cortisol
• Released by the adrenal glands during times of stress
People with depression have been found to have abnormal melatonin secretion
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Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
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• “Dracula hormone”
Handout 17: Biological Model of Unipolar Depression
Biochemical factors

Model has significant limitations:
Depression-like symptoms created in lab animals
• Do these symptoms correlate with human emotions?
Measuring brain activity has been difficult
• Current studies using modern technology are attempting to address this issue
Handout 20: Biological Treatment of Unipolar Depression
Electroconvulsive therapy (ECT)

The discovery of ECT’s effectiveness was accidental and based on a fallacious link
between psychosis and epilepsy
First major form of treatment

The procedure has been modified in recent years to reduce some of the negative effects
For example, patients are given muscle relaxants and anesthetics before and during the procedure

Patients generally report some memory loss
Handout 21: Biological Treatment of Unipolar Depression
Electroconvulsive therapy (ECT)

ECT is clearly effective in treating unipolar depression
Studies find improvement in 60–70% of patients

The procedure seems particularly effective in cases of severe depression with delusions

Although effective, the use of ECT has declined since the 1950s, due to the memory
loss caused by the procedure and the emergence of effective antidepressant drugs
Handout 24: Biological Treatment of Unipolar Depression
Antidepressant drugs: monoamine oxidase inhibitors (MAOIs)

Originally used to treat TB

Doctors noticed that the medication seemed to make patients happier

The drug works by slowing down the body’s production of MAO
MAO breaks down norepinephrine
MAOIs stop this breakdown from occurring
Handout 27: Biological Treatment of Unipolar Depression
Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
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Antidepressant drugs: tricyclics

Hundreds of studies have found that depressed patients taking tricyclics have improved
much more than similar patients taking placebos
Drugs must be taken for at least 10 days before such improvement is seen
About 60–65% of patients find symptom improvement
Handout 28: Biological Treatment of Unipolar Depression
Antidepressant drugs: tricyclics

Most patients who immediately stop taking tricyclics upon relief of symptoms relapse
within one year
Patients who take tricyclics for five additional months (“continuation therapy”) have a significantly
decreased risk of relapse
Patients who take antidepressant drugs for three or more years after initial improvement (“maintenance
therapy”) may reduce the risk of relapse even more
Handout 29: Biological Treatment of Unipolar Depression
Antidepressant drugs: tricyclics

Tricyclics are believed to reduce depression by affecting NT “reuptake”
In order to prevent an NT from remaining in the synapse too long, a pumplike mechanism recaptures
the NT and draws it back into the presynaptic neuron
The reuptake process appears to be too effective in some people, drawing in too much of the NT from
the synapse
This reduction in NT activity in the synapse is thought to result in clinical depression
Tricyclics block this process, thus increasing NT activity in the synapse
Handout 31: Biological Treatment of Unipolar Depression
Second-generation antidepressant drugs

A third group of effective antidepressant drugs is structurally different from the
MAOIs and tricyclics
Most of the drugs in this third group are selective serotonin reuptake inhibitors (SSRIs)

These drugs act only on serotonin; no other NTs are affected
This class includes fluoxetine (Prozac) and sertraline (Zoloft)

Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake
inhibitors are the newer second-generation antidepressants
Handout 32: Biological Treatment of Unipolar Depression
Second-generation antidepressant drugs

The effectiveness of these drugs is on par with the tricyclics, yet they boast
Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
ENORMOUS sales
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Clinicians often prefer these drugs because it is harder to overdose on them than on
other kinds of antidepressants

There are no dietary restrictions like there are with MAOIs

They have fewer side effects than the tricyclics
These drugs may cause some undesired effects of their own, including a
reduction in sex drive
Handout 34: Psychological Models of Unipolar Depression
Link between depression and grief

When a loved one dies, the mourner regresses to the oral stage
For most people, grief is temporary
If grief is severe and long-lasting, depression results
Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing
depression

