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Flashcards in Abnormal - evaluate treatments of depression Deck (15):
1

biomedical treatment

- usually uses medications to alter activity of neurotransmitters in the brain
- assumes that biological changes can improve psychological conditions
- assumes that the cause of the problem is biological and therefore the solution should also be biological

2

biomedical treatment for depression

- using SSRIs (Selective Serotonin Reuptake Inhibitors)
- based on the serotonin hypothesis that low serotonin levels → depression
- maintains high serotonin levels and consequently improves mood
- popular because they have relatively few side effects (e.g. headache, nausea, sleeplessness, agitation, and sexual problems)

3

effectiveness of SSRI

Kirsch et al (2008):
- meta-analysis comparing placebos and SSRIs
- noted that there was virtually no difference in the effects of placebos and SSRIs on moderate depression
- but significant differences were observed between the effects of placebos and SSRIs on severe depression
- concluded that SSRIs are only really effective for severe depression

Broich (2009):
- proposes that instead of measuring only change in severity of symptoms, one should analyze the proportion of patients that achieve a particular threshold of wellness
- economic backlash of ineffectiveness of drugs: massive loss of income for a number of pharmaceutical companies
- ethical problems with research on drug effectiveness: lying to patients about the kind of treatment they receive is deceptive and dangerous

4

effects of SSRIs on the brain

Leuchter et al. (2002):
- used EEG to examine brain f€unction in 51 depression patients
- prior to EEG the patients received either an SSRI or a placebo
- placebo group showed significant increase in activity in the pre€frontal cortex throughout the trial
- SSRI group showed varying activity levels
- both groups showed similar behavioural effects (improved mood)
- the fact that the placebo group showed differences in brain activity indicates that the brain may be able to heal itself just by believing it's being treated

5

strengths of biomedical approach

- time-efficient: work very quickly.
- cost-efficient: no need for long (and potentially costly) sessions with a therapist

6

weaknesses of biomedical approach

- SSRIs alone reduce depressive symptoms but they have side e€€ffects and do not cure patients
- Kirsch et al (2008): placebo eff€€ect could account €for eff€€ectiveness o€f medication
- Leuchter et al. (2002): drugs may affect brain activity, and long-term effects of drugs on the brain are unknown

7

individual approach

- when a client meets alone with a therapist and the therapist uses psychological techniques to help the person with their symptoms
- assumes that the cause of the disorder is NOT biological; rather, that it's purely psychological and simply connected with experience or cognition
- assumes that successful individual therapy will result in full recovery

8

individual approach: CBT

- linked to Beck€'s cognitive triad (1976) where automatic negative thinking is assumed to cause depression
- aims to change negative thinking patterns (cognitive restructuring)
- aims to identify automatic negative thinking patterns and change them

9

individual approach: IPT

- sympathetic person discusses past experiences but without any theoretical guidance
- concentrates on helping the client develop and use positive social support networks as well as improve communication skills
- also helps adjust clients’ expectations to be more realistic

10

individual vs biomedical

IPT vs biomedical
Parker et al. (2006):
- IPT alone is not as quick as medication in relieving symptoms, but does provide substantial improvement later on
- found that a primary focus on IPT with some use of medication was the most effective treatment
- possibly because if it was the other way around patients would have expected medication to solve their problems -- the main focus on IPT prevents them from being too reliant on medication

CBT vs biomedical
March et al. (2007):
- divided 300 depressed teenagers into 4 conditions: Prozac only, CBT only, Prozac + CBT, and placebo only
- after 12 weeks the improvements were: eclectic > Prozac > CBT > placebo
- but by 36 weeks all 3 group were approximately on the same level
- but it was noted that the Prozac only group experienced more suicidal thoughts than groups that received CBT
- March et al concluded that an eclectic approach was most effective

Butler et al. (2006):
- reviewed meta-analyses of efficacy studies for CBT
- concluded that CBT is extremely effective for depression, though the effect is not usually greater than medication alone
- best outcomes have eclectic approach

11

potential problems with IPT

Hodges and Oei (2007):
- in collectivist cultures (e.g. China), the power distance between therapist and client may make CBT more effective
- the power distance compels clients to accept the therapist’s interpretations and advice without complaint
- but successful CBT requires an element of argument
- without this, the true nature or reasons behind the client's depression will simply be temporarily repressed and may trigger a relapse in the future

12

eclectic therapy

- therapies that combine 2 or more approaches to treatment
- most common form in depression is medication + therapy
- generally considered irresponsible to use either medication or therapy on their own
- why not medication only? the patient may become dependent on the medicine and will likely relapse if they stop taking it
- why not therapy only? when a person’s thinking is disordered, appealing to them on a rational basis can be very difficult
- medication is the fastest way to improve the patient's condition so that psychotherapy can begin
- when people reach an acceptable threshold of cognition, therapy teaches people the kind of skills they need in order to function without further use of medication

13

group therapy

- when a therapist works with several clients at the same time, encouraging them to talk to and help each other
- assumes that interpersonal contact with people in a similar situation will improve each individual's condition
- assumes that when people are surrounded by others with similar emotional experiences, they are more likely to discuss about it
- assumes that discussing in a group helps develop important social skills that clients can use in real life

study: Hyun et al. (2005)

14

Hyun et al. (2005)

- randomly assigned depressed adolescents at a shelter for runaways to group CBT or no treatment
- found that group CBT significantly alleviated depression

15

criticism of group therapy

Truax (2001):
- notes that meta-analyses omitted group therapy results involving severely depressed patients
- dissatisfaction with the group might lead to drop-out
- could be counter-productive to treat depressed people by surrounding them with more depressed people

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