Chapter 8 - Treatments for Depressive Disorders Flashcards
What is the psychological approach to treating unipolar depression?
Psychological treatments include psychodynamic, behavioural and cognitive fields
What is the oldest of all modern psychotherapies?
psychodynamic therapy
What is psychodynamic therapy?
Based on the belief that unipolar depression is a result from unconscious grief over real or imagined losses, as well as, excessive dependence on other people, therapists seek to help clients bring these underlying issues to consciousness and work them through
How is therapy conducted?
Encourage the client to associate freely during therapy, suggest interpretations of the client’s associations, dreams, and displays of resistance and transference; and help the person review past events feelings (free association)
What are the expectations of psychodynamic therapy?
Gain awareness of the losses in their lives, become less dependent on others, cope with losses more effectively, and make corresponding changes in their functioning
What have researchers found about psychodynamic therapy?
Long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression
What are two factors that limit the effectiveness of this approach?
Clients may be too passive to join fully in the subtle therapy discussions. Clients may become discouraged and end treatment too early when this long0term approach is unable to provide quick relief
What sort of cases does psychodynamic therapy help the most?
Depression that is modest/moderate in severity and that involve a clear history of childhood loss or trauma, a long-standing sense of emptiness, feelings of perfectionism, and extreme self-criticism
What performs better short-term or long-term psychodynamic therapies?
Short-term psychodynamic therapies, especially when combined with psychotropic medications
What is cognitive-behavioural therapy?
Combine behavioural and cognitive techniques. Seek to get the clients moving again- to engage in and enjoy more activities (behavioural). Guide clients to think in more adaptive, less negative ways (cognitive).
What are the two leading approaches in cognitive-behavioural therapy?
Behavioural activation and cognitive therapy
What is behavioural activation?
A therapy for depression in which the therapist works systematically to increase the number of constructive and pleasurable activities and events in a clients life
Who is Peter Lewinsohn?
Ties mood to the rewards one experiences in life, behavioural activation is built off this work. He combines bother behavioural activation with cognitive strategies
What are the three approaches in behavioural activation?
1) Reintroduce depressed clients to pleasurable events and activities. 2) Consistently reward non depressive behaviours and withhold rewards for depressive behaviours. 3) Help clients improve their social skills
What do Behavioural activation theorists argue?
People who are depressed, their negative behaviours (crying, complaining, etc) keep others at a distance, reducing chances for rewarding experiences and interaction. To correct this, therapists guide clients to monitor their negative behaviours and to try more positive ones
What is the contingency management approach?
Systematically ignoring a client’s depressive behaviours while praising or otherwise rewarding constructive statements and behaviour, friends and family can be recruited to help with this part of the treatment
What is Cognitive therapy?
A therapy developed by Aaron beck that helps people identify and change the maladaptive assumptions and negative ways of thinking that help cause their psychological disorders
How does Aaron Beck view unipolar depression
Result from a pattern of negative thinking that may be triggered by current upsetting situations
How does Aaron Beck’s therapy differ from Albert Elli’s rational-emotive therapy?
Beck’s is tailored to the specific cognitive errors and behaviours found in depression
What are the four phases of Aaron Beck’s cognitive therapy?
Phase 1: Increasing Activities and Elevating Mood
Phase 2: Challenging Automatic Thoughts
Phase 3: Identifying Negative Thinking and Biases
Phase 4: Changing Primary attitudes
What does Phase 2 entail:
Therapists educate clients on their negative thoughts and have clients recognize and record automatic thoughts, then test the reality behind the thoughts with the therapist (which prove to be groundless)
Phase 3: Identifying Negative Thinking and Biases
Therapists show them how illogical thinking processed are contributing to these thoughts. Guide clients to recognize that their interpretations of events have negative bias and help the change that style of interpretation
Phase 4: Changing Primary attitudes
Help clients chance the maladaptive assumptions that set the stage for their depression in the first place, often encourage clients to test their attitudes
What is New-Wave Cognitive Behavioural Therapy?
Therapies such as Acceptance and Commitment Therapy, use mindfulness training and other cognitive-behavioural techniques to help depressed clients recognize and accept their negative cognitions simply as streams of thinking that flow through their minds, rather than as valuable guides for behaviours and decisions
Does New-Wave Cognitive behavioural therapy agree with Aaron Beck?
No, they do not think individuals must fully discard their negative cognitions in order to overcome depression
What is Sociocultural approaches to therapy?
multicultural approach and family-social approach
How does the multicultural approach treat depression?
Culture-sensitive therapies designed to address the unique issues faced by memos of cultural minority groups
How does the multicultural approach treat depression?
Culture-sensitive therapies designed to address the unique issues faced by members of cultural minority groups.
How does the family-social approach treat depression?
Help clients change how they deal with the close relationships in their lives. Therapies include: Interpersonal psychotherapy and couple therapy
Interpersonal psychotherapy developed by Gerald Klerman and Myrna Weissman?
A treatment for unipolar depression that is based on the belief that clarifying and changing one’s interpersonal problems helps lead to recovery
What are the four interpersonal problem areas (interpersonal therapy)?
