You don't need to know everything on this page. The Exam will only ask you about non-biological explanations for "a disorder other than schizophrenia" - it won't ask specifically about depression or cognitive explanations. However, you should be able to explain at least one of these factors in depression and evaluate them. Material from psychological treatments for depression is helpful for evaluating this explanation as well.

NON-BIOLOGICAL EXPLANATIONS OF DEPRESSION

The Unit 2 Exam expects you to know about one non-biological explanation of a disorder other than schizophrenia; in this case, unipolar depression.

You are also expected to understand a psychological treatment for depression which is linked to these explanations.

WHAT ABOUT FREUD?

In Unit 1, students had to learn about Freud's psychodynamic theory and his views on aggression, development and individual differences. Some students might prefer to make use of this material here, as an alternative explanation of depression.

DEPRESSION & FAULTY COGNITIONS
THE EFFECT OF NEGATIVE SCHEMAS

Back in the 1960s, Martin Seligman (left) was researching learning in dogs. For this experiment, the dogs were trapped in harnesses and subjected to an electric shock every time whenever a buzzer sounded. Seligman then put each dog in a "shuttlebox" - a pen with a low wall so the dog could easily escape - and sounded the buzzer then waited to see what the dogs had learned.
You should recognise this as an experiment into classical conditioning and a rather cruel one too. The buzzer is a neutral stimulus (NS) but when paired with the electric shock (UCS) it becomes a conditioned stimulus (CS). But what is the conditioned response (CR) going to be?
The dogs did nothing. They just sat there. Seligman tried sounding the buzzer and giving more electric shocks, but the dogs stayed put. Then Seligman realised what the dogs had learned while they were being conditioned in the harnesses. They had learned to be helpless.
 HeSeligman & Maier (1967) was a bombshell study because it brought Behaviourism (a philosophy based on Learning Theory) crashing down. The dogs demonstrated that there are such things as cognitions - in this case, feelings of helplessness - which influence behaviour more than external stimuli.

By the way, Seligman wasn't always a guy in a suit. In the '60s and '70s, he looked a bit different. He was also one of Rosenhan's pseudopatients.
Best. Decade. Ever.
Seligman went on to link learned helplessness to depression in humans. He suggested that people have an "explanatory style" - their way of making sense of what happens to them.  People with a pessimistic explanatory style see negative events as:
  • stable ("it will always be like this")
  • global ("everything else will be like this too")
  • internal ("it's my fault that it's like this")
Seligman argued that explanatory style was learned through upbringing, but that a different and more optimistic explanatory style could be learned through cognitive therapy. An optimistic explanatory style sees negative events as:
  • unstable ("this too will pass")
  • specific ("other things aren't like this")
  • external ("this happens to everyone, it's not just me")
Learned helplessness is also linked to brain function. Hammack et al. (2011) showed that serotonin is linked to feelings of helplessness as well as activity in the amygdala. Serotonin and the amygdala are known to be linked to depression as well.
Another psychologist investigating the cognitive side of depression was Aaron Beck (right).

Beck proposed three cognitive factors in depression:
  1. the negative cognitive triad
  2. cognitive biases
  3. negative schemas
Beck's negative cognitive triad is the idea that people have negative views about the world that influence their feelings about themselves and their expectations of the future. Negative views about oneself and the future feed back into a negative worldview.  People then act on these feelings, usually by giving up on projects, withdrawing from relationships and blaming themselves. This destructive behaviour causes them to fail at things and struggle in relationships, which convinces them that their core beliefs are right.
This sort of thing is called a VICIOUS CIRCLE.

