Depression Flashcards
What are the 4 key elements of CBT?
- Cognitions
- Emotions
- Behaviour
- Physiology
What are the layers of cognition?
- Core beliefs
- Rules for living
- Automatic thoughts
Name some symptoms of depression
- depressed mood
- anhedonia
- appetite/weight disturbance
- sleep disturbance
- loss of energy
- recurrent thoughts of death + suicide
What key information is needed in a CBT assessment?
- Childhood/background
- Development and course of problems (timeline)
- Current support
- Other problems
- History of treatment
- Risk
What do we need to check when doing a risk assessment?
- Risk to self
- Risk to others
- Access to means
What are standardised self-report measures?
- researched more heavily into
- more formal measure
What are non-standardised self-report measures?
- individualised measures e.g. subjective unit of distress
- think about the frequency, intensity, and duration of a particular symptom
What are methods of self monitoring?
- Activity schedules
- Frequency records
- Thought records
What factors should we look for when dissecting sleep patterns?
- Caffeine intake
- Activities
- Food
- What did they do on certain days to affect their sleep
What does the ABC belief monitoring sheet look at?
A - Antecedent/trigger
B - Belief/thoughts
C - Consequences
What should be said instead of homework?
In between session tasks
Other than self monitoring, what other sources of information are there?
- observations
- family and significant others
- prior documentation
What is the most basic form of formulation?
the hot cross bun
What 3 key elements are important when planning and building alliance?
- overview of treatment
- the therapeutic relationship
- possibility of change
What do we need to check with our client?
- if they’d prefer a more structural or flexible approach
- are they ready to make changes
- where are they as an individual
How can thought challenging be done?
- thought records
- Socratic questioning
- identifying unhelpful thinking styles
What are behavioural experiments?
- experiments derived collaboratively from the formulation by therapist and patients
- planned activities designed for the patient to learn experientially about their beliefs
What behaviour change elements are in CBT?
- behavioural interventions to decrease avoidance: graded exposure
- behavioural activation
- skills and training practice
- communication skills training
- relaxation training
What is behavioural activation?
start to put clients in positions that were positive for them in the past and hope that some of those same reinforcers will help them to feel positive about doing those behaviours again and eventually those things will become more habitual
How do therapists evaluate their treatment?
- verbal feedback from patient
- observations of improvement
- idiosyncratic symptom scales
What is CBT?
- family of talking therapies
- based on the idea of thoughts, feelings, what we do and how our bodies feel are all connected
- if we change one of these, we can alter all the others
- change problematic thinking styles or behaviour patterns
How many CBT sessions are usually needed?
5-20 weekly sessions
What elements are required for CBT for depression?
- identify initial target problem list rather than general descriptions
- introduce cognitive model
- begin work on reducing symptoms
- focus on challenging NATs
- identify and modify dysfunctional assumptions or core beliefs as necessary
Weekly activity schedule (WAS) should contain what?
- brief description of how you spent your time in that hour
- two numbers labelled P for pleasure and A for achievement
What are 3 common ways to improve mood through activity?
- increase overall activity level if low
- focus specifically more of higher pleasure things
- behavioural experiments to test negative cognitions about activity
What risk factors are there for suicide?
- acute suicidal ideation
- history
- medical seriousness of previous attempts
- severe hopelessness
- attraction to death
- recent losses or separations
- misuse of alcohol
What is the management plan of suicidal clients?
- supervised/immediate access to support
- remove accessible means
- communicate helpline options
- build therapeutic relationship
- postpone suicide until next time?
- aspects of therapy to play for time
What are the potential problems in treating depressed clients?
- the nature of depression
- hopelessness and ‘yes but’s
- slow pace
- feedback in sessions
- relapse
What is depression?
- mood disorder involving emotional, motivational, behavioural, physical, and cognitive symptoms
What is likely to trigger periods of sadness, lethargy and rumination?
- losses
- failures
e.g. losing a job or death of a loved one
What is mania?
an emotion characterised by boundless, frenzied energy and feelings of euphoria
What are emotional symptoms of depression?
- sad, hopeless
- crying
- loss of motivation + interest
- lack of initiative + spontaneity
- not caring
- low sex drive
- low appetite
What are behavioural symptoms of depression?
- slowness of speech
- slower behaviour generally
- physically inactive
- decreased energy, tiredness and fatigue
What are physical symptoms of depression?
- sleep disturbance
- headaches
- indigestion
- constipation
- dizzy spells
- general pain
How can posture affect mood?