Interpersonal loss, interpersonal role dispute, interpersonal role transition, and interpersonal deficits
What is interpersonal role dispute?
Two people have different expectations of their relationship and of the role each play
What is interpersonal role transition?
Feeling overwhelmed by the role changes that company a large life change (divorce, birth of a child)
What is interpersonal deficits?
Extreme shyness or social awkwardness, that prevent them from having intimacy the relationships. Teach them social skills and assertiveness in order to improve their social effectiveness
What is couple therapy?
Therapist works with two people who share a LONG-TERM relationship
What is integrative behavioural couples therapy?
Combine cognitive-behavioural and sociocultural techniques to each couples specific communication and problem-solving skills, guide them to recognize that their problematic interactions often reflect basic differences between them
What is the Biological Approach to therapy?
Including antidepressant drugs or popular alternatives such as herbal supplements, and brain stimulation
What are antidepressant drugs?
Three kinds of drugs reduce the symptoms of depression: Monoaime Oxidase (MAO) inhibitors, Tricyclics, and Second-generation antidepressants
What are MAO inhibitors?
An antidepressant drug that prevents the action of the enzyme monoamine oxidase, as a result increases activity levels of neurotransmitters serotonin and norepinephrine
What is the enzyme MAO?
brain supplies of the enzyme MAO break down the neurotransmitters serotonin and norepinephrine
What is the danger of MAO inhibitors?
The combination of MAO inhibitors and the chemical tyramine found in common foods results in dangerously rising a persons blood pressure
What is tricyclic drugs?
An antidepressant drug such as imipramine that has three rings in its molecular structure. The drugs must be taken for at least 10 ten days before improvements
Limitation of tricyclic drugs?
Individuals who stop taking the drugs immediately after obtaining relief, run a high risk of relapsing
What is continuation therapy/maintenance therapy?
Keep patients on antidepressant drugs for at least 5 months after being free of depressive symptoms
How do tricyclic drugs help reduce depression
Act on the neurotransmitter “reuptake” mechanisms of neurons. Inhibit the overly vigorous reuptake process, allowing serotonin and norepinephrine to remain in their synapses longer, this increasing their stimulation of receiving neurons.
How does the re-uptake mechanism function in people with depression?
The re-uptake mechanisms are too vigourous in neurons that use either serotonin or norepinephrine-cutting off the activity of these neurotransmitters in their synaptic spaces too soon, preventing messages from reaching the receiving neurons,
Tricyclic drugs affect on the depression-related brain circuit
The structures and interconnections across the circuit become much more functional. The hippocampus becomes more active, its subgenus cingulate becomes less active, and the interconnections between its preferment cortex and other structures in the circuit become more orderly
What is an herbal supplement people use to treat depression?
Melatonin, Saint-John’s-Wort, Rhodiola rosea to help mild to moderate depression
How does exercise alleviate depression?
Triggers positive changes in depression-related brain circuits, brain-body stress pathways and neurotransmitter activity, improves cognitive functioning
What are Nutraceuticals for depression?
Herbal supplements, nutrients (vitamin B and 2), natural hormones/amino acids (melatonin)
What are second-generation antidepressants?
Drugs are selective serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors
What are SSRI’s?
Increase serotonin activity specifically, without affecting other neurotransmitters such as Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro)
What are norepinephrine reuptake inhibitors?
Increase norepinephrine such as atomoxetine or starter
What are serotonin-norepinephrine reuptake inhibitors?
Increase both serotonin and norepinephrine such as venlafaxine or Effexor
What is publication bias?
The tendency of professional journals to accept for publication mainly those studies that have positive findings
What is brain stimulation?
Biological treatments that directly or indirectly stimulate certain areas of the brain, ex: ECT
What is electroconvulsive therapy?
A treatment for depression in which electrodes attached to a patient’s head send an electrical current through the brain, causing a convulsion (brain seizure), 6 to 12 treatments spaced over 2 to 4 weeks
What is bilateral ECT?
One electrode is applied to each side of the forehead, and a current passes through both sides of the brain. Patients often suffer some form of memory loss can be permanent but sometimes is regained
What is unilateral ECT?
Electrodes are placed so that the current passes through only one side
What are other brain stimulation treatments?
Vagus nerve stimulation, Transcranial magnetic stimulation, and deep brain stimulation
What is vagus nerve stimulation?
An implanted pulse generator sends electrical signals to the vagus nerve, the nerve then stimulates the brain
What is the vagus nerve?
Longest nerve in the brain, serves as a primary channel of communication between the brain and major organs such as the heart, lungs, etc
What is transcranial magnetic stimulation?
Electromagnetic coil is placed on or above a patient’s head and sends a current into the individual’s brain (prefrontal cortex) increasing neuron activity and in turn improve functioning throughout the rest of the depression-related circuit
What is deep brain stimulation?
A pacemaker powers electrodes that have been implanted in the subgenual cingulate, thus stimulating that brain area. Repeated stimulation reduces the activity of the subgenual cingulate which experiences high activity in people with depression
