Transcript Cognitive explanations and treatments

Cognitive explanations: Beck et al
• Q, What do we mean by cognitive
distortions and can you give examples?
Aim
• To understand cognitive distortions in
patients with depression.
Depression
• Q, What is depression, how do we get it
and how is it different to bi-polar?
Method
• Clinical interviews with patients who were
undergoing therapy for depression.
Issues
• Q, What issues must we consider straight
away that may affect the findings?
Participants
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50 patients diagnosed with depression
Aged 18 – 48
Middle to upper class
At least average intelligence
Design
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Independent design
Compared with 31 non-depressed patients
All undergoing psychotherapy
Matched on age, sex, social position
Procedure
• Face to face interviews
• Included retrospective reports of patients
thoughts
• Spontaneous thoughts during the session
• Some patients brought diaries that they
had kept
Procedure
• Records of non-depressed patients
verbalisations also kept for comparison
Findings
• Certain themes appeared more in
depressed patients that did not appear in
non-depressed.
Themes
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Low self-esteem
Self-blame
Overwhelming responsibilities
Anxiety caused by thoughts of personal
danger
• Q, How are these cognitive distortions?
Findings
• Inferior to others (social and occupational
groups).
• Unlovable and alone
• Illogical self-blame
Conclusions
• Patients have cognitive distortions
• These distortions deviate from realistic
and logical thinking
• Seen even in mild depression
• Related only to depression
Group task
Treatments
• Task: List a range of possible treatments
and explain (behavioural, biological and
cognitive):
• Which disorders these treatments best suit
• S&W of the treatments
Behavioural (3.1)
• Study by McGrath
• Successful treatment of a noise phobia
Aim
• Treat a 9 year old girl (Lucy) with noise
phobias
• Using systematic desensitisation
The participant had:
• A fear of sudden loud noises
• Balloons, party poppers, guns, cars
backfiring and fireworks
• Lower than average IQ
• Not depressed, anxious or fearful
• Tested with psychometric tests
Issues?
Design
• Single-participant
Procedure
• Consent given by parents
• Lucy went to therapy sessions (playful
environment)
• Session one, participant constructed a
hierarchy of feared noises (doors banging
etc)
• Lucy taught breathing and imagery to relax
(at home on her bed with her toys)
Procedure
• Lucy used a fear thermometer to rate her
level of fear (1 – 10)
• Stimulus of the loud noise paired with
relaxation technique (deep breathing and
bedroom with toys)
• Relaxation techniques made her feel calm
• Associated noise with feeling calm
Procedure
• After 4 sessions felt calm when stimulus
presents
• Did not need to imagine she was playing
with her toys in her bedroom
Findings
By the end of session one
• Reluctant to let balloons be bust (even far
away, corridor)
• When balloon burst Lucy cried and was
had to be taken away
• Encouraged to breath deeply and relax
By the end f session four:
• Lucy was able to have he balloon burst 10
meters away
• Using fear thermometer only showed mild
anxiety
By the end of session five:
• Lucy was able to pop the balloon herself
Over the next three sessions
• Party poppers were introduced
• To start with Lucy did not allow them in the
room
• Eventually, Was able to pop one herself if
held by therapist
Scores by tenth session (final)
• Balloons: 7/10 to 3/10
• Party poppers: 9/10 to 3/10
Conclusions
• Systematic desensitisation successful in
children
• Control is the key factor
• Use of inhibitors also key (relaxation &
playful environment)
Treatments
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Biological (3.2)
Karp & Frank (1995)
Review article
Considers the effectiveness of drug
therapies for depression
Title
• Combination therapy and the depressed
women
Method
• Review article.
• Considers previous research into the
effectiveness of single treatments and
combined drug and psychotherapeutic
treatments for depression.
Participants
• Research reviewed concentrated on
women diagnosed with depression.
Design
• Majority of research used an independent
design.
• Patients had:
- Single drug treatment
- Single psychological treatment
- Combined treatments
- Sometimes placebo groups.
