Lecture 1—History and Conceptualization
What is Psychopathology?
What is a Mental Disorder?
• What makes something a mental disorder?
• Is the term ‘disorder’
✓ Meaningful?
✓ Helpful?
✓ Dangerous?
✓ Misguided?
✓ Metaphoric?
7/10/25Depression and Bipolar Disorders
September 16, 2024
Psychoanalytic Perspective on Depression
-Psychoanalytic View
-early childhood attachment relationship with caregivers seen as crucial in healthy
development
-attachment in infancy
-Depression is triggered by losses in early life particularly losses of people who very
attached
-Depressive reaction in DSM-1
Life Events Perspective
-Bad things happen, and people get depressed about those bad things
-only severe events empirically linked to depression (more, increased risk)
-additive effect (quality and quantity)
-Historically called exogenous or reactive depression (mind-body dichotomy)
-Predispositions to interpret life events differently
-What may act as a buffer?
Behavioral Conceptualizations
-Focus on learning and reinforcement
-Lewisohn (1970s-1980s)
-Depression is a function of low rate of positive reinforcement. In the absence of
reinforcement, positive behaviors likely to elicit such reinforcement eventually become
extinguished
-Social skills, interpersonal relationships
-Jacobson and colleagues (1990s- present)
-Role of escape and avoidance behavior in reducing reinforcement
Interpersonal Models
-Emphasize role of social/interpersonal interactions
-Relationships buffer against depression
-Depression linked to relationship distress
, -reassurance seeking, reinforcement of dysphoric affect, lack of shared positive
activities, low expression of PA high expression of NA
-Strong relationships enhance likelihood of treatment success for depression
-Couples are a major focus of this line of research
Cognitive Models
-Cognitive self-schemas
-Organized representations of prior experiences, including views of self, ability to
manage, and succeed in the world
-Learned in childhood, shaped over time
-Constructs include:
-self-esteem -Cognitive errors (distortions
-Expectations for others and future -Beliefs (schemas) influence perception
-Information Processes Biases
-Selective attention to depressogenic information
-Biases in memory
-Negative attributional styles
-Diathesis-Stress Models
-Schemas are a vulnerability, dormant until stressor occurs--- first used on people w
schizophrenia
-Depressive Realism
-negative, distorted ways of interpreting things wrong
Memory Updating in Depression (Kube, 2023)
-Clinical observations and theory
-Depressed individuals hold negative beliefs, world, and future
-Presumably based on life experience particularly early in childhood
-Generate negative affect, block positive affect
-Often no consistent with the facts of client’s current situation
-Why don’t they change?
-e.g., repeatedly told they’re a failure in childhood, but is reasonably successful as an
adult. Yet maintain belief about being incompetent
-Negative Information
-readily perceived and incorporated into schema
-Strengthens schema
-Positive Information
-not always perceived
-if perceived reinterpreted in a negative manner
-strengthens schema
-Empirical tests of these clinical ideas
-Examine some type of explicit beliefs
-Performance expectations, interpersonal beliefs, about future events,
psychotherapy outcome expectations
, -Present participants with new information in relation to these beliefs
-Assess beliefs at least twice, such that change in beliefs can be examined
-Test if depressive symptoms or diagnosis moderates’ effects
-Difficulty revising negative beliefs in response to novel positive information
-Belief updating in depression not related to enhanced integration of negative information
-Why? Mechanisms?
- Possible implications for anhedonia and reinforcement?
-Cognitive immunization
-Defensive cognitive strategies to devalue belief- disconfirming evidence
-assigning low reliability or credibility to the source of the information
-regarding the disconfirming information as an exception rather than the rule
-Depends on magnitude of the discrepancy between prior expectations and actual
information (magnitude of the prediction error)
-Negative affect
-Value of beliefs
-beliefs are changed in a new belief has higher value than original one
-people do not update their beliefs if perceived costs of changing the belief are higher
than the perceived benefits
-Value of negative beliefs in depression?
