Book overview
More than forty years ago, Dr. Aaron T. Beck's pioneering Depression: Causes and Treatment presented the first comprehensive account of all aspects of depression and introduced cognitive therapy to health care providers and patients struggling with one of the most common and devastating diseases of the modern age. Since that classic text first appeared, the appreciation of the multifaceted nature of mood disorders has grown, and the phenomenological and biological aspects of psychology are increasingly seen as intertwined. Taking these developments into account, Beck and his colleague Brad A. Alford have written a second edition of Depression that will help patients and caregivers understand depression as a cognitive disorder. |
p. 210 speaks of psychoanalysis, etc. and "integrative" theory underpinning....
behavioural : Ferster, Seligman, Lewinsohn
p. 214 - cognitive and evolutionary theories
217 - aggression, orality
218 - psychodynamic and psychological
220 -exacting obligations so that they are unable to carry out their own
220 - Schulte - inability to be sad at the heart o fhte melancholic experience - lost ability to sympathize and be moved
220 - neurological - kraines
220 - neuropsycholgical - shenal et al
221 - biochemical
(missed some because so many of them weren't in the preview)
p.
p. 224 - chapt. 12 - cognition and psychopathology
hist. most writers on psychological aspects used a motivational or adaptaional model. some authors view symptomatology in terms of the gratification or discharge of certain needs or drives (ftnt 1,2 others emphasized role of defenses against these drives (3) others adapative aspects of symptomatology (2, 4).
Many early attempts had introduced "troublesome conceptual or empirical problems". First, many writers HAD A TENDENCY TO ASCRIBE SOME PURPOSE TO THE SYMPTOMS. RATHER THAN LOOKING UPON THE SYMPTOMS SIMPLY AS A MANIFESTATION OF THE PSCYHOLOGICAL OR PHYSIOLOGICAL DISORDER, THEY VIEWED THE SYMPTOMS AS SERVING AN IMPORTANT INTRAPSYCHIC OR INTERPERSONAL FUNCTION. THE SADNESS OF THE depressed person, for example, was explained by some writers (e.g. Rad oand Adler) as an attempt to manipulate other people. Although SUCH FUNCTIONALIST INTERPRETATIONS SOMETIMES SEEMED TO FIT A PARTICULAR CASE, THEY HAD STRONG TELEOLOGICAL OVERTONES. AS THE HISTORY OF SCIENCE DEMONSTRATES, THEORIEST HTAT ASCRIBE SOME DESIGN OR PURPOSE TO NATURAL PHENOMENA HAVE GENERALLY BEEN SUPERSEDED AS BASIC KNOWLEDGE INCREASED (very interesting account - history makes disappear).
SECOND - in attempting to accoun for paradoxical aspects of despresion - some presented formulations that are so elaborate or abstract that the y canot be correlated with clinical material. Freud's conceptualizatin of depression in terms of the attack fo the sadistic part of the ego on the incorporated loved-object within the ego is so remote from any observables in clinical data that it defies systematic validation (similarly M. Klein's formulation of adult depression as a reactivation of early infantile depression)
THIRD most writers skirted the problem fo the specificity of their formulations. Many of the most poplr psychodnynamic formulations of depression (eg. increased orality or repressed hostility have also been attribute dto a multiplicity of other psychiatric and psychosomatic disorders).
Finally the various theories offered, at best, explanations for only circumscribed aspects of the diversified clinical picture of depression (explanations that seem to fit certain groups of pheomena often seem irrelevant or incongruous when applied ot other phenomena).
225
wide variety of psychopathological pehnemona. Certain clusters of symptoms of depression: "affective (adjectives and prhases employed by patients "sad, lonely, empty, bored, hopeless." Motivational: "intensified wishes for help, yearning to escape, desire to commit suicide, phenomenon of loss of spontaneous motivation (paralysis of the will) (INTERESTING - acedia - but also using "will" as a term). The COGNITIVE group includes "negative self-concept, pessismism, and negative interpretaitons of experience. PHYSICAL and VEGETATIVE symptoms include retardation, fatigability, loss of appetite, loss of libido, sleep disturbance.
These groupings of symptoms may not seem to bear much relationship to each other. Many previous writers have attempted to present a unifying theory that would establish understandable connections among these groupings - (Frued, e.g. but falls short e.g.)
In an attempt to find some altenrative explnataitons for the behavioral characteristic sof depression, Beck reviewed hte clinical mateiral of 50 depressed patinets in psychotherapy and selected those themes that differentiated these patients from a control psychotherapy group (ch. 10).
PRIMARY TRIAD (miss the important pages - 226-227)
228 - SENSE OF LOSS (any expenditure of money - sense of deprivation.
"MAKING COMPARISONS WITH OTHER PEOPLE IS ESPECIALLY LIKELY TO ACTIVATE FEELINGS OF DEPRIVATION - ENVY... hmmm....