A particularly charming portrayal of negative thinking is "Marvin the Android" from Douglas Adams' The Hitch Hikers Guide to the Galaxy (1978). Here he is in the 2005 film version, voiced by the late great Alan Rickman.
Beck also identifies errors in logic, called cognitive biases, in people with depression:
  • magnification: problems are exaggerated
  • minimisation: strengths and opportunities are under-emphasised
  • personalisation: the individual blames themselves for things that are actually beyond their control

Polarised thinking is another bias, also known as black-and-white thinking. For example, people with depression often set themselves unattainable standards such as, “I must be liked by everybody; if not, I’m a terrible person” or "I must succeed at everything; if not, I'm completely useless".
Negative schemas develop during childhood, usually through critical relationships (like parents who are too perfectionist or school cliques that are judgmental) or traumatic events (like the death of a family member, childhood abuse or bullying at school). They are activated when the person experiences similar situations or similar relationships in later life.
You came across SCHEMAS back when you were studying the reconstructive theory of memory. There, schemas were stereotypes that affected how we remember the past; here, they also affect what we expect from the future and how we think we are expected to react to things. They're like the "unwritten rules" of your life. Beck's "schemas" and Seligman's "explanatory styles" seem to be the same thing.
This 5-minute podcast sums up cognitive views of depression - with a bit on CBT as well
FREUD'S PSYCHODYNAMIC EXPLANATION
In Unit 1, you studied Freud as an alternative to the biological explanation of aggression. You could use his ideas again as an alternative to biological explanations of depression.
According to Freud's psychodynamic approach, abnormality is caused when trauma from unresolved conflict between the id, ego, and superego is repressed into the unconscious. Freud believed that in people with depression the superego (or conscience) is over-developed. This  explains the excessive guilt and the sense of worthlessness people with depression feel.

This imbalance can be caused by fixation or  regression to an earlier stage of psychosexual development. Freud argued that, if your needs weren’t met during the oral stage, you develop low self-esteem and excessive dependence ("neediness") which puts you at risk of depression in adulthood.

On the other hand, if your needs were met to excess during the oral stage, you might also might become too dependent on others.
It might seem like you just can't win with Freud! But Freud's idea is that psychological health is a precarious balancing act. Too little parental love and support stunts our growth - but so does smothering.

Remember Goldilocks and the porridge? Your childhood relationships need to be not too hot, not too cold, but "just right".
People who are excessively dependent on others are particularly likely to develop depression after a loss. This could be a bereavement or the breakup of a relationship, losing a job or falling out with a friend. Anger at the loss is displaced, causing you to re-experience a painful loss that occurred in childhood.

APPLYING NON-BIOLOGICAL EXPLANATIONS OF DEPRESSION
AO2

Cognitive explanations of depression suggest cognitive therapies to address the "faulty cognitions". People with depression can learn to recognise faulty cognitions and correct them, training themselves to "think positively".

The patient (client) talks about their experiences with their therapist. Working together, the client and  therapist develop a model of what’s causing the depressive episodes. These factors vary from person to person: some people need to view relationships differently, others need to be more optimistic about the future, some need adopt new ways of interacting with people around them.

The most popular therapy is Cognitive Behavioural Therapy (CBT).
Beck also created the Beck Depression Inventory (BDI) in 1961. This is a 21-question psychometric test that asks about cognitions (hopelessness, irritability, guilt or feelings of being punished) as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex. Each question is multiple-choice, with 4 answers to choose from. These are rated 0 to 3 and the overall score is out of 63.
Beck Depression Inventory.pdf
File Size: 63 kb
File Type: pdf
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BDI is often used to measure the severity of depression and to check how a client is responding to treatment. It's not meant to be a diagnostic tool however so it shouldn't replace visiting your doctor if you think you might be depressed.
The contemporary study in depression by Kroenke et al. introduces a new questionnaire for measuring depression: the PHQ-8. This is also based on a cognitive understanding of depression, asking questions about feeling down, feeling like a failure and inability to concentrate.
APPLYING THE PSYCHODYNAMIC EXPLANATION
Freud was the psychologist who pioneered the idea of the "talking cure" which he called psychoanalysis. However, psychoanalysis is different from normal cognitive therapy.

The psychodynamic explanation suggests that the causes of schizophrenia are buried in the unconscious mind, in memories of a distressing childhood. The client has created the symptoms of depression to protect themselves from these memories. So there's no point in just asking the client for their opinion about their illness.

Instead, the psychoanalyst tries to guide the client towards insight and self-knowledge. This might involve techniques like free association or the Rorschach inkblot test.

EVALUATING NON-BIOLOGICAL EXPLANATIONS
AO3

Credibility
People with depression do have the negative cognitions described by Seligman and Beck and so there is a high level of face validity (it matches up with our common-sense understanding of depression).

Cognitive behavioural therapy (CBT) has been found to be at least as effective as antidepressants, which supports the role of cognitive factors in depression.

Some critics argue that negative cognitions are the result of depression, not the cause of it. This has been tested. Lewinsohn et al. (2001) measured negative thinking in participants who did not have a history of depression. They assessed the participants a year later and found those who scored highest for negative thinking were more likely to have developed depression in response to negative life events. This supports the idea of faulty cognition as a cause rather than an effect of depression.

Freud's psychodynamic explanation also has face validity: people who were traumatised as children often suffer depression as adults. Freud's ideas formed the basis for mental health diagnosis in DSM-I and -II and psychoanalysis is still used for treating depression today.
Objections
Research into cognitive factors relies on self-reports, eg the Beck Depression Inventory (BDI). The self-report method produces subjective data, as it is vulnerable to bias because of researcher effects and demand characteristics. This means it lacks validity.

The evidence that negative cognitions come before depression is not entirely convincing. The Lewinsohn et al. (2001) study may only show that some participants were in the very early stages of depression, which became full-blown depression a year later. It may be that the relationship between thinking and depression is curvilinear: negative thinking predisposes you to suffer depression and depression increases your negative thinking.

The research describes the nature of depressive thoughts but it doesn't explain the origin of depression because it is not clear what causes the negative cognitions in the first place. Beck's negative schemas and Seligman's explanatory styles are rather vague concepts and we still don't know why some people develop a negative outlook after being bullied at school but others don't.

The credibility of Freud's views has been challenged since the 1960s and no longer informs diagnosis in the DSM. Fewer than 10% of people who experience major losses in childhood go on to develop clinical depression. Freud predicts that the the child’s anger should be turned inwards on themselves yet often abused and traumatised children turn their anger outwards on people around them instead.
Differences
Here, I'll compare the non-biological explanations with a biological one
The cognitive approach recommends that people with depression can "think themselves healthier" by changing their beliefs and attitudes. It is more empowering. In contrast, the biological explanation is often criticised for viewing people with depression as faulty humans with "broken brains" that need to be "fixed" by experts.

The cognitive explanation by itself isn't a complete explanation. It could be said to DESCRIBE depression in more depth without really EXPLAINING where it comes from, why some people have these problems but others don't. A similar criticism applies to the biological explanation, which describes that state of depressed brains rather than explaining why they are like that.

On the other hand, the cognitive explanation fills some gaps in the biological approach. For example, biological psychologists notice that even if serotonin levels are corrected by using drugs, it still takes  weeks for depressive symptoms to fade. This could be because faulty core beliefs and learned helplessness carry on as a sort of "bad habit" even when neurotransmitter activity is normal.

Cognitive explanations aren't offered as an alternative to biological explanations of depression. The two types of explanations are COMPLEMENTARY - they work together. For example, Rayner et al. (2016 - not the same Rayner from the Little Albert study) looked at brain scans of 59 people with unipolar depression and found areas of the prefrontal cortex were overactive that dealt with unpleasant memories, guilty feelings and "brooding" along with less activity in areas to do with decisiveness and concentration. This evidence supports both biological AND cognitive explanations.
Applications
Biological explanations have led to the development of cognitive behavioural therapy (CBT). However, CBT can be threatening for some clients because it involves opening up and talking about upsetting or embarrassing experiences with a therapist. For many people with depression, it is easier to pop a pill. Moreover, getting to the bottom of cognitive dysfunction can take months of counseling, whereas antidepressants take effect within a couple of weeks.

