treating depression Flashcards
what is the main treatment of depression?
cognitive behavioural therapy
how does CBT treat depression?
-believes depression is caused by maladaptive thinking
-helps ps identify maladaptive thoughts and akter them
-CBT is an umbrella term for multiple different therapies, including REBT and TNAT (treatment of negative automatic thoughts)
what is REBT?
-rational emotive behaviour therapy
-developed by ellis - ‘people are not disturbed by things but rather their perception of things’
-ellis identified 11 irrational masturbatory beliefs, eg ‘i must be loved by everybody, i must be excellent in all aspects’
-aims to show how irrational thoughts are
-uses reframing (interpreting ABC model in a more positive way)
how does REBT use the ABC model?
-activating event - patients keep a record of events that cause disordered thinking
-belief - patients record negative thoughts sparked by the event
-consequences - patients record negative thoughts and behaviours that follow
what is the structure of REBT?
-generally 2 sessions every 2 weeks for about 15 sessions
-education phase - ps learn the relationship between thoughts, emotions and behaviour
-behavioural activation and pleasant event scheduling phase - increase psychological activity and participation in social activities
-hypothesis testing stage - proving irrational thoughts wrong, usually tasks set by the therapist that can be done
-booster sessions given throughout the year to prevent relapse
what was embling’s research on CBT?
-38 ps aged 19-65 suffering from depression diagnosed using ICD-10
-19 ps given just antidepressants seen once a week by a trained clinician to assess side-effects and symptoms (control group)
-other ps got 12 sessions of CBT
-treatment group’s mean BDI-II score decreased, control group’s didn’t
-those who didn’t improve with CBT had high levels of sociotropy (need to be liked) and perfectionism, and low autonomy and high external LoC
-CBT + drugs is more effective than just drugs
-personality characteristics can affect the success of CBT
-improvement of treatment group could be bcs they were seen more frequently
research on CBT
david et al 2008 - 170 ps suffering from major depressive disorder, those given REBT over 14 weeks had better treatment outcomes than those give fluoxetine 6 months after treatment, suggesting REBT is better long-term
evaluate CBT
-most effective for moderate-severe depression, as well as preventing mild from worsening
-the better the therapist the more successful
-short time period and cost effective in the long-term, plus more long-term benefits
-does depression cause maladaptive thinking or is it the other way? (behavioural therapists argue both ways)
-ethical concerns that it’s too therapist centred, could abuse power
-difficult to evaluate - senra + polaino -different measurement scales gave different results of effectiveness
-not suitable for those who can’t communicate
what are the two other treatments?
-drug therapy
-ECT
how does drug therapy treat depression?
-physical effect on the brain, increase serotonin levels
-3 types of antidepressants - SSRIs, tricyclics, MAOIs
-DeRubeis et al 1999 - compared antidepressants and CBT in 4 clinical trials, finding small advantage for CBT
evaluate drug therapy
-comparison to CBT is difficult to assess as there are different forms of each which all benefit people differently
-relapse rates must also be considered, where CBT is superior
-drugs don’t require a therapist
-drugs take longer to act than CBT, and also take longer to withdraw from to prevent side-effects
what is ECT?
-electroconvulsive therapy
-electrically stimulating the brain thru electrodes on the head, believed to produce changes in neurotransmitter levels, including sensitivity to serotonin and increase in GAB, noradrenaline and dopamine levels
-generally used where other treatments failed
-fenton et al 2006 - gave 6 ps 12 weeks of CBT following ECT, 5/6 had further symptom reduction, showing how the two treatments can be combined
evaluate ECT
-may only have a short-lived positive effect, but gives the opportunity for other therapies to work
-can have side-effects like memory loss
-only generally given to ps who don’t respond to any other treatments, so can save lives
