Practise depressive and bipolar diagnosis, BDI measurement, biological and cognitive explanations and antidepressant or REBT treatment through applied evidence.
Dr Begum is a clinician who sees a patient, Joan. Joan describes how she spends her day feeling miserable and not knowing what to do with her time. She thinks it is her own fault because she cannot decide if she wants to go out, so she stays in. Joan wants to sleep but this is also difficult.
Suggest how Dr Begum could use the Beck depression inventory (BDI) with Joan.
Suggest how Dr Begum could use the Beck depression inventory (BDI) with Joan.
Award 3-4 marks for a detailed answer with clear understanding of using BDI with Joan.
Award 1-2 marks for a basic answer with some understanding of using BDI with Joan.
Beck Depression Inventory
21-item multiple choice questionnaire. It is a psychometric self report that measures the severity of depression. The patient reads various statements and answers with how much the statement applies to them on a 0-3 / 4 point scale over the past two weeks. The statements cover issues such as self-dislike, tiredness, etc. The higher the score, the more depressed the person is deemed to be.
e.g.
- (0) I do not feel sad.
- (1) I feel sad.
- (2) I am sad all the time and I can't snap out of it.
- (3) I am so sad or unhappy that I can't stand it.
1-10: These ups and downs are considered normal
11-16: Mild mood disturbance
17-20: Borderline clinical depression
21-30: Moderate depression
31-40: Severe depression over-40: Extreme depression
4
Cap at 2 marks outlining the features of the BDI with no link to Joan or how it can be used with her.
Cap at 3 marks if no reference is made to Joan specifically (e.g. one of her symptoms) but the response refers to how Dr Begum can use the BDI with Joan (e.g. diagnosis).
Used to diagnose Joan with depression = 1 mark
3(a)
Version 2-got rid of the statements that had the same scoring.
Version 3 - changed questions on body image, hypochondria and difficulty working and added in questions on sleep loss and appetite.
For example:
Dr Begum could use the Beck Depression Inventory with Joan where she would read 21 statements ( 1 ) and answers on a 0-3 scale over the past week. (1) Joan will likely give high scores to the statements about sadness, sleep, losing interest in other people (1). She might also score highly on feeling she is worse than other people and feeling like a failure as she thinks it is her fault. (1) A score over 21 would indicate a diagnosis of depression as this is moderate depression. (1) OR a score over 17 might be considered for a diagnosis of depression as this is borderline clinical depression. (1)
Other appropriate responses should also be credited.
Explain one reason why the Beck depression inventory (BDI) is valid.
Explain one reason why the Beck depression inventory (BDI) is valid.
Award 2 marks for an explanation of why BDI is valid.
Award 1 mark for a basic explanation of why BDI is valid.
Likely answers from:
- There are 21 items, so the measure is valid as measuring a wide variety of symptoms of mood (affective) disorder. Includes both cognitive and physical symptoms (e.g. sadness, sleep).
- There is a choice of 4 items per statement rather than yes/no responses. Gives respondent opportunity to express how they feel in more depth.
- Good validity as covers the symptoms for depression that are in the ICD-11 such as depressed mood and loss of interest in activities.
- Good concurrent validity with Hamilton Psychiatric Scale (another measure of depression). The BDI has a positive correlation with the HAMD.
Example:
The Beck Depression Inventory is a valid way to measure depression as it includes 21 items so measures a wide variety of symptoms. (1) These symptoms include both cognitive and physical symptoms so patients with different types of symptoms (e.g. mainly cognitive) could receive a diagnosis of depression. (1)
Other appropriate responses should also be credited.
2
Allow reference to either ICD-11 or DSM V.
Objective data can be credited where the response explains that the clinician isn't interpreting the response of the patient.
No credit to identifying that the data is objective or quantitative on its own.
No credit to reliability.
Explain one strength of applying the determinism side of the determinism versus free-will debate to the biochemical explanation for depressive disorder (unipolar).
Award 2 marks for a detailed explanation of strength in context. Award 1 mark for a basic outline of strength.
Strengths might include:
- Explanatory power- deterministic explanations align with viewing psychology as a science which explains the causes of behaviour.
- Increases the status of psychology - deterministic explanations establish psychology as a science that offers unbiased and objective explanations for behaviour.
- Application to everyday life - if the cause of behaviour (e.g. low levels of serotonin in the case of depression) then a solution can be found (e.g. SSRIs).
- Establishes cause and effect relationships.
- Enables causes to be tested in a laboratory experiment with good control.
- Takes the blame for behaviour away from the person. The patient with depressive disorder will not feel blamed for their depression as the cause of it is due to internal biochemical factors.
