Severe Depression

Running head: SEVERE DEPRESSION 1

Severe Depression

April Benson

Ashford University

ABS 200 Introduction to Applied Behavioral Sciences

Anthony Hairapetian

April 20, 2015

Running Head: SEVERE DEPRESSION2


Severe Depression

Applied behavioral science is the study of behavior of

individuals or groups of persons through all areas of psychology

and applying learning theories and a combination of research and

development to determine the diagnosis and treatment. In clinical

psychology, one major area of focus is severe depression, as seen

in case study number one. In this case, Joe is suffering with

severe depression. Severe depression can be caused by genetic

traits or environmental influences including “a divorce, a death

in the family, [or] the loss of one's job” (Keen, 2002). This

paper will focus on the symptoms and treatments for severe

depression, including key trends and psychotherapies and their

advantages and disadvantages, how to establish a good rapport and

the benefits of going forward with a plan of action.

There are many things that can contribute to severe

depression.“Depression involves emotional, motivational,


behavioural and cognitive symptoms” (Davey, 2011, p. 99). In

Joe's case, there are both biological and environmental factors

that contribute to his state of severe depression. First of all,

Joe's grandmother, father and two uncles suffered with severe

depression. One of his uncles even committed suicide as a result.

This tells me genetics play a key role and is, perhaps, the

foundation from which his depression originated. As Davey (2011,

p. 99) points out, “there is good evidence that depressive

symptoms runs in families, and this suggests the possible

existence of an inherited or genetic component to depression.”

Moreso, is the evidence found in twin studies. This can be better

understood through the words of Davey. In 2011 (p. 99), he stated

that “twin studies of major depression have indicated concordance

rates of 46% and 20% respectively for MZ and DZ twins” (McGuffin

et al., 1996). Also, there are neurochemical components linked to

depression. There are certain chemicals in the brain that impact

thought and emotional processes, causing a change in mood. Davey

(2011, p. 99) informs us that “depression and mood disorders have

been shown to be reliably associated with abnormalities in the


levels of certain brain neurotransmitters, and two

neurotransmitters are particularly significant – serotonin and

norepinephrine” (Delgado & Moreno, 2000). In cases of severe

depression, both levels are generally low.

The environmental factors that play a key role in Joe's case

are his current life-altering situations. “A divorce, a death in

the family, the loss of one's job are types of insults from the

world that create crisis” (Keen, 2002). Now, Joe lost his job and

started showing signs of depression. He was unable to support his

family and is going through a divorce. In addition, his wife took

the house and the kids. Joe is at a high risk of having severe

depression and is exhibiting signs of “loneliness, lack of social

support, recent stressful life experiences, family history of

depression, marital/relationship problems [and] financial strain”

(Smith, Saisan, & Segal, 2015). Joe will need to find ways to

cope and seek help. “How much stress or depression people

experience in threatening difficult situations depends largely on

how well they think they can cope” (Bandura, 1977). The evidence-


based research found in psychotherapies is ever expanding and

will be a good place for Joe to start.

There are many forms of psychotherapies and new trends

constantly developing through evidence-based research in order to

properly treat severe depression. Davey (2011, p. 41), points out

that “arguably the most disabling symptoms of depression are its

cognitive features.” Depression can effect your mood and behavior

for a few months or over a long period of time. “Many

psychological treatments are effective for treating mental health

problems, but also demonstrate longevity” (Dozois, 2013).

Cognitive-behavioral therapy is the most common form of treatment

for depression, many times while also taking anti-depressants.

“Cognitive-behavioral therapy (CBT) refers to a class of

interventions that share the basic premise that mental disorders

and psychological distress are maintained by cognitive factors”

(Hofmann, Asnaani, Vonk, Sawyer & Fang, 2012). In Joe's case, it

would be advised he undergo CBT along with compatible anti-

depressants. Wellbutrin, Prozac and Lithium are very common for


treating depression. Now, “an entirely new vocabulary of the

accoutrements of depression has appeared - tricyclic

antidepressant medication [and] selective serotonin reuptake

inhibitors” (Keen, 2002). His clinical psychologist will be the

one to determine the drug best suited for Joe. Then, Joe's

behavior will need to be monitored over the course of treatments

in order to detect signs of progress or resistance. Therefore, if

treatment resistance is evident, Joe may need to seek other forms

of treatment better suited for his stage of severe depression.

Electroconvulsive, or electroshock, therapies have been used for

centuries to treat major depression and bipolar disorder. In

addition to electroshock therapies (ECT), researchers found a new

trend with ketamine treatment. They have found “that one-third of

people who had been unaffected by the standard therapeutic

interventions quickly and effectively experienced significant

mood improvement after being treated with ketamine infusions over

a period of several weeks” (Hareyan, 2014).