Some people experience “symbolic” (not actual) loss

Newer psychoanalysts focus on relationships with others (object relations theorists)
Handout 37: Psychological Treatment of Unipolar Depression:
Psychodynamic Therapy
Psychodynamic therapists use the same basic procedures for all psychological
disorders:

Free association
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Therapist interpretation
Handout 38: Psychological Treatment of Unipolar Depression:
Psychodynamic Therapy
Despite successful case reports, researchers have found that long-term
psychodynamic therapy is only occasionally helpful in cases of unipolar
depression
Two features may be particularly limiting:

Depressed clients may be too passive or fatigued to fully participate in clinical
discussions

Depressed clients may become discouraged and end treatment too early when
treatment doesn’t provide fast relief
Short-term approaches have performed better than traditional approaches
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Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
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Handout 39: Psychological Models of Unipolar Depression: Behavioral
View
Depression results from changes in rewards and punishments
As life changes, we experience a change (loss) of rewards
Research supports the relationship between the number of rewards received and
the presence of depression

Social rewards are especially important
Handout 41: Psychological Treatment of Unipolar Depression: Behavioral
Therapy
Lewinsohn, whose theory tied a person’s mood to his/her life rewards,
developed a behavioral therapy for unipolar depression:

Reintroduce clients to pleasurable activities and events

Appropriately reinforce their depressive and nondepressive behaviors

Use a contingency management approach

Help them improve their social skills
Handout 46: Psychological Models of Unipolar Depression: Cognitive View
Learned helplessness

There has been significant research support for this model
Human subjects who undergo helplessness training score higher on depression scales and demonstrate
passivity in laboratory trials
Animal subjects lose interest in sex and social activities
In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain
Handout 47: Psychological Models of Unipolar Depression: Cognitive View
Learned helplessness

Recent versions of the theory focus on attributions

Internal attributions that are global and stable lead to greater feelings of helplessness
and possibly depression
Example: “It’s all my fault [internal]. I ruin everything [global] and I always will [stable]”

If people make other kinds of attributions, this reaction is unlikely
Example: “She had a role in this also [external], but I have been a jerk lately [specific], and I don’t
usually act like that [unstable]”
Handout 50: Psychological Models of Unipolar Depression: Cognitive View
Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
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Negative thinking
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Beck theorizes four interrelated cognitive components of depression:

Maladaptive attitudes
Self-defeating attitudes are developed during childhood
Beck suggests that upsetting situations later in life can trigger further rounds of negative thinking
Handout 51: Psychological Models of Unipolar Depression: Cognitive View
Negative thinking often takes three forms

This is called the cognitive triad:
Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative
ways, leading to depression
Handout 52: Psychological Models of Unipolar Depression: Cognitive View
Negative thinking

Depressed people also make errors in their thinking, including:
Arbitrary inferences
Minimization of the positive and magnification of the negative
Overgeneralization

Depressed people experience automatic thoughts
A steady train of unpleasant thoughts that suggest inadequacy and hopelessness
Handout 55: Psychological Treatment of Unipolar Depression: Cognitive
Therapy
Beck’s cognitive therapy—the leading cognitive treatment for unipolar
depression—is designed to help clients recognize and change their negative
cognitive processes
This approach follows four phases and usually lasts fewer than 20 sessions
Phases:
1. Increase activities and elevate mood
2. Challenge automatic thoughts
3. Identify negative thinking and biases
4. Change primary attitudes
Handout 56: Psychological Treatment of Unipolar Depression: Cognitive
Therapy
Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
Over the past three decades, hundreds of studies have shown that cognitive
therapy helps unipolar depression
Around 50–60% of clients show near elimination of symptoms
This treatment has also been used in a group therapy format
Handout 58: Sociocultural Model of Unipolar Depression
How are culture and depression related?

Depression is a worldwide phenomena that varies from culture to culture, but the
experience of symptoms differs
For example, non-Westerners report more physical (rather than psychological) symptoms
As cultures become more Western, symptoms shift
Handout 59: Sociocultural Model of Unipolar Depression
How do gender and race relate to depression?

