6. Working with People with Depression Flashcards

1
Q

Do various therapeutic models come into conflict?

A

Usually complementary. But one will usually come to the forefront with others offering ad hoc insight. For revolving door clients, can consider different models if previous one not effective.

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2
Q

If child has not been formally assessed and there is no RTI, but have obvious delays in learning, what do you do?

A
  • Recommend for the child to get assessed
  • Collect detailed information for parents and psychologist. This is to rule out psychosocial factors and confirm that there is a learning disability.
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3
Q

What are some problems with administration of standardized psychological tests for children?

A

Can be quite long and tiring (up to 3h). Need to know the purpose of the assessment and meaning of the diagnosis for the child and the family. If assessment is just to soothe the parent’s anxiety, then maybe just need some systemic interventions will do.

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4
Q

How do you introduce psychological tests to children?

A

Introduce it as “puzzles and games” to assess the child’s strengths and weaknesses.

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5
Q

What does Mick Power argue about emotions?

A

Argue that all emotions have a function, whether good or bad. If any emotion is sidelined, it can have consequences for the individual.

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6
Q

What are the 3 categories of depression symptoms?

A

1) Biased thoughts
2) Emotions
3) Physical drives

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7
Q

What are some biased thoughts for people with depression? (3)

A
  • thoughts of worthlessness
  • difficulty thinking or concentrating
  • suicidal thoughts, attempt or plan
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8
Q

What are some emotions that people with depression have? (3)

A
  • feeling “down or depressed”
  • loss of pleasure in activities (anhedonia)
  • feelings of guilt
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9
Q

What are some physical drives of people with depression? (4)

A
  • change in weight and appetite
  • sleep problems
  • visible restlessness or slowing down
  • tiredness and loss of energy
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10
Q

What are the 7 theories of depression?

A

1) Learning view (learnt helplessness)
2) Attributional style theory
3) Cognitive theory (core beliefs and automatic thoughts)
4) Cognitive theory SPAARS (multiple routes)
5) Metacognitive Awareness (seeing thoughts as thoughts)
6) Ruminative response style
7) Memory specificity (overgeneral personal memories)

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11
Q

Describe the learning view of depression. (Martin Seligman)

A

Learnt helplessness
Dogs in cages who are unable to escape electric shocks. overtime, the dogs just lay there and did not escape even when given the opportunity to. demonstrates learned helplessness and how they feel they can’t do anything about it.

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12
Q

Describe the Attributional Style Theory of depression.

A

“It’s how you explain events to yourself”

  • Refers to how you interpret and make meaning of events
  • Attribution style as a vulnerability
  • Internal + Stable + Pervasive = low self-esteem
  • External + Stable + Pervasive = hopelessness
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13
Q

Describe cognitive theory in explaining depression.

A

Aaron Beck - “It’s all about the content of your thoughts!”

Core beliefs about the self, the world/others, and the future

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14
Q

Describe the SPAARS approach to cognitive theory with regard to explaining depression.

A

Mick Power - “There are multiple routes!”
(Event -> NAT -> Appraisal)
(eg. Fail exam -> I am never going to pass -> I am useless)
- Schematic: appraisal of negative automatic thought. Conscious.
- Associative: repeated appraisals become automatic and associative learning occurs. Begin to associate negative event with appraisal (skip NAT). Unconscious.
Keep going through the same schematic route over and over again until it becomes automatic and associative.

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15
Q

What does the metacognitive awareness view say about depression?

A

“It’s about poor ability to see thoughts as thoughts”

  • argues that people lack the metacognitive ability to see thoughts objectively and get too caught up in their thoughts. Cannot remove themselves from their thoughts as their thoughts feel very real to them.
  • “I am having a thought that I am useless” vs “I am useless”
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16
Q

What does the ruminative response style say about depression?

A

argues that depression is caused by repetitious and passive thinking about past action, negative emotions, and negative events.

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17
Q

What does the memory specificity view argue about the cause of depression?

A

Mark Williams - “It’s all about overgeneral autobiographical memories!”
- when depressed, working memory declines, and ability to think about the past reduces. Tend to think of the past in a biased way, and no working memory available to think about alternatives.

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18
Q

With regard to learnt helplessness and associative learning, what should we do in therapy?

A

Give clients new positive experiences to help them realise that not all hope is lost and develop a sense of control.

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19
Q

With regard to attentional bias, cognitive errors, and dysfunctional schema, what should we do in therapy?

A

Help clients develop new meaning about situations and identify logical errors.

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20
Q

With regard to rumination, what should we do in therapy?

