Psychological Problems: Characteristics and Treatments

What you'll learn

This revision guide covers psychological problems as specified in the Edexcel GCSE Psychology specification. You will learn to identify the characteristics of mental health disorders, particularly depression, and evaluate both biological and psychological treatment approaches. This topic requires you to apply knowledge of symptoms, causes and evidence-based interventions.

Key terms and definitions

Depression — A mood disorder characterised by persistent low mood, loss of interest in activities, and negative thoughts lasting at least two weeks.

Unipolar depression — A type of depression involving periods of low mood without alternating periods of mania (unlike bipolar disorder).

Cognitive Behavioural Therapy (CBT) — A psychological treatment that challenges negative thought patterns and behaviours to improve mental health outcomes.

Antidepressants — Medication that alters neurotransmitter activity in the brain to relieve symptoms of depression, including SSRIs.

SSRIs (Selective Serotonin Reuptake Inhibitors) — A class of antidepressant medication that increases serotonin availability in the brain by blocking its reabsorption.

Systematic desensitisation — A behavioural therapy for phobias involving gradual exposure to feared stimuli whilst using relaxation techniques.

Biochemical explanation — The theory that mental health problems result from imbalances in brain chemistry, particularly neurotransmitters.

Relapse — The return of symptoms after a period of improvement or recovery from a mental health disorder.

Core concepts

Characteristics of depression

Depression affects approximately 1 in 10 people in the UK at some point in their lives. The disorder presents with emotional, cognitive, behavioural and physical symptoms that significantly impair daily functioning.

Emotional characteristics:

• Persistent sadness and low mood lasting most of the day
• Loss of interest or pleasure in previously enjoyed activities (anhedonia)
• Feelings of worthlessness or excessive guilt
• Emotional numbness or inability to feel positive emotions

Cognitive characteristics:

• Negative thinking patterns about self, world and future (Beck's cognitive triad)
• Difficulty concentrating or making decisions
• Recurrent thoughts of death or suicide
• Memory problems and reduced attention span

Behavioural characteristics:

• Social withdrawal and isolation from friends and family
• Reduced activity levels and lack of energy
• Changes in sleep patterns (insomnia or hypersomnia)
• Appetite changes leading to weight loss or gain
• Neglect of personal hygiene and responsibilities

Physical characteristics:

• Fatigue and loss of energy
• Psychomotor agitation (restlessness) or retardation (slowed movements)
• Unexplained aches and pains
• Disrupted sleep-wake cycles

For a clinical diagnosis of depression, symptoms must be present for at least two weeks and cause significant distress or impairment in social, occupational or other important areas of functioning.

Biological explanations and treatments

The biochemical explanation:

The biochemical approach proposes that depression results from neurotransmitter imbalances, particularly low levels of serotonin and noradrenaline in the brain. The monoamine hypothesis suggests that deficiencies in these neurotransmitters reduce neural communication in brain circuits controlling mood, motivation and pleasure.

Evidence supporting this explanation:

• Post-mortem studies show reduced serotonin metabolites in brains of people who died by suicide
• Antidepressant medications that increase neurotransmitter availability effectively reduce symptoms in many patients
• Tryptophan depletion (reducing serotonin precursors) can trigger depressive symptoms in vulnerable individuals

Limitations of the biochemical explanation:

• Antidepressants take 2-4 weeks to work despite immediately increasing neurotransmitter levels, suggesting more complex mechanisms
• Not all patients respond to medication, indicating other causal factors
• Cannot explain why life events and psychological factors influence depression onset
• Correlation does not prove causation — neurotransmitter changes may be effects rather than causes

Drug treatments (chemotherapy):

SSRIs (Selective Serotonin Reuptake Inhibitors) are the first-line medication treatment for depression. Common examples include fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa).

Mechanism of action:

1. SSRIs block the reuptake (reabsorption) of serotonin at the presynaptic neuron
2. This increases serotonin concentration in the synaptic gap
3. More serotonin binds to postsynaptic receptors
4. Enhanced serotonin neurotransmission improves mood regulation

Strengths of SSRIs:

• Effective for 60-70% of patients with moderate to severe depression
• Evidence-based: randomised controlled trials demonstrate superiority over placebo
• Relatively safe with fewer side effects than older antidepressants (tricyclics, MAOIs)
• Easy to administer (typically one daily tablet)
• Cost-effective treatment for the NHS

Limitations of SSRIs:

• Common side effects include nausea, headaches, sexual dysfunction and insomnia
• Delayed onset of therapeutic effects (2-4 weeks minimum)
• 30-40% of patients show minimal or no improvement
• Risk of increased suicidal thoughts in young people during initial weeks
• Withdrawal symptoms if stopped abruptly
• Does not address underlying psychological or social causes
• High relapse rates when medication is discontinued (50-80%)

Psychological explanations and treatments

Cognitive explanation:

Aaron Beck's cognitive theory proposes that depression results from negative thinking patterns developed through early experiences. These create a negative cognitive triad consisting of:

1. Negative views about oneself ("I am worthless")
2. Negative views about the world ("Everyone dislikes me")
3. Negative views about the future ("Things will never improve")

Cognitive distortions maintain depression:

• Overgeneralisation — drawing broad conclusions from single events
• Catastrophising — expecting the worst possible outcome
• Personalisation — attributing negative events to personal failings
• Black-and-white thinking — seeing situations as all good or all bad
• Mental filtering — focusing only on negative aspects whilst ignoring positives

Evidence supporting cognitive explanations:

• People with depression consistently show negative automatic thoughts
• Cognitive distortions correlate with depression severity
• Challenging negative thoughts reduces symptoms

Limitations:

• Unclear whether negative thoughts cause depression or result from it
• Does not explain biological aspects (neurotransmitter changes, genetic factors)
• Cannot fully account for depression triggered by life events without prior negative schemas

Cognitive Behavioural Therapy (CBT):

CBT is a structured, time-limited psychological treatment (typically 12-20 sessions) that targets both thoughts and behaviours maintaining depression.

CBT process:

1. Assessment — therapist and client identify negative thought patterns and problematic behaviours
2. Goal setting — establishing specific, measurable therapy objectives
3. Cognitive restructuring — identifying and challenging negative automatic thoughts using evidence
4. Behavioural activation — gradually increasing engagement in pleasurable and meaningful activities
5. Homework assignments — practising new skills between sessions through thought records and activity scheduling
6. Relapse prevention — developing strategies to maintain improvements

Techniques used in CBT:

• Thought records — documenting situations, thoughts, emotions and alternative interpretations
• Socratic questioning — therapist asks questions to help client examine thought validity
• Behavioural experiments — testing negative predictions through real-world activities
• Activity scheduling — planning enjoyable and achievement-oriented tasks
• Graded task assignment — breaking overwhelming tasks into manageable steps

Strengths of CBT:

• Substantial research evidence: NICE (National Institute for Health and Care Excellence) recommends CBT as first-line treatment
• Meta-analyses show effectiveness comparable to antidepressants for moderate depression
• Lower relapse rates than medication alone (30% vs 60-80%)
• Teaches practical skills for managing future difficulties
• No physical side effects
• Addresses thinking patterns maintaining depression
• Can be delivered individually, in groups, or via computerised programmes (cCBT)

Limitations of CBT:

• Requires motivation and active engagement — challenging for severely depressed patients
• Less effective for severe depression without concurrent medication
• Typically 12-20 sessions required — time-intensive and expensive
• Waiting lists on NHS can be 6-12 months in some areas
• Effectiveness depends on therapist skill and therapeutic relationship
• Cultural differences in expressing emotions may affect suitability
• Does not address underlying biological factors
• Some patients find homework assignments difficult to complete

Comparing biological and psychological approaches

When biological treatments are preferred:

• Severe depression where psychological therapy alone is insufficient
• Patients unable to engage with talking therapy due to symptom severity
• Rapid symptom relief needed
• Patient preference for medication
• Limited access to qualified therapists

When psychological treatments are preferred:

• Mild to moderate depression
• Patients wishing to avoid medication side effects
• Pregnant or breastfeeding women
• Children and adolescents (first-line recommendation)
• Patients wanting long-term relapse prevention
• Co-occurring psychological issues requiring exploration

Combined treatment approach:

Research indicates that combining CBT with antidepressants produces superior outcomes for severe depression compared to either treatment alone. The combination:

• Addresses both biological and psychological maintaining factors
• Medication provides symptom relief enabling engagement with therapy
• CBT provides skills reducing relapse when medication discontinued
• NICE guidelines recommend combined treatment for severe or recurrent depression

Worked examples

Example 1: Describe characteristics of depression (4 marks)

Student answer: Depression involves feeling sad all the time and not enjoying things you used to like. People with depression might stay in bed and not want to see their friends. They also think negative thoughts about themselves and might have trouble sleeping or eating properly.

Mark scheme commentary: This would achieve 3-4 marks. The answer demonstrates knowledge across multiple symptom categories: emotional (sadness, anhedonia), behavioural (social withdrawal, sleep/appetite changes) and cognitive (negative thoughts). To guarantee full marks, use precise terminology such as "persistent low mood," "anhedonia," "social withdrawal," and "negative cognitive triad."

