Clinical Psychology

Question 1

What are the symptoms of depression?

Answer 1

lethargy, feelings of despair and hopelessness and loss of interest in usual activities.

Question 2

What are the features of depression?

Answer 2

• Depression is twice as common in women as in men but men are more likely to commit suicide
• At any one time, 5-9% of women will be clinically depressed and 2-3% of men
• Depression is most common from the ages of 25-44 but the most at-risk age group is 50-54
• Depressed people tend to live shorter lives than the general population

Question 3

What are the 4 antidepressants?

Answer 3

MAOIs Monoamine oxidase inhibitors
Tricyclic antidepressants
Specific Serotonin Reuptake inhibitors - SSRIs
Atypical antidepressants

Question 4

How do antidepressants work?

Answer 4

used to treat depression based of the principle that low levels of monoamine cause depression and so increasing levels will help

Question 5

Key things about MAOIs and how do they work ?

Answer 5

• The oldest antidepressant drugs.
• They affect several neurotransmitters by inhibiting the activity of monoamine oxidase enzymes, prevent the enzyme from breaking down NA and 5-HT increasing levels in the synapse.
• Must not be combined with SSRIs.
• Combination with certain foods and other medications can cause serious problems.
• Only used if other drugs do not work.
• side affects = insomnia, wight gain, headaches, dizziness

Question 6

Key things about Tricyclic antidepressants and how do they work ?

Answer 6

• An older type of antidepressant drug.
• Inhibits the reuptake of 5-HT, NA, and to some extent DA, increasing the amount of these neurotransmitters in the synapse to be picked up by the post synaptic receptors and thereby improving mood, energy and motivation.
• Cause severe side effects and are usually only used as a last resort if SSRIs and atypical drugs do not work.

Question 7

Key things about Specific Serotonin Reuptake Inhibitors (SSRIs) and how do they work ?

Answer 7

• SSRIs prevent the reuptake of serotonin (5-HT) in the presynaptic neuron, increasing the amount of serotonin in the synapse to be picked up by the postsynaptic receptors and thereby improving mood.
• Examples include Fluoxetine (Prozac), Sertraline (Zoloft)
• Fewer and less severe side effects compared to older antidepressant drugs like tricyclics and MAOIs.

Question 8

Key things about Atypical antidepressants and how do they work ?

Answer 8

• Most recent, New drugs including trazodone and bupropion that affect 5-HT and other neurotransmitters, such as NA and DA.
• Drugs like Trazodone, which target 5-HT and NA are called SNRIs - Serotonin-norepinephrine reuptake inhibitors.
• Bupropion (Wellbutrin) causes fewer side effects and can give more energy than other antidepressants

Question 9

TIME WEAKNESSES

• how long before treatment takes effect?
• how long should treatment last?

antidepressants

Answer 9

⤫ Antidepressants usually take a few weeks to work.

⤫ Treatment may continue for a period of months or years, depending on the patient.

• there can be serious side effects if patients suddenly stop taking them.

Question 10

TIME STRENGTHS

antidepressants

Answer 10

✰ It is quick and easy for the patient to take medication.

Question 11

What evidence is there to support the EFFECTIVENESS of antidepressants?
name and explain the studies

Answer 11

✰ Barbui et al (2003) (meta-analysis) found that SSRIs are more effective than tricyclics.

✰ Arroll (2005) found that both TCAs and SSRIs were effective. In a meta-analysis of RCTs comparing SSRIs and TCAs to placebos, they found that 56-60% in most studies responded well to treatment compared to 42-47% for placebo groups.

Question 12

What evidence is there to challenge the EFFECTIVENESS of antidepressants?
name and explain the studies

Answer 12

⤫ A government study (2006) found that less than 50% of patients became symptom-free and many relapsed even if they were still taking antidepressants.

Question 13

What evidence is there to challenge the ACCEPTABILITY of antidepressants?
name and explain the studies

Answer 13

⤫ Caporino and Karver (2012) asked adolescent girls to rate treatments for depression on their acceptability. Psychotherapy more acceptable than combined therapy (both psychotherapy and drug treatment). Drug treatment on its own seen as not acceptable.

Question 14

What evidence is there to support the ability of antidepressants to prevent RELAPSE?
name and explain the studies

Answer 14

✰ Muller (2013) cites a longitudinal study in the Netherlands which followed 222 patients over 10 years.
76% of those who had NOT received medication recovered and did not relapse
50% of those who took medication recovered and did not relapse.