Hunched postures elicit feelings of depression
What are the two types of depression?
Major depression/unipolar depression
Bipolar disorder
What is major depression?
characterised by relatively extended periods of clinical depression which cause significant distress to the individual and impairment in social or occupational functioning
What is bipolar disorder?
characterised by periods of mania that alternate with periods of depression
What is a major depressive episode?
episode of major depression, defined by the presence of 5 or more depressive symptoms during the same 2 week period
What is dysthymic disorder?
form of depression in which the sufferer has experienced at least 2 years of depressed mood for more days than not
What is premenstrual dysphoric disorder?
condition in which some women experience severe depression symptoms between 5-11 days prior to the start of menstruation - symptoms then imporve significantly within a few days after the onset of menses
What is seasonal affective disorder (SAD)?
condition of regularly occurring depressions in winter with a remission the following spring or summer
What is chronic fatigue syndrome (CFS)?
disorder characterised by depression and mood fluctuations together with physical symptoms such as extreme fatigue, muscle pain, chest pain, headaches and noise and light sensitivity
What is melatonin?
hormone that acts to slow organisms down, making them sleepy and less energetic
What biological factors are there of depression?
- genetic factors
- neurochemical factors
- brain abnormalities
- neuroendocrine factors
What neurotransmitters are affected in depression?
- serotonin
- norepinephrine
- dopamine
What parts of the brain are associated with depression?
- prefrontal cortex
- anterior cingulate cortex
- hippocampus
- amygdala
What are tricyclic drugs?
drugs which block the reuptake of both serotonin and norepinephrine (alleviating symptoms of depression)
What is cortisol?
an adrenocortical hormone
How can cortisol influence depressive symptoms?
- causing enlargement of the adrenal glands and in turn lowering the frequency of serotonin transmitters in the brain
- released by the body in times of stress
What psychological theories of depression are there?
- psychodynamic explanations
- behavioural theories
- negative cognitions and self-schema
- learned helplessness and attribution
- hopelessness theory
- rumination theory
What is introjection?
a response to a loss where individuals regress to the oral stage of development, which allows them to integrate the identity of the person they have lost with their own
What is a symbolic loss?
a Freudian concept whereby other kinds of losses within one’s life are viewed as equivalent to losing a loved one
What is affectionless control?
a type of parenting characterised by high levels of overprotection combined with a lack or warmth and care
What is a psychodynamic explanation of depression?
Argues that depression is a response to a loss, and in particular, a response to the loss of a loved one
What are intrapersonal theories?
theories that argue that depression is maintained by a cycle of reassurance-seeking by depressed individuals that is subsequently rejected by family and friends because of the negative way in which depressed people talk about their problems
What is a negative schema?
a set of beliefs that tends individuals towards viewing the world and themselves in a negative way
What is the negative triad?
a theory of depresson in which depressed people hold negative views of themselves, their future, and the world
What is pessimistic thinking?
a form of dysfunctional thinking where sufferers believe nothing can improve their lot
What is experimental psychopathology?
experimental field of psychological science aimed at understanding the processes underlying psychopathology
What is learned helplessness?
a theory of depression that argues people become depressed following unavoidable negative life events because these events give rise to a cognitive set that makes individuals learn to become helpless, lethargic and depressed
What is battered woman syndrome?
the view that a pattern of repeated partner abuse leads battered women to believe that they are powerless to change their situation
What are attribution theories?
theories of depression in which individuals exhibit an expectation that positive outcomes will not occur, negative outcomes will occur, and that the individual has no responses available that will change this state of affairs
What is rumination?
the tendency to repetitively dwell on the experience of depression or its possible causes
What is the lifetime comorbidity rate of major depression with another anxiety disorder?
58%
What is the lifetime comorbidity rate of major depression with more than one other DSM disorder?
74%
What are the lifetime prevalence rates for major depressive disorder?
between 5.2-17.1%
What do behavioural theories claim about depression?
that depression results from a lack of appropriate reinforcement for positive and constructive behaviours and this is especially the case following a loss such as bereavement or losing a job
What does Beck’s theory of depression argue?
The depression is maintained by a negative schema that leads depressed individuals to hold negative views about themselves, their future, and the world
how does depressive rumination affect depression?
Can increase the risk of depression or the risk of relapse
What is hypomania?
mild episodes of mania (everything feels amazing and intensely interesting)
What are the symptoms of bipolar disorder 1?