Critics in the Recovery Movement tend to embrace the cognitive explanation with its focus on self-help and positivity. The recovery model recommends that people with depression stop thinking of themselves as 'sick', embrace their symptoms and learn to cope with them and focus on changing their lifestyle/outlook instead.
With only 8 marks for AO1, don't waste time with describing cognitive explanations
Just start with an evaluation point and use evidence to back it up.
You can add in extra knowledge to develop an argument.
More purple (AO3) than blue (AO1) is a good sign.
An AO3 point with AO1 backup is a "logical chain of reasoning"
Evaluation point + evidence + counterpoint is another  good structure
For a top band answer, address factors (plural) not just one factor - eg. Freud or behaviourism (conditioning, role models)
The integrated approach or the diathesis-stress model make great conclusions

EXEMPLAR ESSAY
How to write a 8-mark answer

Evaluate the role of non-biological factors as possible causes of one mental disorder you have studied other than schizophrenia. (20 marks)
  • A 20-mark “evaluate” question awards 8 marks for describing non-biological explanations of depression (AO1) and 12 marks for evaluating them (AO3).
Cognitive explanations of depression have credibility because people with depression show negative thoughts like helplessness and pessimism, as described by Seligman and Beck. However, research into cognitive factors relies on self-reports, eg the Beck Depression Inventory (BDI). Self-reports produce subjective data, as they suffer from researcher effects and demand characteristics. This means research into cognitions may lack validity.
On the other hand, these explanations are purely descriptive because they don't tell us why some people develop negative schemas and others don't. Beck suggests that people with depression have picked up negative schemas from traumatic experiences and relationships. However, Beck's negative schemas and Seligman's explanatory styles are rather vague concepts and we still don't know why some people develop a negative outlook  but others don't.
Cognitive explanation fill some gaps in the biological approach. For example, biological psychologists notice that even if serotonin levels are corrected by using drugs, it still takes  weeks for depressive symptoms to fade. This could be because faulty core beliefs and learned helplessness carry on as a sort of "bad habit" even when neurotransmitter activity is normal.
Some critics argue that negative cognitions are the result of depression, not the cause of it. However Lewinsohn et al. (2001) found that patients who scored highest for negative thinking were more likely to develop depression later. This supports the idea of faulty cognition as a cause rather than an effect of depression. However, the relationship between thinking and depression may be curvilinear: negative thinking predisposes you to suffer depression and depression increases your negative thinking.
The cognitive approach is empowering for patients because people with depression can "think themselves healthier" by changing their beliefs using CBT. In contrast, the biological explanation is often criticised for viewing people with depression as faulty humans with "broken brains" that need to be "fixed" by experts.
The role of cognitive factors in depression is supported by the success of cognitive behavioural therapy (CBT) to cure depression. For example, Stiles et al. (2006) found that cognitive and psychodynamic therapies used in the NHS reduced the relapse rate over 3 years. This suggests that tackling cognitions is an effective treatment. However, In many studies, CBT is compared against TAU or 'treatment as usual'. This difference may not be due to CBT; it may be because TAU is positively harmful.
Freud's psychodynamic explanation also has face validity: people who were traumatised as children often suffer depression as adults. Freud believed that in people with depression the superego (or conscience) is over-developed. This  explains the excessive guilt and the sense of worthlessness people with depression feel.
Freud's theories have application because psychoanalysis is a treatment for depression and Freud's ideas formed the basis for mental health diagnosis in DSM-I and -II. Stiles et al. (2006) found psychoanalysis to be as effective as CBT in treating depression in the NHS.
In conclusion, even if cognitive explanations aren't complete explanations of depression, they are very helpful for treating it. An integrated approach combining antidepressants and CBT or psychoanalysis is best. Clinical psychologists should continue to research cognitive and Freudian explanations so that sufferers can be offered treatments other than antidepressant drugs,
  • Notice that for a 20-mark answer you don’t have to include everything about the cognitive explanation of depression. Here, all the description appears as evidence in support of an evaluation point. The AO1 description is blue and the AO3 evaluation is purple. You can see there's more purple than blue in this essay - because there are 12 AO3 marks but only 8 AO1.
  • About 6 paragraphs like this, each with a mix of AO1 and AO3, should be enough, plus the conclusion of course. If you aim for the top band, add 2 more paragraphs considering other factors than just cognitivism.