While anti-depressants and CBT are the most common and widely

used forms of treatment for depression, there are advantages and

disadvantages found within both forms of treatment. The use of

drugs to treat depression has become more excessive and readily

available. The advantages of drug therapy is “liberation from

enormously difficult psychological strains, as well as from less

difficult, but still painful and inconvenient, moods and

anxieties” (Keen, 2002). It is true that “drugs make depression

and anxiety disappear more efficiently with every generation of

pharmaceutical refinement. But depression and anxiety are about

something in life that needs attention” (Keen, 2002). temporary

relief is great for those who are suffering, however “what could

curb, if not reverse, the tendency of human being to augment

their capability for happiness chemically” (Keen, 2002)? With

psychotherapies, such as CBT, patients find a way to understand

and deal with emotions and behaviors in a more positive way. At

times, the learned responses can help to heal depression every

time it occurs. The cognitive and behavioral psychotherapies have

“gained a great deal of prominence in recent years [and] have


shown that CBT is effective in addressing a wide range of

difficulties” (Davey, 2011, p. 423). They are designed to help us

to control how we think and behave and learn to change our

negative responses in order to overcome the depression. “However,

this process is time-consuming and personally demanding on the

part of both patient and therapist” (Keen, 2002). Also, CBT does

not always work for everyone. Some patients may require more

face-to-face therapy or group therapies to get down to the

underlying cause of the depression order to prevent a relapse.

Compared to drug therapy, “the average risk of relapse following

antidepressant medication is more than double the rate following

CBT” (Dozois, 2013). Each individual is different in how they

respond to stressful, life-altering experiences. If you or

someone you know is suffering with severe depression, the first

thing to do is seek help and set a plan of action.

Initially, seeking treatment may be hard for someone with

depression. To admit help is needed can be embarrassing and may

take encouragement from friends and family. In order to get the


proper help, seeking guidance from a clinical psychologist may be

necessary. Depression often causes one to hold in their thoughts

and feelings. So, by establishing a relationship and building an

honest rapport, both the client and patient are able to feel more

comfortable.

and Moreno (2000) state “depression and mood disorde

evere depression includes symptoms such as loss of appetite, lack

of energy or desire to engage in daily activities, feelings of

loneliness, hopelessness and helplessness. Severe depression can

be triggered by *****The trends in treatment include

interventions and psychotherapies using anti-depressants and/or

cognitive behavior therapy.


There are instances in life that impact each of us

individually, in different ways. They can impact ones mental and

physical health, social and cognitive well-being. ****** There

are many factors that can trigger severe depression ****** death

of a loved one, loss of a job, divorce. Also, being a child of

divorce can cause long-term effects on one's mental state. More

often than not it is triggered by a psychosocial stressor that

creates crisis. In Joe's case, there are a couple of underlying

sources that are causing his depression.

A. Genetic

1. Evidence-based research

There have been many proven theories that support the

fact that depression is a genetic trait. There are


certain chemicals in the brain that impact thought and

emotional processes, causing a change in mood.

B. Environmental

Also, there are several life-changing events occurring

simultaneously in Joe's life that have a direct impact on

his emotional state. He was laid off from work, and he

became disabling when his wife divorced him taking their

kids and their home. Undoubtedly, these changes in Joe's

environment prompted a state of depression.

1. Evidence-based research

Depression is diagnosed separately from sadness in that

it takes over your every day activities, daily

functions and habits, leaving you in a total state of despair.

III. Clinical Psychology: Psychotherapy.


Psychotherapy involves continuous face-to-face sessions with a

counselor with whom you have established a trusting and 'safe'

relationship with. It aims to treat not only emotional and

behavioral disorders but also personality and psychiatric

disorders.

A. Cognitive Behavior Therapy (CBT)

An approach using cognitive and/or behavioral principles to

establish the client's way of thinking by recognizing style

of reasoning and then rearrange those thoughts to produce

more positive, effective ones.

1. Pros/Cons

While this is the the most popular approach used to

treat depression, it is not always the first form used.


B. Psychopharmacological.

The use of pharmaceuticals has become increasingly popular

amongst psychologists. More often than not, it is sometimes

the first type of treatment suggested for a client.

1. Pros/Cons

There are several types of medications recommended by

psychologists, psychiatrists and doctors. They

include antidepressants such as Wellbutrin and Prozac, to

name a few.

C. Electroconvulsive therapy (ECT)

When the client is unresponsive or treatment-resistant,

there are other forms of treatment such as electroconvulsive

therapy. This can involve vagus nerve stimulation (VNS) or

transcranial magnetic stimulation (TMS).


1. Pros/Cons

While used mainly on those suffering with severe

depression, there are advantages and disadvantages to

electroconvulsive therapy.

Other forms of therapy that are less common include, but are not

limited to, the following: self-help books, hypnosis,

electroshock therapy, interventions, play therapy and stress-

reduction therapy.

