Transcript Treatment of Depression

Psychology of Individual Differences
What is Depression?







Sad/flat mood
Loss of interest in usual hobbies.
Difficulty sleeping.
Shift in activity level.
Change in appetite (decrease or increase).
Feelings of worthlessness/guilt.
Thoughts of death/suicide
 These symptoms must be persistent and last a
minimum of 2 weeks.
Who suffers?
 Anyone!!!
 Only 1 in 3 people suffering from a mood disorder seeks
help.
 The risk of suicide is 30 times greater among people with
depression than in the general population.
 A study by the World Health Organization (WHO) and the
Harvard School of Public Health reveals that by the year
2020 depression will be the single leading cause of death
around the globe.
 For youth between the ages of 15 and 24, suicide is now the
third leading cause of death. For college students, it is the
second leading cause.
Medical Model
 Depression is inherited
 McGuffin et al, 1996
 Harrington et al, 1993
 Wender et al, 1986
 Neurotransmitters
 Bunney and Davis, 1965
 McNeal and Cimbolic, 1986
Treatments
 The treatments used by the medical model are known
as ‘somatic’ treatments, meaning ‘of the body’
 They aim to fix the part of the body which is ‘not
working’
 There are three main types of anti-depressant, all of
which affect the chemical balance of the brain.
Anti-Depressants
 MAO-Inhibitors
 Effective in approximately 50% of cases, but with severe
side effects. Used only when other treatments have
failed.
 Tricyclic antidepressants
 Prevent the re-absorption of serotonin and adrenaline,
increasing the level in our system. However, SommersFlanagan et al (1996) found they were no more effective
than a placebo.
Anti - Depressants
 Selective Serotonin Re-uptake Inhibitors (SSRIs)
 These include widely-used brands such as Prozac, and
work in a similar way to tricyclics.
 However, they only block serotonin reabsorption – not
all neurotransmitters.
 Joffe et al (1996) found they were more effective than
placebos.
Evaluation of Anti-Depressants
 Doesn’t work for all patients.
 Side effects.
 Nausea, diarrhea, anxiety insomnia, loss of libido
(Hollander and McCarley, 1992; Jacobsen, 1992;
Montgomery, 1995)
 Can be quick acting to relieve the symptoms.
 Cost free for the patients.
ECT
 What can be used when drug treatments are
ineffective?
 Electro-Convulsive Therapy (ECT) is a controversial
treatment mainly used as a ‘last resort’.
 Comer (2002) found a 60-70% improvement rate, but
Sackheim et al (2001) argued that many patients later
relapsed.
ECT Process
 A current of moderate intensity is passed through 2
electrodes attached to the patient’s head for about half
a second.
 This results in a 30-60 second convulsive seizure.
 Usually this is repeated 6-10 times over a 2 week
period.
 Current patients are given an anaesthetic. Previously
they were not which resulted in thrashing and injury.
Evaluation
 Works for 70-80% of patients who have not responded
to drugs (Janicak et al, 1985)
 Works faster than some anti-depressants (Weiner,
1985)
 Can cause memory impairment which can last for
months (Squire 1977)
 For more info on ECT check out the list of useful
websites in the ‘Individual in the Social Context’ tab
on the blog.
Revision essay question
 Discuss the origins and treatment of
depression according to the medical model.
 To answer this task you should look at:
 The approaches core beliefs.
 What it believes causes depression.
 How it attempts to treat depression.
 Remember to evaluate each of these points. (What are
its advantages and disadvantages?)
Cognitive- Behavioural Therapy
 Teach clients to think more positively.
 Eases the pain of hopelessness.
 Client-centred – allows the client to make the changes
for themselves.
 Changing how you think (cognitive) in order to change
what you do (behavioural)
Beck’s Cognitive Therapy (1976)
Beck’s Cognitive Therapy Process
 Replace negative thoughts with positive ones.
 Stage 1 Therapist & client agree on nature of problem
& goals for therapy
 Stage 2 Therapist challenges the client’s negative
thoughts
Example
 Situation: You've had a bad day, feel fed up, so go out
shopping. As you walk down the road, someone you
know walks by and, apparently, ignores you.
 Thoughts: They ignored me – they must not like me.
 Emotions: Rejected, sad. Feel sick, low energy.
 Reaction: Go home and avoid them in the future.
Altered thinking
 By altering this way of thinking the reaction (and
therefore the behaviour) would be a lot different.
 Thoughts: They look a bit distracted, I wonder if
there is something wrong.
 Emotions: Concern for the other person.
 Action: Go home and phone them to see if they are
ok.
Rational Emotive Behaviour
Therapy (Ellis, 1957)
 Like Beck’s Triad, Ellis believed that depression was a
result of maladaptive thinking (self-defeating).
 ABC model:
 Activating events (the things that happen, eg getting
fired)
 Beliefs (how you interpret the event. This can be
maladaptive, eg I am useless, or rational, eg My boss is
an idiot)
 Consequences (the behaviour as a result, eg become
depressed or go out and find a new job)
 This is what the current CBT is based on (as in the
example above)
Success
 Ellis, 1957 claimed 90% success rate with an average of
27 sessions.
 Smith and Class, 1977 carried out a meta- analysis and
found CBT to be most effective form of psychotherapy
to treat depression (systematic desensitisation was
first overall, CBT 2nd overall).
 Ethical? Rosenhan and Eligman, 1989, criticised this
method as being ‘judgemental’ and ‘aggressive’.
CBT Process
 Sessions can be individual, in groups, or even via a self