Example 2: Evaluate SSRIs as a treatment for depression (6 marks)

Student answer: SSRIs are effective because research shows they work for about 60-70% of patients with moderate to severe depression, which is better than placebo in controlled trials. This is a strength because it provides scientific evidence supporting their use. They also have fewer side effects than older antidepressants and are easy to take as one tablet daily.

However, SSRIs have limitations. They take 2-4 weeks to start working, which means patients must wait for relief. About 30-40% of patients don't improve much with SSRIs, suggesting they don't work for everyone. Side effects like nausea and sexual dysfunction can make people stop taking them. Additionally, SSRIs only treat symptoms not underlying causes, and relapse rates are high (50-80%) when medication stops, suggesting psychological therapy might be needed too.

Mark scheme commentary: This would achieve 5-6 marks. The answer provides balanced evaluation with multiple strengths (effectiveness with statistical evidence, comparison to placebo, side effect profile, ease of use) and limitations (delayed onset, variable effectiveness with statistics, side effects, lack of addressing causes, relapse rates). Evidence is used effectively. The answer demonstrates analytical thinking by considering alternative treatments.

Example 3: Explain how CBT treats depression (4 marks)

Student answer: CBT helps people with depression identify their negative thoughts and challenge them with evidence. For example, if someone thinks "I'm useless at everything," the therapist helps them find evidence against this thought, like times they succeeded at tasks. CBT also uses behavioural activation where patients schedule enjoyable activities to improve their mood. Through homework assignments like thought records, patients practice these skills between sessions and learn to change both their thinking patterns and behaviours.

Mark scheme commentary: This would achieve 4 marks. The answer explains the process clearly with both cognitive restructuring and behavioural components. The inclusion of a specific example demonstrates understanding. Key terminology (negative thoughts, evidence, behavioural activation, homework assignments, thought records) is used accurately.

Common mistakes and how to avoid them

• Confusing unipolar depression with bipolar disorder — Remember that unipolar depression involves only low mood episodes, while bipolar includes manic episodes. Exam questions specifically ask about depression (unipolar), not bipolar disorder.

• Describing treatments without linking to mechanisms — Don't just state "SSRIs increase serotonin." Explain that they block reuptake at the synapse, increasing availability for receptor binding, which improves mood regulation.

• Listing symptoms without categories — Structure symptom descriptions using emotional, cognitive, behavioural and physical categories to demonstrate comprehensive knowledge and ensure full coverage.

• One-sided evaluation — Always provide balanced evaluation with both strengths and limitations. Aim for at least two points on each side for 6-mark questions.

• Vague research evidence — Avoid phrases like "studies show." Instead, provide specific statistics (e.g., "60-70% effectiveness rate") or name concepts (e.g., "randomised controlled trials," "meta-analyses").

• Confusing CBT with other therapies — CBT is specifically cognitive-behavioural, combining thought challenging with behaviour change. Don't confuse it with psychoanalysis, counselling or other approaches not on the specification.

Exam technique for "Psychological Problems: Characteristics and Treatments"

• "Describe" questions (2-4 marks) — Provide factual information without evaluation. Include specific characteristics, processes or features. Aim for approximately one developed point per mark. Use psychological terminology accurately.

• "Explain" questions (4-6 marks) — Go beyond description to show understanding of how or why something occurs. Use connectives like "because," "therefore," "this leads to." Link concepts together logically and include examples where appropriate.

• "Evaluate" questions (6-8 marks) — Provide balanced analysis with strengths and limitations. Use evidence (research findings, statistics, real-world applications) to support points. Make comparisons between treatments. Consider issues like effectiveness, ethics, practicality and individual differences. Conclude with overall judgement where appropriate.

• Command word awareness — "Outline" requires brief details (less depth than "describe"). "Assess" and "evaluate" are similar, requiring judgement. "Compare" requires explicit similarities and differences, not just describing each separately.

Quick revision summary

Depression is characterised by persistent low mood, anhedonia, negative thinking, social withdrawal and physical symptoms lasting at least two weeks. Biological treatments include SSRIs, which increase serotonin availability by blocking reuptake; they're effective for 60-70% of patients but have side effects and high relapse rates. Psychological treatments like CBT challenge negative thought patterns and increase activity; research shows comparable effectiveness to medication with lower relapse rates. Combined treatments are recommended for severe depression. Evaluate treatments using evidence, comparing effectiveness, side effects and addressing underlying causes.