Understanding Depression
What is Behavioural Activations Psychotherapy and How Efficacious is it in Treatment of Depression?
Depression is a psychological disorder that affects a person both mentally and physically if not treated well. It may cause sleeplessness, loss of energy, loss of interest in their favourite activities etc. Behavioural activation therapy is the most popular and worldwide accepted therapy to treat depression. The behavioural activation psychotherapy is a therapy used to treat people with mild and moderate depression. It is a component of cognitive behavioural therapy. The main strategy behind this therapy is to activate the positive aspects of life and to reduce negative thoughts from patient’s brain. Sometimes people with psychological disorders like depression and stress induce some negative thoughts like he or she is not worth, life has no meaning, suicide thoughts, lack of social involvement and many more. People with these disorders given some tasks that are beneficial for them like remind their loved ones, the areas where he or she enjoys mostly, their friend’s etc. The efficacy and importance of behavioural activation therapy to treat depression will be discussed in this essay.
Depression is a mood disorder that induces feelings like sad, guilt. It is not a new concept; it has been affecting people for years and now becomes the most common problem for every person of almost every age group. It was previously called Melancholia and mentioned in ancient Greek, Roman, Chinese, Egyptian history. Depression not only affects the normal activities of depressed person but also result in suicide thoughts sometime. Nearly 300 million people were found to be depressed worldwide that means around 5 per cent population is affected by this mind disorder , it was also revealed that it affects women’s more than men. In Singapore nearly 6 per cent population experienced depression once in a life. Depression is also associated with various other diseases like stress, and they also revealed that suicide is the second most cause of deaths among adults specially the college students World Health Organisation (2018). It was stated by Kerr (2017) that Most of the undergraduate students face depression because of low grades, hard study course and placements, when they do not achieve what they expected then depression occurs automatically.
Depression also affects school students, when they do not fulfil parent’s expectation they felt guilty and develop other psychological issues like stress. There are various symptoms can be seen in a depressed person, some of them are: loss of interest in physical activities, feeling low, feeling guilty all the time, weight loss, insomnia, agitation, feeling alone and suicide thoughts. It is the main cause of suicides worldwide and it accounts for 800000 deaths per year. Depression could be reason of other physical diseases like cancer although the evidences of it are not very strong (National Cancer Institute, 2012) but the unfavourable habits occurred due to depression may cause cancer. Most of the people with depression started smoking cigarettes and drinking alcohol to reduce depression. These unhealthy habits temporarily helped the depressed mood but it causes other serious health issues.
Factors Associated with Depression
There are various factors associated with depression that cause mood disorder; these factors are biological, environmental, psychological and genetic. There are four sites of brain that are responsible for stabilize, regulation and alteration in emotions: prefrontal cortex, the amygdala, hippocampus and subcortical white matter. The brain uses various chemical to send messages from one part of the body to other parts called neurotransmitters. Neurons communicate with each other by these transmitters to send responses to the whole body. Some of the neurotransmitters like 5-HT, NA and NE are found in above mentioned areas of brain responsible for unfavourable behavioural in depressed mood. Another transmitter that contributes in signalling to induce depression is dopamine. When stress occurs it induces pro-inflammatory cytokines which results in reduced activity of 5-HT, NA neurotransmission. 5- HT is a receptor found in central nervous system responsible for regulation of neurons. Imbalance occurred in this neurotransmitter further accounts for alterations in BDNF (Brain Derived Neurotraphic Factor). BDNF’s are the major factors to regulate growth, maintenance of neurons in brain circuits which are related to emotional functions (Philips, 2017). BDNF imbalance cause HPA (Hypothalamo- Pituitary – Adrenal Axis) abnormal regulation, this will further results in increased cortisol. Increased level of cortisol causes hippocampal atrophy which means degeneration of hippocampus. This deregulation in hippocampus causes prefrontal hypo activity and limbic hyperactivity which results in depression (Palazidou, 2012).
Some of the studies also suggested that depression is also associated with genetic factors. Studies like twin study and family studies are possibly identified the genetic relations of depression and other psychological diseases. According to family study first degree relatives with depressed parents have more risk of having depression compare to normal people (Hodgson & Mcguffin, 2012). Identical twins are very similar in behaviour and psychological activities, when one person feel depression another also becomes depressed, so twin study is a reasonable study to understand genetic involvement of depression. Genetically twins are monozygotic but dizygotic are no identical. The difference and similarities of both can be useful to understand the hereditary of traits (Hodgson & Mcguffin, 2012). Some studies suggested that genes also responsible for depressed behavioural. A study published by Lohoff (2010) stated that no single gene is responsible for causing depression but small fraction of each gene helps to develop it. Some of the studies indicated towards involvement of chromosomes to cause depression. Faris (2016) found that 800 families with depression were found to have 3p25-26 chromosome who suffered from depression, so there is a probability that alterations in chromosome might play role in depression.
Diagnosis of Depression
To treat a person with depression it is essential to identify the symptoms. It can be diagnosed by using DSM-5. The diagnostic Manual of Mental Disorder is a manual that has been used for many years to diagnose mental disorder. The first edition of this book was published in 1952, by American Psychiatric Association. This manual mostly focused on symptoms and statistics based diagnosis. There are some criteria mentioned in this book to diagnose Major Depression Disorders (MDD) Categorized alphabetically as A, B, C, D, F. The criteria first involves a statement that the person is found to be depressed all the day and almost daily with symptoms like feeling sad defined as Dysphoria, loss of interest in everything nearly whole day and daily called Anhedonia, weight loss, insomnia or hypersomnia every day, fatigue or loss of energy, agitation, feeling of worthlessness and guilt, loss of concentration and suicide thoughts (American Psychiatric Association, 2013). Criteria B stated that the depressed person faced symptoms of dysphoria or anhedonia. Criteria C include symptoms of distress and social impairment. Next one stated that symptoms are not occurred because of physiological effects of medicines. According to criteria E there is no persistent depressive disorder and cyclothymic disorder found in patient and the last point indicated that during psychotic disorder there is no mood disturbance found (Up to date, 2018).
