Major Depressive Disorder

People who suffer from major depressive disorder have a constant sense of hopelessness and despair and it can be difficult for them to work, study, sleep, eat, and enjoy friends and activities.
Symptoms of major depressive disorder might include:

• Fatigue or loss of energy almost every day.
• Feelings of worthlessness or guilt almost every day.
• Impaired concentration, indecisiveness.
• Insomnia or hypersomnia (excessive sleeping) almost every day.
• Markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia, this symptom can be indicated by reports from significant others).
• Restlessness or feeling slowed down.
• Recurring thoughts of death or suicide.
• Significant weight loss or gain (a change of more than 5% of body weight in a month).

According to DSM-IV you have to suffer from at least 5 of the symptoms listed above for at least a two-week period.
Risk-factors

• Being a woman (they think more about things than men)
• Having biological relatives with major depressive disorder
• Having a traumatic experience
• Having few friends
• Recently having given birth (postpartum depression)
• Having certain personality traits, such as having low self-esteem and being overly dependent, self-critical or pessimistic

Causes

Biological Factors: Major depressive disorder tends to run in the families, so if someone if your family has it, it is more likely that you will have it, too. Hormones also play a huge role because they make our moods more unstable so there is a bigger chance to suffer from the depression.

Cognitive Factors: How a person interprets life events can be a major factor in the tendency to become depressed. Overly negative views of the self (low self esteem), and pessimism about the future can play an important role. The combination of anger and feelings of helplessness are often found at the root of depressive episodes. Hopelessness and lack of control may also contribute.

Environmental Factors: Social difficulties, such as death, divorce, financial problems, and other stressful life events can trigger depression. Compounding stressful events can make depression even more likely.

Treatments

 There are many ways to treat major depressive disorder, and research has shown the most effective treatments are cognitive, interpersonal, or behavioral therapy, as well as antidepressant medication. Cognitive therapy focuses on recognizing, challenging, and overcoming how one thinks of a situation. It helps the person to think about the situation differently. Interpersonal therapy focuses on helping relationships. Behavioral therapy focuses on changing behaviors, such as exercise to help the patient. Antidepressant medication is medication that changes brain chemistry, and is often used with other forms of therapy. Usually multiple forms of treatment are used at the same time. Faith-based and self-help strategies can be helpful for people who are highly motivated. Electroconvulsive therapy (ECT), also called "Shock Treatment," is a remedy of last resort for those with severe depression.

Specific Phobia

Specific Phobia

A specific phobia is an intense and irrational fear of a specified object or situation. There are four defined categories of specific phobias: natural, medical, animal and situational. Many people suffer multiple specific phobias simultaneously.

DSM - IV (Diagnostic and Statistical Manual, 4th Ed.) provides diagnostic criteria for specific phobia:

Marked, Excessive Fear: A persistent and intense fear that is triggered by a specific object or situation.
Immediate Anxiety Response: The fear reaction appears almost instantaneously when the object or situation is presented. The response may resemble a panic attack.

Recognition That Fear Is Irrational: Adults with specific phobias recognize that their fears are out of proportion to reality. Children may not have this awareness.

Avoidance or Extreme Distress: The sufferer goes out of his or her way to avoid the object or situation, or endures it with extreme distress.
Life-Limiting: The phobia significantly impacts the sufferer’s school, work or personal life.
Six Months Duration: In children and teens, the symptoms must have lasted for at least six months.
Not Caused by Another Disorder: Many anxiety disorders have similar symptoms. The therapist will rule out other disorders before diagnosing a specific phobia.\

Risk factors:
Your age. Social phobia usually develops early in life, often before age 25. Specific phobias having to do with the environment or personal injury also first appear in childhood — as early as age 5. Fear of tunnels, elevators, bridges, flying, driving and other situational phobias usually develop by the mid-20s.
Your sex. Phobias affect both sexes, but women and girls are more likely to have specific or social phobias than are men and boys. Women are also more likely to be diagnosed with agoraphobia, but this may be because men tend to hide anxiety or mask it with alcohol. Men and boys may be less likely to seek help for emotional problems than women and girls.
Your family. If someone in your immediate family has a specific phobia, such as a fear of spiders or snakes, you're more likely to develop it also.
A traumatic event. Experiencing a traumatic event, such as being trapped in an elevator or attacked by an animal, may trigger the development of a phobia.

Causes:

Biological factors: Specific phobia tends to run in the family so if somebody in your family suffered from this disorder, you are more likely to suffer from it, too. The research shows that first-degree relatives of individuals with specific phobia, animal type are more likely to have an animal phobia themselves, but they may not necessary fear the same animal. First-degree relatives of individuals with specific phobia, situational type, are likely to develop situational phobias.

Cognitive factors: People who suffer from specific phobia are usually the ones that pay attention to things more than other people do. For example, individuals with a spider phobia tend to notice the presence of a spider in a room before anybody else. Also, it is common for individuals with specific phobia to have distortions regarding memories that involve the phobic stimulus. They recall the phobic situation as more dangerous than it really was, or the feared animal larger, faster, or more aggressive than it was in reality. The memory distortions can be supported by impaired beliefs and interpretations attributed to feared objects or situations. The anxiety response experienced during a phobic situation can be maintained or increased by these impaired beliefs and interpretations.