help book.
Individually can meet up with the therapist 5-20 times,
weekly or fortnightly and from 30mins-hr.
Therapist asks questions about the past in order to
determine why they think that way now and how they
can change it in the here and now.
Clients decide their goals.
Work with the therapist to determine what they want
to achieve from each session.
CBT Process contd.
 Keep a diary between sessions to track progress and
identify any thought patterns.
 Work with the therapist to determine what is
unhelpful and how to alter it in the future.
 Homework between sessions is to actively attempt to
change this way thinking.
Evaluation
 Not a quick fix – takes time to train the client.
 If the client is feeling low, it can be difficult to
concentrate and get motivated.
 To overcome anxiety, clients need to confront it. This
may lead them to feel more anxious for a short time.
Evaluation
 DeRubeis et al, 2005. Compared the effects of anti-
depressants vs CBT. Found that CBT could be just as
effective as AD but that its success was dependant on
therapist experience and expertise.
 Hollon, 2005 followed up DeRubeis study 12 months
later and found that 31% CBT, 47% Drug therapy and
76% no treatment had relapsed. (CBT has longer
lasting success)
 David and Avellino, 2003, found that CBT was the
most effective of the psychotherapies.
Revision Qstn
 Discuss the origins and treatment of depression
according to the Cognitive-Behavioural model.
 To answer this task you should look at:
 The approaches core beliefs.
 What it believes causes depression.
 How it attempts to treat depression.
 Remember to evaluate each of these points. (What are
its advantages and disadvantages?)
Psychodynamic Therapy
 Psychodynamic Therapy sessions occur once a week for
approx. 50mins.
 Unlike CBT there is no agenda. It is open-ended and allows
for ‘free association’. Also, the sessions can be longer term
 the patient is encouraged to talk freely about whatever
happens to be on his or her mind. As the patient does this,
patterns of behaviour and feelings that stem from past
experiences and unrecognized feelings become apparent.
The focus is put then on those patterns so the patient can
become more aware of how past experience and the
unconscious mind are affecting his or her present life.
Sessions involve . . .
 Discussion:
 what's happening in their life at the moment - how they
do things and the part they play in things going right or
wrong for themselves;
 what has happened in the past;
 how the past can affect how they are feeling, thinking
and behaving right now.
 Understanding:
 By understanding their own unconscious thoughts and
feelings the patients can make better decisions.
Other psychodynamic approaches:
 Dream analysis.
 Free association.
 These are used to unlock and give an insight into the
unconscious mind in order to elicit understanding.
Evaluation
 Task:
 Read through the handout, highlighting all relevant
evaluative studies.
 Where possible, make notes on the aim, participants,
method, results and conclusions.
Essay Question – Thursday 8th
November
 C4. Atypical Behaviour
Describe one psychological approach which attempts to
explain either depression or eating disorders. Explain this
approach and its therapy for treating the same disorder.
In your answer you may wish to include:
• a definition of either depression or eating disorders;
• a description of the chosen psychological approach and its
therapy;
• an evaluation of this approach and its therapy;
• any relevant research evidence;
• any other relevant points.