IV. Relevant trends.

While face-to-face therapy and psychotherapy treatments are still

used to treat those with depression, several growing trends are

becoming more and more popular. The time constraint entailed and,

possibly, the cost has a lot to do with the decrease in these

types of therapy.


A. Drug Treatment

Not surprisingly, the increase in the use of drugs to

alleviate symptoms of depression has become widespread. The

reason being the results are immediate.

B. Ketamine Treatment

Though ketamine infusions seem to have a positive result

amongst patients, the relief is only temporary.

V. Plan of action.

Whether reading self-help books, seeking therapy and treatment,

or under the influence of anti-depressants, it is always a good

idea to create a plan of action.


A. Ideas for a plan of action

A concrete plan that helps guide the client to a course of

action relevant to their continuous progress.

B. A specific plan of action for Joe

It is my opinion that Joe develop a plan to help him not

only deal with the underlying issue of depression from

a genetic standpoint, but also to induce positive strategies to

help him cope with current issues in his environment.

While there are many kinds of therapies, treatments and coping

strategies to undergo in order to deal with and, perhaps,

eliminate severe depression, there are advantages and

disadvantages to each. It depends on the individual and as such,

should be dealt with on a personal level in order to find the

proper treatment.


VI. Building a rapport.

It is important for a clinical psychiatrist to build a

relationship with the client/patient in order to gain their trust

and allow them to feel more comfortable. Depression often causes

one to hold in their thoughts and feelings. Whether they are

ashamed to say what they feel or just don't want to open up, the

existence of an emotional connection between the two is relevant

in achieving progress.

A. Steps to building a trusting relationship

1. Good rapport

2. Quick discovery and understanding

3. Realization

4. Psychodynamic inquiry


VII. Ethical considerations.

There are certain ethical obligations that must be complied with

when conducting research.

A. Competence

Psychologists must practice within their field of expertise

and knowledge and have the ability to perform their duties

that are in their skill set.

B. Informed Consent

In order to insure there is no harm brought upon the client,

an informed consent must be presented to the client in order

to authorize further research and/or treatment.


Annotated Bibliography

1. Davey, G. (2011). Applied Psychology. (G. Davey, Ed.) Southern

Gate, West Sussex, UK: British Psychological Society and

Blackwell Publishing Ltd.

This is, by far, my favorite reference because it is our

textbook and is filled with information and examples in all

aspects of psychology. The many chapters covered and quotes


mentioned above help to better understand mood disorders, like

depression, and give educated, scholarly insights on the

treatments entailed.

2. Bandura, A. (1997) Insights. Self-efficacy. Harvard Mental

Health Letter, 13(9), p. 4-7. Retrieved from the EBSCOhost

database.

This article on self-efficacy really speaks to how one can

control their mood. It gives a deeper understanding of how

one is affected when undergoing a lot of stress, dealing

with emotional problems, and perhaps severe depression.

3. Dozois, D. A. (2013). Psychological treatments: Putting

evidence into practice and practice into evidence. Canadian

Psychology/Psychologie Canadienne, 54(1), 1-11.

doi:10.1037/a0031125. Retrieved from the EBSCOhost database.

http://vizedhtmlcontent.next.ecollege.com/pub/content/c0a959fe-bdd7-4947-94a6-c435882db973/Dozois_Psychological_treatments.pdf

http://vizedhtmlcontent.next.ecollege.com/pub/content/c0a959fe-bdd7-4947-94a6-c435882db973/Dozois_Psychological_treatments.pdf


This article explains a lot of evidence-based practice

theories. It included insight into CBT and depression.

4.. Keen, E. (2002). Depression : Self-Consciousness, Pretending, and Guilt.

Westport, CT, USA. Greenwood Press. Retrieved from

http://www.ebrary.com

Ernest Keen, in this narrative, provides great insight into

depression and the self-consciousness. He recalls his own

personal struggles and feeds off of clients' he has helped

to cope throughout the years. He compares the newfound

therapies and pharmaceutical treatments to that of building

a new society and paving new highways, for instance. How we

cope and deal with depression in the new century has

drastically changed. Is it for the better?

5. Tjeltveit, Alan C., (1999). Ethics and Values in Psychotherapy.

Florence, KY, USA. Routledge. Retrieved from

http://site.ebrary.com/lib/alltitles/docDetail.action?

docID=10097425&p00=ethics%20clinical%20psychology.

http://site.ebrary.com/lib/alltitles/docDetail.action?docID=10097425&p00=ethics%20clinical%20psychology

http://site.ebrary.com/lib/alltitles/docDetail.action?docID=10097425&p00=ethics%20clinical%20psychology

http://www.ebrary.com/


Alan Tjeltveit makes it easier to comprehend the expectations of

values and ethics from the clinical psychology perspective.

6.

Severe Depression

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Transcript of Severe Depression