Psychological therapies for mood disorders Flashcards
(35 cards)
What are the most common types of psychological therapies for mood disorders?
- CBT
- Interpersonal therapy (IPT)
- Behavioural activation
- Behavioural couples therapy
- Mindfulness (MBCT, MBSR)
- Psychodynamic therapy
- Counselling
What is the current evidence and use of CBT?
- Very common
- Extensively researched and strong evidence base
- Involved in many different forms to treat numerous psychological disorders
What is the current evidence and use of interpersonal therapy (IPT)?
- Strong evidence base
- Rarely used in UK
- More popular in EU and US
What is the current evidence of behavioural activation?
- Less evidence base compared to CBT and IPT
- Can still be effective
What are the advantages of behavioural activation?
- Simple
- Minimal training/experience required to administer
- Favours patient engagement: can be used to initially engage patients before using another therapy
What is the theory underlying behavioural couples therapy?
> Systemic tradition:
- problem and solution don’t exist within the individual, but also involves their wider system (social network) (i.e. family, friends, colleagues)
> Focus on the person with depression and their partner
What are the two therapies within the mindfulness approach?
> Mindfulness Based Cognitive Therapy (MBCT)
- from Zindel Segal, Mark Williams, and John Teasdale
> based on: Minfullness Based Stress Reduction Program (MBSR)
What is the current evidence and use of Psychodynamic therapy?
Also called Dynamic interpersonal therapy (DIT)
- one of oldest forms of therapy
- based on Sigmund Freud
- lack of research support
- can take several years
- short form: 16 sessions
- more research taking place
What does counselling refer to?
“Systematic process which gives individuals an opportunity to explore, discover and clarify ways of living more resourcefully, with a greater sense of wellbeing”
- most often delivered in primary care settings by GPs
- person-centered, looking at individual’s circumstances
- drawing on therapeutic approaches
- can be mixed-approaches
What are the different types of depression?
> Subthreshold depression
> Mild moderate depression
> Moderate severe depression
> Chronic depression
> Treatment-resistant depression
What is depression?
A heterogeneous condition that can take different forms
What characterises subthreshold depression?
- Low mood
- Low esteem
- Important to detect and treat early
- Associated with increased risk of other mental health problems
- Under the clinical threshold for depression diagnosis
What characterises mild moderate depression?
- Most common form
- Low mood/esteem
- Loss of pleasure
- Changes in appetite
- Sleep disturbance and fatigue
What characterises moderate severe depression?
- Similar symptoms to mild-moderate depression
- Severe impact on day-to-day functioning
- Feelings of worthlessness and death
- Suicidal ideation
What characterises chronic depression?
- Many episodes of depression
- Multiple relapses
What characterises treatment resistant depression?
- Moderate to severe symptoms
- No improvement despite 2 or more courses of antidepressants
What does CBT consist of?
> Active approach focused on identifying and understanding links between thoughts, feelings, behaviour, and physical reactions
> Thoughts triggered by situations and life events
- > identify and monitor distressing thoughts/beliefs (schemas)
- > develop coping skills
> Activity schedule for behaviour
- increase person’s engagement by reinforcing activities
- identify avoided activities
(avoidance can be key in maintenance of depression)
What does behavioural activation consist of?
> Takes behavioural elements of CBT, but doesn’t address cognitive issues
> Patient encouraged to identify effects of their behaviour on current symptoms and emotional states
> Functional analysis: ABC
- also applicable to avoidant behaviour
> Important to schedule pleasurable activities (mastery and achievement)
Why can behavioural activation be referred to as a “sticking plaster therapy”?
Can patch a person up, making them feel better
BUT high risk of relapse
- you’re not addressing the underlying thought patterns
What does the functional analysis in behavioural activation consist of?
Analysis of:
1. Antecedent: before the behaviour
- Behaviour: its function and form
- Consequences: results after behaviour
What does Mindfulness based cognitive therapy (MBCT) consist of?
> Important in preventing relapse and recurrence of depression
> Evidence from early trials: only works if you’ve had 3 or more episodes of depression
> Format:
- 8 weeks
- group based
- mindfulness meditation practices are taught
- recap of CBT skills
> Focus on helping patient recognise “autopilot mode”
- when same thought process persists
- meditation used to step outside of it
- decentre from thoughts and feelings
- respond more objectively, with healthier ways
- develop compassion and kindness
What does interpersonal therapy consist of?
> Derived from interpersonal model of affective disorders
- depression occurs as response to loss from interpersonal difficulties
- relationships affect our mood
> Focus on interpersonal conflict (e.g. grief)
- > help patients examine social skills and improve them
- draw links between interpersonal conflict and feelings
> Learn to cope with and resolve interpersonal difficulties more effectively
What does couples therapy consist of?
> Interpersonal focus (like IPT)
> Limited to an individual and a partner
- must have a partner who is willing to engage in the sessions
> Can be vey effective when appropriate
> Focus on understanding the effects of interactions as factors in development and maintenance of depression
- then look at changing those interactions: increase supportive behaviours, decrease behaviours causing conflict
> Lot takes place between sessions, including set tasks to try at home
What does psychodynamic therapy consist of?
> Derived from analytical model of Sigmund Freud
> Emphasis on past patterns of behaviour and relationships and how they play out in session
> Transference and countertransference in therapeutic relationship
-> enabling revisit of past conflicts, conscious and unconscious
> Can take years to complete -> costly
> Dynamic interpersonal therapy (DIT)
- short form, in 16 sessions