Procedure
• Depression was analysed (using a range
of psychometric tests and questionnaires)
• Patients were generally tested prior to
treatment, after treatment (and in some
cases after a period of time as a follow up)
Is depression caused by a chemical
imbalance in the brain?
• Depression may be caused by a chemical imbalance in
the brain.
• According to the chemical imbalance theory, low levels
of the brain chemical serotonin lead to depression
• depression medication works by bringing serotonin
levels back to normal.
• However, researchers know very little about how
antidepressants work.
• There is no test that can measure the amount of
serotonin in the living brain
• no way to even know what a low or normal level of
serotonin is
• let alone show that depression medication fixes these
levels.
Drugs used in depression
• Antidepressant medication may relieve
some symptoms.
• Prozac increase serotonin levels in the
brain
• They come with their own side effects and
dangers.
• Recent studies have raised questions
about their effectiveness.
Side effects
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Nausea
Insomnia
Anxiety
Restlessness
Decreased sex drive
Dizziness
Weight gain or loss
Tremors
Sweating
Sleepiness
Fatigue
Dry mouth
Diarrhea
Constipation
Headaches
Suicidal risks
Psychological treatment for
depression
• Psychotherapy can assist the depressed individual in several
ways.
• First, supportive counseling helps ease the pain of depression,
and addresses the feelings of hopelessness that accompany
depression.
• Second, cognitive therapy changes the pessimistic ideas,
unrealistic expectations, and overly critical self-evaluations
that create depression and sustain it.
• Cognitive therapy helps the depressed person recognise which
life problems are critical, and which are minor.
• Helps to develop positive life goals, and a more positive selfassessment.
• Third, problem solving therapy changes the areas of the
person's life that are creating significant stress, and
contributing to the depression (work, relationships)
Findings
• A lot of research suggested adding
psychological treatments to drug therapy
did not increase the effectiveness of drug
therapy.
Findings
• Some research suggested less attrition
(withdrawal) when combination therapies
were used.
• Therefore more people were likely to
continue the treatment if cognitive therapy
was given in addition to drug therapy.
Conclusions
• Two treatments are not necessarily better
than one
• Drug therapy is not effective within the
treatment of depression
Treatments
• Cognitive (3.3)
Ellis (1991) Identified the ABC of
rational emotive therapy
• A, Activating events (failing an exam)
• B, Your beliefs (you think you are not
intelligent as you failed the exam)
• C, Consequences (you may continue to
have this illogical thinking)
Beck et al
• Comparing the effectiveness of drug
therapy and cognitive therapy.
Aim
• To see which therapy leads to better
treatment for depression.
Methodology
• Controlled experiment
• Ps allocated to one of two conditions
Design
• Independent design
• Random allocation a condition
Participants
• 44 Ps (patients)
• Diagnosed with moderate to severe
depression (major issue)
• Attending psychiatric outpatients clinic
Procedure
• P’s assessed with 3 self reports
• One method was Beck Depression Inventory (a
21-question multiple-choice self-report
inventory)
• The questionnaire is designed for individuals
aged 13 and over
• Composed of items relating to symptoms of
depression such as hopelessness and irritability,
cognitions such as guilt or feelings of being
punished.
Procedure
• 12 week programme
• Condition 1: One hour cognitive therapy
session twice a week
• Condition 2: 100 Imipramine
(antidepressant medication) capsules
(prescribed by visiting doctor for 20
minutes once a week)
Procedure
• Cognitive therapy sessions were suited to
the individuals needs (individual
differences considered)
• Were all controlled
• Therapists observed to increase reliability
Findings
• Both groups = Significant decrease in
depressive symptoms on all 3 rating
scales
• Cognitive treatment showed significantly
greater improvements in self-reports and
observer based ratings
• 78.9% increase in cognitive treatment
• 20% increase in drug treatment
Findings
• Drop-out rate = 5% in Cognitive Therapy
• Drop-out rate = 32% in Drug Therapy
Conclusions
• Cognitive Therapy leads to better
treatment of depression
• Also better adherence