DEPRECATION - prone to read insults, ridicule, or disparagement into what other ppl say - interpret neutral remarks as directed against them - may even twist favorable comment so it seems unfavorbale.
Negative self-conccept
(equate with superficial phys. characteristics"
"inexcusability" of "letting themselves" become ill.
NEGATIVE EXPECTATIONS - ANXIETY - interesting.....
AFFECTIVE RESPONSE - p. 231
p. 232 - 1602 Felix Platter described melancholia as a "kind of mental alienation, in which imaginaiton and judgment are so perverted that iwthout any cause the victims become very sad and fearful - ftnt 9 - emphasiezd rests on "ofundation of false conceptions" pftnt 10 - who is this guy?
COGNITIVE PRIMACY - p. 232 - 50's and early 60's (ftnts 11-14) Ellis - primacy of irrational thinking
234 - Changes in Motivation - Four groupings "paralysis of the will" escapist and avoidance wishes; suicidal wishes; intensified dependency wishes.
235 patients express senselessness - of moving on
236 - PHYSical Symptoms - explanation of phys and veg symptoms in the framework of physiological variables requires the mixing of different conceptual levels and entails the risk of confounding rather than clarifying the problem. (patients verbal material has been a rich source of info for establishing meaningful connections among the psychological variables, provided scanty data for determining psychophysiologicaBeck - retardation, fatigability and agitation. 237 - "benign stupors" patients may believe they're already dead. "profound motor inhibition" appears congruent with patients' naegative view ofthemselves, sense of futility and loss of spontaneous motivation. When Beck was able to stimulate the patient's deisre to do smoething (as described in the section on motivation) he foun that the retardation became reduced or temporality disappeared. moreveore when the patient COULD ENTERTAIN THE IDEA OF GAINIGN SOME GRATIFICATION FROM WHAT THEY WERE DONIG, THERE WAS A REDUCTION IN THE SUBJECTIVE SENSE OF FATIGUE!!!! (PLEASURE!!)
infl. of psych. factors on inertia, retardation and fatigability in depression has been confirmed by several systemtaic studies.
- AGITATED DERPESSIVE - thought content congruent with their overt behaviour - DON'T ACCEP TTHEIR FATE PASSIVELY unlike retarded - desparately (DESPARATELY interesting... acedia is the same - superactive or not) seek some way to ease the distress or escape fromt he problems - since no apparent method - frantic search drives them into aimless motor activity such as pacing, scratching skin, tearing clothes - also frenzied entreaties for help.
COGNITION IN MANIA AND OTHER DISORDERS p. 237-238
RELATION BETWEEN THE DEPRESSIVE AND MANIC PHRASES under this heading - which I was looking for - illustrated by a case history.... bot 237 top 238
239 - COGNITIVE CLASSIFICATION OF PSYCHIATRIC DISORDERS
240
Neuroes - dif. on basis of thought content
DEPRESSIVE - concerned w/ ideas of personal deficiency, impossible environmental demands and obstacles, and nihilistic expectations (sadness, loss of motivaitn, suicidal wishes and agistation or retardation as a result) (acedia)
Hypomaniac - opposite to depression - exaggerated ideas of personal abilities, minimization of external obstacles, and overly optimistic expectations (euporhia, increased drive, overactivity).
ANXIOUS
ideational content dominated by themes of personal danger - contrast to phobic who experiences a sense of danger only in specific, avoidable situations - anxiety enurotic perceives danger continuously (may be perceived as intenral -e.g. cancer - may be external - another constantly in dread of being rejected by members of family, freinds, even strangers)
PHOBIC - in certain defined situations expet some phys. or pscyological injury in certain sitations.
SOMATIZATION
conversion *hysterical) reactions - experience sensory and/or motor abnormalities consistent with the faulty conception of organic pathology.
Charcot - hysterical paralysis
PARANOID
misinterpretation of experience (mistreatment, abuse, persecution)
OBSESSIVE AND COMPULSIVE
recurent thoughts having same or similar content.
PSYCHOSES
(243 missed)
CH 13 - Devleopment of Depression
Predispostion
Formation of Permanent Concepts (early in life, experiences, attitudes and opinions communicated to by others, identiifcations.
Self-cocnepts
-once particular attidute or concept has been formed, can influence subssequent jdugments and become more firmly set. (...)
246 - Value Judgments and Affect
SPECIFIC UVULNERABLITY
248 - Precipation
specific stress
(missed 250)
Nonspecific Stress
252 - Other cotnributing Factors
Cohrnic stress - psych strain
Genetic risk, prev. episode,s chronic stress
p. 254 Definitions of Schemas - individuals - why df. ppl react -
habitual - may be cultural or idiosyncratic to the individual.
"cognitive structure" (Piaget, Rapaport, Postman, Kelly, Bruner, Sarbin, Harvey - all give dif. names for such postulated structures)
256 Idenification of Schemas (...)
p. 259 - Persevaration (Rumination)
BROODING in other words
loss of objectivity
p. 260
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