Transcript Guidelines for Counseling People With Depression

Major Depressive Disorder
 1. Represents a change in previous function
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2. Symptoms cause clinically significant, social,
occupational, or other important arras of functioning
(e.g...)
3. FIVE or more of :the following occur nearly very
day for most waking over the same 2-week period
◦ a) Depressed mood most of the day, nearly every day
◦ b) Anhedonia
◦ c) Significant weight loss or gain (more than 5% of body
weight on one month)
◦ d) Insomnia or hypersomnia
◦ e) Increased or decreased motor activity
◦ f) anergia (fatigue or loss of energy)
◦ g) feelings of worthlessness or inappropriate guilt
(may be delusional)
◦ h) decreased concentration or indecisiveness
◦ i) recurrent thoughts of death or suicidal ideation
(with or without plan)
Primary Risk
Factors for
Depression
Neurological: (e.g. epilepsies, Parkinson’s
disease, multiple sclerosis, Alzheimer’s)
Infectious or inflammatory: AIDS
Cardiac disorders: ischemic heart disease,
cardiomyopathies
Endocrine: hypothyroidism, diabetes,
parathyroid disorders
Inflammatory disorders: collagen-vascular
diseases, irritable bowl syndrome, chronic
liver disorders
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Central nervous system depressants: alcohol,
barbiturates, benzodiazepines, clonidine
Central nervous system medications:
amatadine, bromocryptine, levodopa,
phenothyazines, phenytoin
Psychostimulants: amphedamines
Systemic medications: corticosteroids,
digoxin, dilitazem, enapranil, reserpine,
thiaziodes, vincristine
Intervention
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Help the patient question underlying
assumptions and beliefs and consider
alternate explanations to problems.
 Rationale: Reconstructing a healthier and more hopeful
attitude about the future can alter a depressed mood.
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Work with the patient to identify cognitive
distortions the encourage negative selfappraisal.
 Rationale: Cognitive distortions reinforce a negative,
inaccurate perception of self and world
◦ For example:
Overgeneralizations
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Rationale: the patient takes one fact or event and
makes a general rule out of it (“He always…”; “I
never…”)
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Self-blame
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Rationale: The patient consistently blames self
for everything perceived as negative.
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◦ Further examples:
Mind reading
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Rationale: The patient assumes others don’t like
him or her, without any real evidence that
assumptions are correct.
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Discounting of positive attributes
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Rationale: The patient focuses on the negative
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Encourage activities that can raise selfesteem.
Identify the need for (a) problem solving
skills, (b) coping skills, (c) assertiveness
skills.
 Rationale: Many people with depression do not have a
range of problem solving and coping skills. Increasing
social, family, and job skills can change negative selfassessment.
 Note social determinants of health barriers
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Encourage exercise, such as running and/or
weight lifting (**in the context of barriers)
 Rationale: Exercise can improve self-concept and
potentially shift neurochemical balance.
 Note social determinants of health barriers
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Encourage formation of supportive
relationships, such as through support
groups, therapy, and peer support.
 Rationale: Such relationships reduce social isolation
and enable the patient to work on personal goals and
relationship needs.
 Note social determinants of health barriers
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Provide information referrals, when needed,
for religious or spiritual information (e.g.,
readings, programs, tapes, community
resources).
 Rationale: Spiritual and existential issues may be
heightened during depressive episodes; many people
find strength and comfort in spirituality or religion.
 Note social determinants of health barriers
Assumptions of brief Therapy: Along with the central
philosophy, SFBT makes several assumptions that
nurses can use to guide their interactions with the
client:
• Change is inevitable and constantly occurring.
• Focusing on the positive, the solution and the
future facilitate change.
• The client is the “expert.”
• It’s not necessary to assess or diagnose the
problem before being able to help.
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Only a small change may be necessary.
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No problems happen all the time.
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Individuals have the strengths and resources that
they need to change.
There are many ways to look at a situation. None is
more correct than the others.
Two client examples: nutrition during
pregnancy; addiction to alcohol
1. Useful questions at initial contact
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During the initial contact, these typical questions
invite the client to describe his or her problems
and goals:
“What brings you here today?”
“How can I help?”
“What would need to happen here today in order
for you to know it was a good idea to come?”
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2. Pre-session change questions
Another kind of question is one that seeks to
outline any pre-session change that may have
occurred. For example:
◦ “What has been different or better since you made
the decision to come here today?”
◦ This question recognizes that the client is already
making an effort toward positive change by asking
for help.
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3. The Miracle Question
One of the most powerful techniques developed by Berg
and de Shazer (2001) is The miracle question:
“Suppose that tonight, while you are asleep, a miracle
happens. As a result of this miracle, all of the problems
that brought you here today are gone. But, because you
were sleeping, you don’t know a miracle has happened
and the problems are now solved. What is the first thing
you will notice that will tell you something is different?”
The miracle question is an effective tool because it helps
clients set goals even when they are in crisis and feel
stuck. Framed as unrealistic, the miracle question helps
the client feel less threatened about expressing what he or
she wants
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4. The Scaling Questions
“On a scale of 1 to 10 (10 means that
you_____, and 1 means that
you_____,where are you now?”
 “Realistically, where on the scale do
you want to be?”
 “What would you need to do in order
to move up one point on the scale?”
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Brief or Solution-focused therapy is a whole
field of therapeutic knowledge
However, these basic principles and
techniques are essential for nursing, no
matter where you eventually practice