✰ Geddes et al (2003) carried out a research review and found that
Drug treatment for depression showed a relapse rate of 18%.
Placebo group had 41% relapse rate.

Question 15

What evidence is there to challenge the ability of antidepressants to prevent RELAPSE?

Answer 15

⤫ Antidepressants treat symptoms but are not a cure.

Question 16

What is the reasoning behind CBT and what is it ?

Answer 16

Cognitive treatments are based on Beck’s theory that if people think negatively, this has a negative impact on their emotional state.

• Cognitive-Behaviour Therapy (CBT) is cognitive therapy combined with behavioural components.
• These therapies aim to help the person suffering from a mood disorder by changing their negative thought processes into more positive ones and to ultimately change their perceptions and the way in which they think about things.

Question 17

Describe what happens in CBT treatment.

in detail

Answer 17

6 sessions, each lasting around 50 minutes.

• the first session = there is a review and it is made clear what is expected. Issues such as confidentiality and privacy as well as the expectation for the client to complete homework tasks, will be discussed.
• During each session = an agenda is set with the client. The client’s frame of reference has to be understood by the therapist so initially the client talks about themselves, then the therapist summarises what the client has said and helps them to uncover their core beliefs and thinking patterns.
• therapist uses CBT tools such as the downward arrow technique to drill down to the client’s core beliefs. Starting with one of the client’s thoughts, perhaps ‘I should have…..’ or I must always ….’, the therapist might then ask ‘and why is that important to you?’ or ‘If that were true, what would that mean?’

Once the core beliefs are revealed they can be tested and evidence explored that shows that the beliefs are not entirely true.

Question 18

What are the four phases of Becks CBT

Answer 18

1. First you elevate the client’s mood and increase confidence
2. then you challenge the automatic negative thoughts
3. thirdly you identify the negative thoughts
4. finally changing these negative thoughts and beliefs for more positive ones.

Question 19

CBT
TIME weaknesses
- how long before treatment takes effect?
- how long should treatment last?

Answer 19

⤫ Clients have at least 6 sessions, 50 mins each

⤫ Clients have to travel to and from sessions which may be quite time consuming

⤫ Takes consistent attendance of sessions

Question 20

What evidence is there to support the EFFECTIVENESS of CBT?

explain the evidence

Answer 20

✰ Hoffman et al (2012) conducted a review of over 100 meta-analyses using CBT. From their review they found that evidence for the effectiveness of CBT is strong, as it was more effective than control conditions.

this study shows cbt is more effective than drugs
✰ Kuyken et al (2008) compared the effectiveness of antidepressants and a form of CBT, 123 depressed patients were randomly assigned to a treatment group for an 8 week trial- to continue with their drug treatment or to participate in the group MBCT. The MBCT group reported a much better quality of life and many reported having greater control over their negative thinking.

✰ Can treat moderate-severe depression and prevent mild forms from becoming severe

Question 21

What evidence is there to challenge the EFFECTIVENESS of CBT?
explain the evidence

Answer 21

✰ Hoffman et al (2012)

found some evidence that CBT was as effective as other psychological treatments but not more effective

Question 22

What evidence is there to support the ACCEPTABILITY of CBT?

explain the evidence

Answer 22

✰ Some people dislike taking medication and prefer talk based therapy

Question 23

What evidence is there to challenge the ACCEPTABILITY of CBT?
explain the evidence

Answer 23

⤫ There may be a stigma attached to being ‘in therapy’

⤫ Learning new ways of thinking is effortful and time consuming which makes it less accessible for everyone

⤫ More expensive than drug therapy

Question 24

What evidence is there to support the ability of CBT to prevent RELAPSE?
explain the evidence

Answer 24

✰ Kuyken et al (2008) Did an RCT of drugs vs CBT and at follow up 15 months after the treatment, 47% of the MBCT group had relapsed, compared to 60% of the antidepressant-only group. They concluded that the MBCT had given the clients skills for life, making it more effective at preventing relapse.

✰ Holland et al (2001) found that clients taking antidepressants had a relapse rate of 45% compared to 40% in CT

✰ CBT works just as well as drugs and is more likely to prevent relapse because the client is equipped with tools to cope in the future

Question 25

What are the SIDE EFFECTS of CBT?

Answer 25

✰ No side effects so it has no negative implications on quality of life