Introduction to mood disorders and their treatment

Mood disorders, also known as affective disorders, involve persistent disturbances in emotional state, such as prolonged sadness or extreme mood swings. These can significantly impact daily functioning, relationships, and overall wellbeing. Treatment aims to alleviate symptoms and restore balance, often combining biological and psychological methods. Biological approaches target brain chemistry, while psychological ones focus on thought patterns and behaviours.

Biological treatments for mood disorders

Biological treatments primarily involve antidepressant drugs, which work by altering levels of neurotransmitters in the brain. Neurotransmitters are chemical messengers that transmit signals between nerve cells, influencing mood and emotion. These drugs aim to correct imbalances often associated with mood disorders like depression.

Types of antidepressant drugs

Antidepressants come in several classes, each with a specific mode of action and potential side effects.

This variety allows treatments to be tailored to individual needs, though side effects must be carefully managed.

Psychological treatments for mood disorders

Psychological treatments address the cognitive and behavioural aspects of mood disorders, helping individuals reframe negative thought patterns. These therapies emphasise active participation and skill-building to manage symptoms long-term.

Beck's cognitive restructuring

Cognitive restructuring, developed by Aaron Beck, is a form of cognitive therapy that targets irrational beliefs contributing to depression. Irrational beliefs are distorted thoughts that exaggerate negative aspects of oneself, the world, or the future, often leading to emotional distress.

Core process:

• Therapists guide clients to identify these irrational beliefs, challenge them with evidence, and replace them with more balanced, rational perspectives.
• This helps individuals become less dependent on dysfunctional thinking and more objective in their attributions (explanations for events).

Techniques used:

• Socratic questioning - Therapists use guided questions to encourage clients to examine the validity of their thoughts.
• Psychoeducation - Clients learn about the link between thoughts, emotions, and behaviours.
• Homework - Practical tasks, such as journaling thoughts, reinforce new thinking patterns outside sessions.

Sessions usually last 50 minutes, with clients attending between five and twenty sessions. This approach builds resilience by teaching clients to manage their own thought processes.

Ellis's rational emotive behaviour therapy (REBT)

Rational emotive behaviour therapy (REBT), created by Albert Ellis, focuses on how interpretations of events, rather than the events themselves, drive emotional responses. It aims to replace self-defeating thoughts with healthier ones to reduce negative emotions and behaviours.

Key principles:

• Therapy emphasises present-focused solutions over dwelling on past events.
• Clients and therapists collaborate to dispute irrational beliefs, such as "musturbation" (rigid demands like "I must be perfect"), which lead to emotional turmoil.

Process:

1. Identify self-defeating thoughts and their emotional consequences.
2. Challenge these through logical, empirical, and pragmatic disputing (e.g., questioning if the belief is realistic or helpful).
3. Develop acceptance of oneself, others, and life circumstances, embracing both positive and negative aspects.

REBT promotes personal responsibility and quick, practical changes in thinking. Clients learn to respond more adaptively to situations, fostering emotional stability without relying on external validation.

Strengths and weaknesses of treatments

Evaluating treatments involves weighing their effectiveness, practicality, and limitations.

Supporting research

Cipriani et al. (2018):

• Method - Meta-analysis of 522 randomised, double-blind controlled trials comparing antidepressants to placebos.
• Results - All drugs showed greater efficacy than placebos in alleviating depressive symptoms.
• Evaluation - Provides robust evidence but highlights the need to consider individual responses and side effects.

Fava et al. (1998):

• Method - Longitudinal study comparing outcomes of drug treatment alone versus drugs plus cognitive therapy over two years.
• Results - Combined treatment led to a 75% remission rate, far higher than the 25% for drugs only.
• Evaluation - Demonstrates the added value of psychological input, though results may vary based on participant motivation.

These evaluations highlight that a combined approach often yields the best results.

Issues and debates in treatment approaches

Psychological treatments raise broader questions about the nature of human behaviour and societal influences. Two key debates are particularly relevant.

Individual versus situational explanations

Both biological and psychological treatments focus on changing aspects of the individual – that is, their biochemistry or their beliefs.

This sidelines the role of situational factors. Tackling sources of stress in society (e.g. poverty and discrimination) could also improve wellbeing without the need for treatment.

Determinism versus free will

Determinism suggests that behaviour is shaped by uncontrollable factors, such as irrational beliefs dictating emotional responses. In contrast, free will posits that individuals can actively choose their thoughts and actions.

Therapies like cognitive restructuring and REBT support free will by empowering clients to wilfully challenge and control negative thoughts, rather than being passively influenced by them. This perspective encourages personal agency in managing mood disorders.