Depression

Question 1

DSM 5 criteria

Answer 1

The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

(must cause significant stress of impairment, not a result of substance use)

Question 2

Protocol for behavioural activation

Answer 2

Richards, 2010
• Focus on behavioural avoidance as key maintaining factor in depression
• Aim to reduce negatively reinforced avoidance as well as increasing opportunity for positive reinforcement
• Emphasis on necessary, pleasurable and routine activities

Question 3

BA model of depression

Answer 3

Martell et al 2001
The BA model proposes that life events, which can include specific trauma or loss, biological predispositions to depression, or the daily hassles of life, lead to individuals experiencing low levels of positive reinforcement in their lives. This leads to feelings of sadness and low energy. In response to this, individuals adopt behaviors to cope with negative feelings. These behaviours include avoidance behaviours, such as staying at home and avoiding work. Avoidance bahviours make the individual feel better in the short-run by providing a temporary sense of relief, which negatively reinforces the avoidance behaviours. However, avoidance behaviours are detrimental in the long-run because the individual also experiences less positive reinforcement. As a person adopts more and more avoidance behaviours, they experience fewer rewarding experiences to lift their mood. Therefore, the avoidance behaviours continue and the depression is maintained. It is natural for a person that feels sad and is no longer finding pleasure in activities that were previously enjoyed to attempt to cope by withdrawing socially, ceasing to engage in activities and “shutting down”.
BA targets avoidance behaviour. When depression zaps motivation, the BA approach is to work from the “outside-in”, scheduling activities and using graded task assignments to allow the client to slowly begin to increase their chance of having activity positively reinforced.

Question 4

6 steps of BA in practice

Answer 4

1. Psychoeducation about BA
2. Identifying activities
3. Ranking activities in order of difficulty
4. Setting SMART goals & schedule
5. Trying out the schedule
6. Reviewing the schedule (review progress, problem solve, adapt schedule)

Question 5

Evidence supporting behavioural activation

Answer 5

Ekers et al 2014

This meta-analysis indicates that Behavioural Activation is an effective treatment for depression.