Environmental factors: Specific phobia can be developed as a result of traumatic experience. This means that the individual was either directly exposed to the traumatic event, witnessed the traumatic event, or he only heard or read about the traumatic event. The first case of being directly exposed to the traumatic event means that the person develops the specific phobia as the result of being directly exposed to the traumatic event. For example, a person that gets stung by a bee develops a bee phobia. The second case of witnessing the traumatic event can be for example when a person witnesses somebody falling from a high building, he might develop a phobia of heights. The third case is that the individual has only heard or read about some kind of a traumatic event. For example if a person hears a lot about the plane crashes, he might develop a phobia of flying. However, experiencing a traumatic experience does not always result in the development of a specific phobia, and some individuals with specific phobia do not recall any obvious trigger, cause, or source of their phobia.

Treatments:

Specific phobia is the only anxiety disorder that is effectively treated with psychological approaches rather than medication. The most effective forms of psychotherapy are: cognitive behavioral therapy and behavioral therapy. Cognitive behavioral therapy combines two components (cognitive and behavioral component) for a better outcome. The cognitive component targets the individuals dysfunctional thinking patterns that supports and maintains the anxiety response, replacing them with more adaptive and realistic cognitions. The most effective technique is cognitive restructuring which challenges the irrational beliefs. This method is based on the theory that the unrealistic beliefs built when exposed to fear stimuli generate, maintain, and increase dysfunctional emotions and behaviors. The behavioral component targets the individual's reaction to the phobic stimulus. The most effective behavioral approach is exposure therapy where in a safe setting the individual gradually gets exposed to their feared stimulus, first using the imagination and then by direct confrontation. Behavioral therapy is another effective form of therapy that can treat specific phobia. The goal of behavioral therapy is to modify the fear-related behaviors and gain control over the dysfunctional behaviors. Two of the most effective behavioral techniques used to treat specific phobia are: learning a relaxation technique which allows the individual to control the anxiety, and exposure technique which gradually exposed the individual to feared stimuli. Medication, can be another treatment approach for individuals with specific phobia. However, medication has a limited utility in the treatment of specific phobia. In some cases, antidepressants (such as selective serotonin reuptake inhibitors - SSRIs) and tranquilizers (to reduce the anxiety) can be prescribed for individuals with specific phobia. Medication seems to be more effective when the individual with specific phobia has another coexistent anxiety disorder.

Cognitive Triad Theory and Cognitive Behavioral Therapy

Aaron Beck is an American psychiatrist pioneered research on psychotherapy, psychopathology, suicide, and psychometrics, and developed the cognitive therapy. He became interested in psychiatry during an internship at the Rhode Island hospital, where he studied neurology as a specialty. He is considered to be the father of Cognitive Behavioral Therapy. According to Beck,"If beliefs do not change, there is no improvement. If beliefs change, symptoms change. Beliefs function as little operational units," which means that one's thoughts and beliefs affect one's behavior and subsequent actions. He believed that dysfunctional behavior is caused due to dysfunctional thinking, and that thinking is shaped by our beliefs. Our beliefs decide the course of our actions. Beck was convinced of positive results if patients could be persuaded to think constructively and forsake negative thinking.

Cognitive Triad Theory

Behavioral theorists suggest that depression results from faulty and irrational psychological perception, causing distorted learning and reasoning. These depressive cognition could be a result of traumatic experience or incapability of adaptive coping skills. Depressive people have a negative perception or belief about themselves and their environment. More the severity of one's negative thoughts, more is the severity of depression symptoms.

People who suffer from depression have a negative view of:

‘I am a bad person’

2. Experiences and Environment

‘My life is terrible’

3. The Future

‘Things will not improve’

Beck’s theory suggests that many of the secondary symptoms of depression can be understood in terms of this core of negative beliefs. For example, a lack of motivation could be the result of a combination of pessimism and helplessness. A person might lose interest in things they used to enjoy if they do not have the expectation that they will feel better by doing them.

Cognitive Behavioral Therapy as a treatment for depression
Beck developed Cognitive Behavioral Therapy which was meant to treat a variety of psychological, psychiatric and medical disorders such as uncontrolable anger, personality diorders, obesity, but mainly depression. At the heart of CBT is an assumption that a person's mood is directly related to his or her patterns of thought. Negative, dysfunctional thinking affects a person's mood, sense of self, behavior, and even physical state. The goal of cognitive behavioral therapy is to help a person learn to recognize negative patterns of thought, evaluate their validity, and replace them with healthier ways of thinking. Aaron Beck laid major emphasis on understanding and changing core beliefs as an approach to treating depression. By restructuring destructive thinking, he believed that positive changes could be brought in the patient. He considered the role of a therapist as crucial in the treatment. The therapist involves the patient in setting realistic goals and taking responsibilities for action and thought. By changing thought and perception, a change can be brought in behavior and emotional responses. A course is outlined to educate the patient on the concept of faulty thinking. New ideas and ways are generated to develop a positive outlook of oneself, experiences and the environment around. Sometimes, home assignments are also given to help the depressed person review and understand the impact of faulty thinking on his behavior and emotional well-being.

1. The Self