Rumination, Working Memory, and Anhedonia
-Reward Processing
-processes related to engagement in goal-directed behavior towards rewards (appetitive
motivation)
-responses to rewarding stimuli (reward sensitivity)
-ability to learn from rewards to adapt future behaviors (reinforcement learning)
-Facets of anhedonia
-Anticipatory reward
-Consummatory reward
-Consummatory pleasure
-liking, satiation, or pleasure
-Anticipatory pleasure
-wanting or pleasure one expects to experience from a future rewarding experience
-Depression associated with
-Diminished anticipatory pleasure, intact consummatory pleasure
-Lower anticipatory pleasure predicted depressed individuals working less hard for a reward
-Working memory
-cognitive system for temporarily storing, actively maintaining, and manipulating
information across a short delay
-necessary to carry out temporally relevant goal-directed tasks
, -Interfere with ability to attend to social and environmental cues could restore positive
affect
-Rumination
-Repetitive and perseverative attention is paid to specific thoughts
-May reflect a failure of cognitive control in attention gets stuck on salient, but not
necessarily, goal- relevant, aspects of a situation
-Experienced as a “problem solving”
Rumination Working Memory Reward Processing Anhedonia
Biological Perspectives
-Depression is disease of brain
-Neurotransmitters implicated
-especially 5HT
-Brain asymmetry
-decreased activation in left hemisphere (prefrontal cortex) linked to risk
-Strong evidence for heritability
-Genetic underpinnings
-high concordance in MZ twins and run in families
-30 -40 % heritable
-possibly accounted for by trait-neuroticism (endophenotype)
-may create a ‘diathesis” that increases stress sensitivity
-people with 1 or 2 copies of 5HTTLPR experience higher levels of depression
and suicidality following life stressor
-effect of environment varies as function of genes and conversely
-effect of genes varies as function of the environment
-Polymorphisms in Serotonin Transporter Gene
-5-HTTLPR short allele is associated with risk
Gender and Depression
-meta- analysis of gender differences
-nationally representative samples
-Study examined:
-pattern over time, national characteristic such as gender equity and wealth, variations
across US ethnic groups, differences across cohorts from the 1970s to 2014
-Nation level variables
-larger gender differences in wealthier countries compared to low to middle income
countries
-income inequality not significant predictor
-Gender differences in depression diagnoses were larger in nations with greater gender
equity
-women had more control over their reproduction, more executive positions, more
like men in literacy rates
What is Psychopathology?
What is a Mental Disorder?
• What makes something a mental disorder?
• Is the term ‘disorder’
✓ Meaningful?
✓ Helpful?
✓ Dangerous?
✓ Misguided?
✓ Metaphoric?
7/10/25Depression and Bipolar Disorders
September 16, 2024
Psychoanalytic Perspective on Depression
-Psychoanalytic View
-early childhood attachment relationship with caregivers seen as crucial in healthy
development
-attachment in infancy
-Depression is triggered by losses in early life particularly losses of people who very
attached
-Depressive reaction in DSM-1
Life Events Perspective
-Bad things happen, and people get depressed about those bad things
-only severe events empirically linked to depression (more, increased risk)
-additive effect (quality and quantity)
-Historically called exogenous or reactive depression (mind-body dichotomy)
-Predispositions to interpret life events differently
-What may act as a buffer?
Behavioral Conceptualizations
-Focus on learning and reinforcement
-Lewisohn (1970s-1980s)
-Depression is a function of low rate of positive reinforcement. In the absence of
reinforcement, positive behaviors likely to elicit such reinforcement eventually become
extinguished
-Social skills, interpersonal relationships
-Jacobson and colleagues (1990s- present)
-Role of escape and avoidance behavior in reducing reinforcement
Interpersonal Models
-Emphasize role of social/interpersonal interactions
-Relationships buffer against depression
-Depression linked to relationship distress
, -reassurance seeking, reinforcement of dysphoric affect, lack of shared positive
activities, low expression of PA high expression of NA
-Strong relationships enhance likelihood of treatment success for depression
-Couples are a major focus of this line of research
Cognitive Models
-Cognitive self-schemas
-Organized representations of prior experiences, including views of self, ability to
manage, and succeed in the world
-Learned in childhood, shaped over time
-Constructs include:
-self-esteem -Cognitive errors (distortions
-Expectations for others and future -Beliefs (schemas) influence perception
-Information Processes Biases
-Selective attention to depressogenic information
-Biases in memory
-Negative attributional styles
-Diathesis-Stress Models
-Schemas are a vulnerability, dormant until stressor occurs--- first used on people w
schizophrenia
-Depressive Realism
-negative, distorted ways of interpreting things wrong
Memory Updating in Depression (Kube, 2023)
-Clinical observations and theory
-Depressed individuals hold negative beliefs, world, and future
-Presumably based on life experience particularly early in childhood
-Generate negative affect, block positive affect
-Often no consistent with the facts of client’s current situation
-Why don’t they change?
