Abnormal- Implementing treatment Flashcards
Biomedical approach to depression
treatments for depression are indicated by theories that claim that depression, like other mental disorders, is a disease of the brain caused by physiological factors, therefore it follows the ‘medical model’ of mental illness.
Drug therapies
- how do most common work
- MAOIs
- Tricyclic antidepressants
- Prozac
Most common biomedical treatments for depression *Most antidepressants work by altering the levels of neurotransmitters in the synaptic cleft:
MAOIs: blocking the action of monoamine oxidase, a chemical that breaks down monoamines, tf elevating monoamine levels. However: negative side-effects such as night-time insomnia and daytime sedation
Tricyclic antidepressants: block reuptake of monoamines from the synaptic.
-most used: SSRIs
=elevated levels of serotonin in synaptic cleft
Prozac one of the most commonly prescribed SSRIs. SSRIs are relatively safe, but side-effects can include vomiting, nausea, sexual dysfunction or headaches. Also, Prozac has been linked to increased risk of suicide. However, this is explained by many researchers as due to the fact that Prozac makes people who were previously lifeless more active, and so allows them to carry out their plans.
Effectiveness of biomedical approach
- Bernstein et al (1994)
- Kirsch et al (2008)
Bernstein et al (1994): antidepressants help 60-80% of patients with depression in the short term
Kirsch et al (2008): review of 47 clinical trials in the USA found that drug treatment was no more effective in the treatment of depression than placebos. They concluded that antidepressants should only be prescribed to the most depressed patients or when alternative methods have failed
Elkin et al (1989)
-very well-controlled study of depression treatments.
-compared the effects of an antidepressant drug (imipramine), interpersonal therapy and cognitive-behavioural therapy
-control group: a placebo in combination with weekly therapy sessions.
-The placebo/drug comparison was double blinded
-All the participants were assessed at the start, at 16 weeks and at an 18 month follow-up.
-found that just over 50% of patients recovered in the cognitive-behavioural and interpersonal therapy groups as well as in the drug group
-29% in the control group. The drug treatment produced faster results, but there was no difference in overall efficacy
=all the therapeutic approaches were equally effective, perhaps because they are tackling different aspects of the same problem
Criticisms of biomedical approach
1) publication bias:negative studies not being published and about drug companies sponsoring trials of their own drugs. Drug trials sponsored by drug companies are far more likely to come up with positive results than independent studies.
2) drugs merely tackle symptoms rather than root of illness. Support: often high relapse rates. However doesn’t mean drugs don’t play role in treatment (should be combined)
3) side effects
Individual approches to treatment
*CBT
- CBT most common individual
- developed along side cognitive theory of depression (Beck)
- reasoning behind therapy: if D caused by negative patterns of thinking, then can be treated by altering these patterns
- aim: identify and correct faulty cognitions and unhelpful behaviours
- 1 course: 12-20 weekly sessions, combined with daily practice exercises to put into practice the skills and techniques learned in the sessions.
e. g. through cognitive restructuring, where the patient is asked what sort of thoughts are associated with depressed feelings and is helped in challenging these
Behavioural aspect: encouraging people to increase their engagement in activities that can be rewarding e.g. sport
Effectiveness of individual approach
- Dobson (1989)
- De Rubeis et al (2005)
- Hollon et al (2005)
- Riggs et al (2007)
Dobson (1989): CBT superior to no treatment and to placebo treatment
De Rubeis et al (2005) found a success rate of ~60% after 16-20 weeks of therapy
-maintenance sessions once a month or so after the main course has finished – can help to improve relapse rates
- relatively cheap
- Hollon et al (2005): relapse rates without maintenance were 30-40% over the first year after treatment
- studies shown:CBT in combination with drug treatment is more effective than either therapy alone
Riggs et al (2007) compared the effects of a CBT + SSRI regime with a CBT + placebo regime in 126 adolescent males who suffered from depression as well as a substance use disorder and conduct disorder.
Results:
76% of CBT + SSRI group were “very much improved” or “much improved” after four months
67% of CBT + placebo group were “very much improved” or “much improved” after four months
The researchers concluded that treatment with drugs and CBT is effective, but that treatment with a placebo and CBT is nearly as effective.
*supporting a multifaceted explanation of depression as an eclectic approach to treatment was most effective.
Criticisms of individual approach
Researchers use outcome studies to assess the efficacy of therapeutic techniques. Problems with this methodology include:
- That every individual is different, has different symptom patterns etc.. So it can be problematic to state that all of the participants suffered from the same problem before therapy
- Deciding how long after the beginning of treatment to measure the outcomes. It might be that different treatments are effective at different intervals, and that some treatments lead to higher relapse rates than others
- Deciding what measures should be used. Self-report questionnaires? Normal clinical interviews? Purely behavioural data? The problem here is the problem of defining when a person is “healthy”
- Most outcome studies support the claim that therapy is useful in treating mental illnesses
- however unclear what aspect doing the work
-suggested that CBT is not special & works as provides patient with calm, trusting relationship rather than because the underlying theory is ‘true’.
Group approaches to treatment
- group of clients meet with one or more therapists
- due to the etiological association between depression and marital problems.
Advantages :
- It is less expensive than individual therapy: therapist counsel several clients at same time
- provides support group for the client & reduces dependency on therapist
- helps clients realise not alone – great stresses for individuals with mental disorders-they are abnormal & that their problems are unique and insurmountable
- helps foster social skills & confidence often lacking in people with mental disorders by providing a safe, supportive environment
Disadvantages:
- used on its own, it may not allow patients to get to heart of their personal problems
- some individuals might not want to disclose their problems
- confidentiality
- group dynamics-therapy not equally useful for everyone
- not appropriate for some cultures-Al Mutual&Chaleby (1995) problems in arabic countries-strict gender roles, respect to members of group on basis of age or status
Effectiveness of group approach
- Toseland & Siporin (1986)
- Tucker & Oei (2006)
- McDermut et al (2001)
Toseland & Siporin (1986) reviewed 74 studies comparing individual and group treatment. Group treatment was found to be equally effective as individual treatment in 75% of the studies, and more effective in 25% of the studies.
Tucker & Oei (2006), in a review of 36 studies, found group CBT to be more cost-effective than individual CBT in the treatment of depression.
McDermut et al (2001)
In a meta-analytic review of 48 studies, they found:
43 showing significant reductions in depressive symptoms following group therapy
9 showing no difference in effectiveness between group and individual psychotherapy
8 showing individual CBT to be more effective than psychodynamic group therapy (not CBT)
Criticisms to group approaches
-Yalom (2005)
Yalom (2005)
hard to scientifically study the effects of group therapy because the group dynamics mean that there are so many variables
potential influences on the effectiveness of group therapy:
Group cohesion – some group members might feel that they don’t ‘belong’ to the group
Exclusion – some sorts of people should perhaps be excluded from the group sessions, such as drug abusers
Confidentiality – everybody must trust that they can speak freely
Relationship with the therapist – the therapist has a difficult role. He is not a member of the group, but must be empathetic towards the group members and understand their problems
Eclectic approach to treatment
*do not use one treatment method exclusively, but tailor their approach to the problems of the client. Eclectic approaches incorporate principles of techniques from various systems or theories.