A
  • Help clients become aware that rumination is unhelpful and find alternatives.
  • Set aside time for rumination and worrying (eg. 10 min) after that you stop worrying and get on with your life. your worries are captured somewhere at least.
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21
Q

With regard to poor metacognitive ability, what should we do?

A

Help clients distance themselves from negative thoughts. Mindfulness based intervention.

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22
Q

With regard to overgeneralised memories, what should we do?

A
  • Explore positive memories that client has overlooked.
  • Help them find other evidence that is inconsistent with current thoughts.
  • Narrative therapy: tell a different story about their lives
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23
Q

How do you formulate a case using CBT for a person with depression?

A

Early experiences -> Core beliefs -> Intermediate beliefs (rules for life) -> Critical incidents/precipitating events -> Vicious cycle (automatic thoughts, feelings, behavior, consequences)

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24
Q

For a patient with depression, which intervention should we begin with? behavior, emotion, or cognitive?

A

Behavior

- behavioral techniques are means towards cognitive ends

25
Q

What are some behavioral interventions you can administer to someone with depression? (Behavioral activation)

A

Activity scheduling

  • hour by hour schedule each day
  • can add any activity from the list to the schedule
  • have a mix of achieving, enjoying, and relating activities
  • Evaluate the activity before and after in terms of depression, pleasure, and achievement.
26
Q

How do we engage in cognitive restructuring for clients with depression?

A

1) psychoeducation
- explain CBT
- cognition = any thought or image
2) guided discovery
- don’t tell them what is a helpful alternative thought
- use socratic questioning to help them to discover the helpful alternative thought themselves

27
Q

What are the 3 common themes in negative automatic thoughts

A

Loss, failure, hopelessness

28
Q

What is beck’s ‘cognitive triad’ of core beliefs?

A
  • the self
  • the world/others
  • the future
29
Q

What are 6 types of negative automatic thoughts?

A

1) All or none thinking
2) Discounting positives - only concentrating on the negative issues
3) Over-generalizing/ catastrophizing- drawing general conclusions from minimal evidence (eg. 1 bad grade and thinking I am a useless student)
4) Mind-reading
5) Self-Labelling
6) Personalizing - believing that everything is somehow directly related to you. (eg. taking things personally)

30
Q

How do we do a self-assessment of the client’s thoughts?

A

Thought record:

  • situation (who, what, where, when)
  • emotion + rating (mood at that time)
  • automatic thought (what went through by mind before I felt like this? What does this say about me, my life, and my future?)
  • evidence for
  • evidence against
  • helpful thoughts + rating (alternative thoughts, how much do you believe)
  • emotions now + rating
  • note that sometimes negative thoughts can be realistic about the current situation.
31
Q

What is usually done in behavioral experiments?

A

1) define the automatic thought in the head (old/new thought)
2) discuss possible alternative perspectives
3) make predictions about the outcome
4) begin experiment and assess results. client can test himself and report results to you.
5) reflect on the experience to consolidate learning

32
Q

What happens if the behavioral experiment supports his own hypothesis instead? (ie. didn’t go the way you expected)

A

Clients get validated as well. As a therapist, you learn that you have your own biases as well. Helps you to change the nature of the work instead.

33
Q

How to engage the client in doing more meaningful activities?

A

Get them in touch with their values.

Eg. What do you wanna be when you grow up?

34
Q

At the end of CBT, what should you do?

A

Evaluate the treatment with more questionnaires.

35
Q

Suicidal and depressed people tend to have what kind of autobiographical memory?

A
  • Overgeneral
  • More categorical than specific memories when the cue word is ‘sad’ (eg. “Every time I will fail exams” vs “I failed last semester’s stats exam”)
36
Q

Overgeneralised memories are associated with what?

A

Various kinds of trauma

eg. sexual and physical abuse, war, traffice accidents

37
Q

In memory and the self framework, memory is represented by what?

A

Hierarchy

- Higher categories of general events is constituted by lower representations called episodic memories.

38
Q

What happens to episodic memories for people with depression?

A

Episodic memories are avoided because they are painful. Person is left with higher representations that may not be a good representation of all experiences.

39
Q

With regard to memory and the self framework, what should the work of therapy focus on?

A

To increase memory specificity. Get them more in touch with specific events (ie. the good square boxes that they have forgotten)

40
Q

How do we increase memory specificity?

A
  • Mindfulness strategies

- Narrative therapy

41
Q

What is the rationale behind narrative therapy?

