MODULE 5 - Treatments for Mood and Anxiety Flashcards
What are the major treatments for mood?
Psychotherapy
Medication
Neurostimulation
Integrative (complementary)
Psychotherapy for unipolar depression
CBT
IPT (interpersonal therapy)
CBT for uniploar depression
Typically 16-20 sessions
Significantly more effective than minimal or no treatment
Equally as effective as other psychotherapies and antidepressant medications and had significantly lower relapse than those who took medication
Common interventions:
-Thought record
-Behavioural experiments
-Activity scheduling (Behavioural activation therapy)
-MBCT (mindfulness based cognitive therapy)
Integrative treatments:
- Exercise - significantly more effective than no treatment and similarly effective to psychotherapy and medication
- