Abnormal - evaluate treatments of depression Flashcards
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
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)
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
effects of SSRIs on the brain
Leuchter et al. (2002):
- used EEG to examine brain function 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 prefrontal 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
strengths of biomedical approach
- time-efficient: work very quickly.
- cost-efficient: no need for long (and potentially costly) sessions with a therapist
weaknesses of biomedical approach
- SSRIs alone reduce depressive symptoms but they have side effects and do not cure patients
- Kirsch et al (2008): placebo effect could account for effectiveness of medication
- Leuchter et al. (2002): drugs may affect brain activity, and long-term effects of drugs on the brain are unknown
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
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
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
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
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
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
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)
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
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