-e.g., repeatedly told they’re a failure in childhood, but is reasonably successful as an
adult. Yet maintain belief about being incompetent
-Negative Information
-readily perceived and incorporated into schema
-Strengthens schema
-Positive Information
-not always perceived
-if perceived reinterpreted in a negative manner
-strengthens schema
-Empirical tests of these clinical ideas
-Examine some type of explicit beliefs
-Performance expectations, interpersonal beliefs, about future events,
psychotherapy outcome expectations
, -Present participants with new information in relation to these beliefs
-Assess beliefs at least twice, such that change in beliefs can be examined
-Test if depressive symptoms or diagnosis moderates’ effects
-Difficulty revising negative beliefs in response to novel positive information
-Belief updating in depression not related to enhanced integration of negative information
-Why? Mechanisms?
- Possible implications for anhedonia and reinforcement?
-Cognitive immunization
-Defensive cognitive strategies to devalue belief- disconfirming evidence
-assigning low reliability or credibility to the source of the information
-regarding the disconfirming information as an exception rather than the rule
-Depends on magnitude of the discrepancy between prior expectations and actual
information (magnitude of the prediction error)
-Negative affect
-Value of beliefs
-beliefs are changed in a new belief has higher value than original one
-people do not update their beliefs if perceived costs of changing the belief are higher
than the perceived benefits
-Value of negative beliefs in depression?
Rumination, Working Memory, and Anhedonia
-Reward Processing
-processes related to engagement in goal-directed behavior towards rewards (appetitive
motivation)
-responses to rewarding stimuli (reward sensitivity)
-ability to learn from rewards to adapt future behaviors (reinforcement learning)
-Facets of anhedonia
-Anticipatory reward
-Consummatory reward
-Consummatory pleasure
-liking, satiation, or pleasure
-Anticipatory pleasure
-wanting or pleasure one expects to experience from a future rewarding experience
-Depression associated with
-Diminished anticipatory pleasure, intact consummatory pleasure
-Lower anticipatory pleasure predicted depressed individuals working less hard for a reward
-Working memory
-cognitive system for temporarily storing, actively maintaining, and manipulating
information across a short delay
-necessary to carry out temporally relevant goal-directed tasks
, -Interfere with ability to attend to social and environmental cues could restore positive
affect
-Rumination
-Repetitive and perseverative attention is paid to specific thoughts
-May reflect a failure of cognitive control in attention gets stuck on salient, but not
necessarily, goal- relevant, aspects of a situation
-Experienced as a “problem solving”
Rumination Working Memory Reward Processing Anhedonia
Biological Perspectives
-Depression is disease of brain
-Neurotransmitters implicated
-especially 5HT
-Brain asymmetry
-decreased activation in left hemisphere (prefrontal cortex) linked to risk
-Strong evidence for heritability
-Genetic underpinnings
-high concordance in MZ twins and run in families
-30 -40 % heritable
-possibly accounted for by trait-neuroticism (endophenotype)
-may create a ‘diathesis” that increases stress sensitivity
-people with 1 or 2 copies of 5HTTLPR experience higher levels of depression
and suicidality following life stressor
-effect of environment varies as function of genes and conversely
-effect of genes varies as function of the environment
-Polymorphisms in Serotonin Transporter Gene
-5-HTTLPR short allele is associated with risk
Gender and Depression
-meta- analysis of gender differences
-nationally representative samples
-Study examined:
-pattern over time, national characteristic such as gender equity and wealth, variations
across US ethnic groups, differences across cohorts from the 1970s to 2014
-Nation level variables
-larger gender differences in wealthier countries compared to low to middle income
countries
-income inequality not significant predictor
-Gender differences in depression diagnoses were larger in nations with greater gender
equity
-women had more control over their reproduction, more executive positions, more
like men in literacy rates