Rates of depression are much higher among women than men


One sociocultural theory holds that the complexity of women’s roles in society leaves them
particularly prone to depression
Few differences have been seen among Caucasians, African Americans, and Hispanic
Americans, but striking differences exist in specific subcultures:
In a study of one Native American village, lifetime risk was 37% among women, 19% among men,
and 28% overall
These findings are thought to be the result of economic and social pressures
Handout 61: Sociocultural Treatment of Unipolar Depression
The most effective sociocultural approaches to treating unipolar depression are
interpersonal psychotherapy and couple therapy

The techniques used in these approaches borrow from other models
Handout 64: Bipolar Disorders
People with a bipolar disorder experience both the lows of depression and the
highs of mania

Many describe their lives as emotional roller coasters
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Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
Handout 66: What Are the Symptoms of Mania?
Five main areas of functioning may be affected:

Behavioral symptoms
 Very active – move quickly; talk loudly or rapidly
 Key word: flamboyance!
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Cognitive symptoms
 Show poor judgment or planning


Especially prone to poor (or no) planning
Physical symptoms
 High energy level – often in the presence of little or no rest
Handout 75: What Causes Bipolar Disorders?
Neurotransmitters (NTs)

This apparent contradiction is addressed by the “permissive theory” about mood
disorders:
Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define
the particular for the disorder will take:
Low serotonin + low norepinephrine = depression
Low serotonin + high norepinephrine = mania
Handout 77: What Causes Bipolar Disorders?

Genetic factors

Many experts believe that people inherit a biological predisposition to develop bipolar
disorders

Findings from family pedigree studies support this theory; when one twin or sibling has bipolar
disorder, the likelihood for the other twin or sibling increases:
Identical (MZ) twins = 40% likelihood
Fraternal (DZ) twins and siblings = 5 to 10% likelihood
General population = 1% likelihood

Recently, genetic linkage studies have examined the possibility of “faulty” genes

Other researchers are using techniques from molecular biology to further examine
genetic patterns
Handout 79: Treatments for Bipolar Disorder
Lithium therapy

Discovered in 1949, lithium is a metallic element occurring as mineral salt
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Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
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It is extraordinarily effective in treating bipolar disorders and mania
Determining correct dosage is a difficult process
Too low = no effect
Too high = lithium intoxication (poisoning)
Handout 80: Treatments for Bipolar Disorder
Lithium therapy

Lithium provides improvement for 60% of manic patients

Most patients also experience fewer new episodes while on the drug

Lithium may be a prophylactic drug, one that actually prevents symptoms from
developing

Lithium also helps those with bipolar disorder overcome their depressive episodes
Handout 81: Treatments for Bipolar Disorder
Lithium therapy

Researchers do not fully understand how lithium operates
They suspect that it changes synaptic activity in neurons, but in a different way than antidepressant
drugs
While antidepressant drugs affect a neuron’s initial reception on NTs, lithium seems to affect a
neuron’s second messengers
Another theory is that lithium corrects bipolar functioning by directly changing sodium and potassium
ion activity in neurons
Handout 82: Treatments for Bipolar Disorder
Adjunctive psychotherapy

Psychotherapy alone is rarely helpful for persons with bipolar disorder

Lithium therapy is also not always effective alone
30% of patients don’t respond, may not receive the correct dose, or may relapse while taking it

As a result, clinicians often use psychotherapy to supplement lithium (or other
medication-based) therapy
Handout 83: Treatments for Bipolar Disorder
Adjunctive psychotherapy

Therapy focuses on medication management, social skills, and relationship issues

Few controlled studies have tested the effectiveness of psychotherapy as an adjunct to
drug therapy for severe bipolar disorders
Growing research suggests that it helps reduce hospitalization, improves social functioning, and
increases clients’ ability to obtain and hold a job