Example:
One strength is application to everyday life, as a deterministic explanation identifies the cause of behaviour (e.g. low levels of serotonin for depressive disorder) which can then be treated. (1) For example, depressive disorder can be treated using SSRIs which increase serotonin levels through blocking re-uptake of serotonin into neurons. (1)
Other appropriate responses should also be credited.
2
Context = biological explanation of depressive disorder (unipolar)
No credit for explanation of why biochemical explanation is deterministic.
No credit for just identifying the strength.
3
Olivia has a bipolar disorder and is receiving cognitive restructuring as therapy. In her first session she said:
'My life used to be 100% perfect! I had an amazing job and friends. I stayed up one night to research an expensive holiday.
Recently everything has changed. I am not working and have no energy. No one likes me, not even my family, as I am not fun to be with. I have cancelled the holiday. Why does this keep happening to me? I feel amazing for a while and then it all
changes and I am depressed again.'
Olivia has a bipolar disorder and is receiving cognitive restructuring as therapy. In her first session she said:
'My life used to be 100% perfect! I had an amazing job and friends. I stayed up one night to research an expensive holiday. Recently everything has changed. I am not working and have no energy. No one likes me, not even my family, as I am not fun to be with. I have cancelled the holiday. Why does this keep happening to me? I feel amazing for a while and then it all changes and I am depressed again.'
Suggest how cognitive restructuring can help Olivia with both her depressive and manic episodes.
Award 3-4 marks for a detailed suggestion with clear understanding of cognitive restructuring linked to helping Olivia with both her depression and manic episodes.
Maximum 3 marks for detailed suggestion with clear understanding of cognitive restructuring linked to helping Olivia with either her depression or her manic episodes.
Award 1-2 marks for a basic suggestion with some understanding of cognitive restructuring linked to helping Olivia with both her depression and manic episodes.
4
Can credit reference to type I or II bipolar.
If candidate discusses either depression or manic and not both can get 3 out of 4 marks.
No direct link to Olivia's specific symptoms 2 marks.
3(a)
Cognitive restructuring involves -
Talking therapy where the therapist asks questions and identifies the patient's irrational/illogical thinking patterns. Initially the therapist explains how the cognitive triad (self, others and future) works and the effect this has on behaviour and mood. The patient is set homework to identify their mood, thoughts and behaviour and this is discussed in subsequent sessions with the therapist. The therapist will discuss with the patient more rational and logical thoughts and help the patient to recognise the irrational thinking outside of the therapy sessions ('reality testing'). At the end of therapy, the patient will have the ability to challenge their irrational thoughts, engage in positive behaviour and increase mood. The manic episodes for someone with bipolar disorder are characterised by an overly positive view of self, world and future.
Example:
Olivia's therapist can use Olivia's description of her life to explain the cognitive triad is made up of thoughts about yourself, the world/others and the future. (1) The therapist can challenge both the manic and the depression illogical thinking and help Olivia to replace these thoughts with more rational statements about herself, the world and her future. (1) For example, no one's life is 100% perfect - a more rational view is that life can be good but doesn't need to be perfect - this will help Olivia to see herself in a more logical way and help her mania reduce. (1) For the depression, the therapist could challenge that it is unlikely that no one likes her and that she is never any fun to be around with a more realistic view that Olivia is liked by people in her life which will increase her mood. (1)
Other appropriate responses should also be credited.
Explain one strength of using cognitive restructuring therapy with Olivia.
Award 2 marks for an explanation of a strength of cognitive
restructure for Olivia.
Award 1 mark for a basic explanation of a strength of cognitive
One strength from:
- There are no side effects, unlike medication (e.g. Lithium -
mood stabiliser - feeling tired, weight gain, dry mouth,
excessive thirst, etc.)
- Effective therapy - e.g. Dobson found those who had
cognitive restructuring as opposed to drug therapy did
significantly better ( 90% versus 70% improvement in
depression symptoms).
- Long term effectiveness - teaches the patient how to
recognise automatic overly positive or overly negative
thinking and how to challenge these thoughts. The patients
can do this on their own when therapy is over.
- Cognitive therapy is shorter term and therefore cost
effective (6-12 sessions) compared to other types of
therapy (e.g. psychotherapy).
Example:
One strength of cognitive restructuring for Olivia is that it has
long-term effectiveness as Olivia will learn how to recognise her
automatic overly positive and negative thoughts. (1) Once
therapy has finished if Olivia goes back into a manic episode,
she can replace the overly positive thoughts (e.g. 'my life is
perfect') with more rational thinking (e.g. 'my life is really good,
not perfect. No one's life is perfect'). (1)
Other appropriate responses should also be credited.
2
No credit to 'will improve her mania and depression' on its own.
0 marks to long term benefits/improvements on its own. No credit to just identifying a strength.
Allow full credit for reference to research that shows effectiveness for bi-polar or depression.