There are two different ways to treat depression: physical and psychological treatment. Physical treatment is related to medicinal treatment where psychiatrist prescribed some medicines like antidepressants, mood stabilisers etc. psychological treatment involves cognitive behavioural therapy, counselling, and positive psychology. Behavioural activation (BA) psychotherapy is the most common mechanism to treat mental disorders and it was previously comes under cognitive behavioural therapy. BA is evidence based therapy for depression. It is basically a coping mechanism and a short term treatment that is found to be effective on depressed mood. The people suffering from depression usually don’t think about enjoy full activities they used to do before, they make distance from their loved ones. The main strategy behind this method is to change the mood by encouraging patient, to remind the most important areas of life, to find out most favourable activities that are more effective like favourite sport, involving them in such activities that could change their mind, rewarding them and assess the results after successful treatment. It is found that BA is very less time consuming therapy, it takes only five days for effective results (Ekers, Webster, Straten, Cuijpers, Richard, & Gilbody, 2014). There are some techniques provided by positive psychology program (2018): schedule activity, self-monitoring of activities, activity structuring, problem solving, social skill training sessions, construction of hierarchy, shaping, reward , persuasion, behaviour contract and life assessment. Some of the benefits of using behavioural activation therapy are: It is easier to train staff to conduct this therapy, it takes only 5 days to complete the task, simple principles, and it is cost effective than other therapies. Although the principle are difficult for patient to follow but it has long term effects. Sometimes it is difficult to forget the problems that cause depression among them depressed person after. BA therapy is an effective therapy for mild depression and moderate depression. According to Veale (2008) Behavioural activation therapy has greater efficacy in severe cases of depression and advantages over medicinal treatment, it was also stated that depressed patient prefer this therapy more than antidepressant. According to study published in science daily (2016) behavioural activation therapy is effective same as CBT (Cognitive Behavioural Therapy), it also revealed that treatment with effectiveness and low cost is a main priority in case of depression. Some of the trials conducted on depressed patient evidenced efficacy of behavioural activation therapy, they differentiate between lets act and time matched control treatment on two groups of people and revealed that in both the groups there was some reduction seen in symptoms of depression, it was also found that behavioural activation therapy results in greater effects (Ross et al., 2011).
Treatment of Depression
After reviewing various studies it is concluded that depression is a worldwide problem which affected many people and needs to be resolved. To diagnose depression DSM 5 found to be the most promising manual which assess the symptoms of the depressed person. Depression can be treated by using various methods like physical and psychological treatment. Psychological treatments are found to be more reliable rather than medicinal treatment because medicinal treatments found to be more time consuming. Medicinal therapies are short term treatments and might induce some side effects. Various genetic and neurological aspects has been studied and concluded that genetic factors and neurotransmitters takes part in depression. It was also studied that behavioural activation therapy is the most popular and effective therapy to treat depression because it has various positive aspects like low cost, less time consuming and long term effects. Various studies that are mentioned above supported that behavioural activation is a short term treatment for depression with long term results.
References
American psychiatric association (2013). Diagnostic and statistical manual of mental disorder. (5th ed). Arlington, VA: American Psychiatric Publication.
Ekers, D., Webster, L., Straten, A. V., Cuijpers, P., Richard, D., & Gilbody, S. (2014). Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. Plos one, 9(6).
Faris, S. (2016). Is depression genetic?. Retrieved from: https://www.healthline.com/health/depression/genetic
Hodgson, K. & Mcguffin, P. (2012). Behavioural neurology of depression and its treatment. Berlin: Springer.
Kerr, M. (2017). Depression and college students. Healthline. Retrieved From: https://www.healthline.com/health/depression/college-students
Lohoff, F. W. (2010). Overview of the genetics of major depressive disorder. Current Psychiatry reports, 12(6), 539-46.
National Cancer Institute (2012). Psychological stress and cancer. Retrieved from: https://www.cancer.gov/about-cancer/coping/feelings/stress-fact-sheet#q3
Palazidou, E. (2012). The neurobiology of depression. British Medical Bulletin, 101(1), 127-145.
Philips, C. (2017). Brain derived neurotrophic factors, depression, and physical activity: making the neuroplastic connection. Neural plasticity, 2017.
Positive Psychology Program (2018). Behavioural activation: behavioural therapy for depression treatment. Retrieved from: https://positivepsychologyprogram.com › Therapies
Ross, J., Teeson, M., Lejuez, C., Mills, K., Kaye, S., Brady, K., Dore, G., Prior, K., Larkin, X., Cassar, J., Ewer, P., Memedovic, S., Kihas, I., & Mastwer, S. L. (2016). The efficacy of behavioural activation treatment for Co-occurring depression and substance use disorder (the activate study study): a randomised controlled trail. BMC psychiatry, 16(1).
Science daily (2016). Behavioural activation as cost effective as CBT for depression, at lower cost. Retrieved from: https://www.sciencedaily.com/releases/2016/07/160722212245.htm
Up to Date (2018). DSM- 5 diagnostic criteria for a major depressive episode. Retrieved from: https://www.uptodate.com/contents/image?imageKey=PSYCH/89994
Veale, D. (2008). Behavioural activation for depression. Advances in psychiatric treatment, 14(1), 29-36.
WHO (2018). Depression: key facts. World Health Organisation. Retrieved from: https://www.who.int/en/news-room/fact-sheets/detail/depression
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