A
  • stories are not necessarily chosen by you but are stories that others in society tell about you.
  • these stories can be reductionistic as they only highlight certain parts of your life, but not all
  • problem lies in the discourse around the individual. these stereotypes and perceptions become your story
42
Q

What is the aim of narrative therapy?

A

To re-examine existing self-stories and construct alternative self-stories. Involves pulling out the multiple strands of one’s identity that has been forgotten.

43
Q

What are 3 steps to narrative therapy?

A

1) externalizing the problem
2) telling a new story
3) gathering witnesses for this new story

44
Q

How do you externalize the problem in narrative therapy?

A
  • objectify the problem
    (eg. ‘the depression’) and give it a name (eg. Dr. Doom)
  • Power of language! Frame the problem lies in the depression, not the individual. Less shame on the individual (“What do you think Dr. Doom is up to? What is he doing to you?”)
45
Q

How do you tell yourself a new story in narrative therapy/?

A
  • find exceptions to the dominant storyline
  • develop the new story by finding more evidence for it in the person’s history
  • look out for specific past actions and what values these actions reflect
46
Q

How do you gather witnesses for the new story?

A

Get people to testify to the person’s alternative identities.

  • can be from the past (eg. “you stayed up all night so you could be there for your friend! what does that say about you?”)
  • can be from the present (client will read his alternative life story to an audience. audience can be moved by the new story. something public and concrete about this new identity)
47
Q

What are the bio-psychosocial factors influencing one’s vulnerability to depression?

A

Biological - genetics, brain structure, neurochemical factors, circadian rhythms, physical health
Psychological - self esteem, beliefs about the self, the world and the future, coping skills
Social - social skills, early life experiences, life stress, social support, economic circumstances, education

48
Q

What do attachment theories emphasize about vulnerability to depression?

A

Highlights the role of early relationships with caregivers as paving the way for patterns of relationships throughout the lifespan, which may be depressogenic

49
Q

What do NICE guidelines recommend for people with depression?

A
  • Cognitive Behavioral Therapy (CBT)
  • Interpersonal therapy
  • Behavioral Activation
  • behavioral couples therapy
  • Counseling or short-term psychodynamic therapy
50
Q

To prevent relapse, what therapy is usually used?

A

Mindfulness-based cognitive therapy

51
Q

What do clients do in CBT?

A

Clients learn to identify unrealistic and unhelpful thinking patterns that may be maintaining their depression, and are taught techniques to challenge these thoughts in their daily lives. They start developing more adaptive ways of thinking about themselves and their world, and learn practical ways to improve their state of mind.

52
Q

How does behavioral activation work in helping clients with depression?

A

Based on the principle that when people become depressed, many of their activities function as avoidance or escape from unpleasant thoughts, feelings, or situations. BA forcuses on activity scheduling to help clients with depression re-engage in pleasurable and meaningful activities. Level of activity will be built up towards long-term goals. This reduces behavioral and cognitive avoidance.

53
Q

How does interpersonal therapy help clients with depression?

A
  • Based on the idea that depression can be understood in the context of current difficulties in relationships.
  • Focuses on current relationship themes: conflict with another person, life changes, grief and loss, difficulty in starting or keeping relationships going
  • Help clients recognize the reciprocal relationship between interpersonal factors and depression, and teach clients to cope or resolve interpersonal problems
54
Q

How does behavioral couples therapy help clients with depression?

A

Help couples understand how their interactions may affect one another. Help develop more helpful interactions to reduce stress and increase support within the couple. Focus is on improving communication, changing behavior, increasing emotional regulation, solving problems and promoting acceptance, and revising perceptions

55
Q

How does counselling help people with depression?

A

Provides a genuine and empathic therapeutic relationship in which therapist demonstrates unconditional positive regard for client

56
Q

What is mindfulness-based Cognitive therapy? (MBCT)

A
  • Incorporates mindfulness practice with principles of cognitive therapy.
  • Help clients fully notice their current experiences (thoughts, feelings, bodily sensations) while being kind, accepting, and non-judgmental of these experiences.
  • CBT is interested in changing the negative thoughts and beliefs. but MBCT is a different way of relating to negative thoughts.
  • MBCT sees rumination as the problem rather than the content of the thought itself.
57
Q

What do mindfulness meditation practices help the client to do?

A

Help them learn to step back and observe experiences and thoughts at a distance in a non-judgmental way. ie. don’t see these experiences and thoughts as good/bad, right/wrong, but mindfully make decisions about how best to respond in helpful ways.

58
Q

What is the usefulness of MBCT?

A
  • preventing relapse

- reducing symptoms of current depressive episode