- presence or history of at least one manic episode
- episode may have been preceded or followe by hypomanic or major depressive episodes
- symptoms not better accounted for by schizoaffective disorder or other disorders
What are the symptoms of bipolar disorder 2?
- presence or history of at least one major depressive episode
- presence or history of at least one hypomanic episode
- no history of manic episodes
- symptoms are not better accounted for by the schizoaffective disorder or other disorders
What is cyclothymic disorder?
form of depression characterised by at least 2 years od hypomania symptoms that do not meet the criteria for a manic episode and in which the sufferer experiences alternating periods of withdrawal then exuberance, inadequacy and then high self-esteem
What biological theories are there of bipolar disorder?
- genetic factors
- neurochemical factors
What neurotransmitters are involved in bipolar disorder?
- Dopamine
- Norepinephrine
What is olanzapine?
antipsychotic drug commonly prescribed in combination with the antidepressant SSRI drug fluoxetine as a treatment for bipolar disorder
What is fluoxetine?
(Prozac) - a selective serotonin reuptake inhibitor (SSRI) which reduces the reuptake of serotonin in the brain and is taken to treat depression
What are the triggers for depression in bipolar disorder?
- similar to depression
- losses
- failures
- negative life events
What are the triggers for mania in bipolar disorder?
- reactions to antidepressant medication
- disrupted sleep patterns
- circadian rhythms
- stressful life events
- exposure to high emotional expression in family members or caregivers
- goal attainment
What is the lifetime risk of bipolar disorder?
0.4-1.6%
What is electroconvulsive therapy (ECT)?
treatment for depression or psychosis, which involves passing an electric current of around 70-130V through the head of a patient for around half a second
What are stepped-care models?
treatments for psychopathology that emphasize the type of treatment provided for those individuals should be tailored to the severity of their symptoms and their personal and social circumstances
What is lithium carbonate?
a drug used in the treatment of bipolar disorder
What is dream interpretation?
the process of assigning meaning to dreams
What is social skill training?
a therapy for depression that assumed that depression in part results from an individual’s inability to communicate and socialise appropriately and that addressing these skills deficits should help to alleviate many of the symptoms of depression
What is behavioural activation therapy?
a therapy for depression that attempts to increase clients’ access to pleasant events and rewards and decreases their experience of aversive events and consequences
What is cognitive retraining?
an approach to treating depression developed by Aaron Beck - also known as cognitive therapy of cognitive restructuring
What are negative automatic thoughts?
negatively valanced thoughts that the individual finds difficult to control or dismiss
What is reattribution training?
a technique used in the treatment of depression which attempts to get clients to interpret their difficulties in more hopeful and constructive ways rather than in the negative global, stable ways typical of depressed individuals
What biological treatments are there for bipolar disorder?
drug therapy
What psychological treatments are there for bipolar disorder?
- psychoanalysis
- social skills training
- behavioural activation therapy
- cognitive therapy
- mindfulness-based cognitive therapy (MBCT)
What are the three types of medication for depression?
- tricyclic drugs
- monoamine oxidase (MAO)
- selective serotoninreuptake inhibitors (SSRIs)
When is it best to use electroconvulsive therapy (ECT)?
in individuals suffering severe depression who have not responded well to other forms of treatment
What techniques does psychodynamic therapy use?
- free association
- dream analysis
What therapy can be used for milder forms of depression?
Computerised CBT
What is deliberate self-harm?
a parasuicidal phenomenon that commonly includes cutting or burning oneself, taking overdoses, hitting oneself, pulling hair or picking skin, or self-strangulation
What is non-suicidal self-injury?
the act of deliberately causing injury to one’s body without conscious suicidal intent
When is self-harm most common?
Adolescence
Why do people self-harm?
- self-soothing
- help-seeking
What kind of therapy is useful for self-harming individuals?
problem-solving therapy
What is the suicide prevalence according to WHO?
approx 1 million people a year
How do suicide rates compare in men and women?
- Women are 3x more likely to attempt suicide
- Successful suicide is 4x more common in men
What are suicidal risk factors?
- existing psychiatric diagnosis
- low self-esteem
- poor physical health and physical disability
- experiencing a significant negative life event
How high is the hereditary component for suicide?
Could be as high as 48%
What suicide prevention facilities are available?
- 24 hour helplines
- telephone support lines (e.g. the Samaritans)
- school-based educational programmed warning about the early signs of suicidal tendencies
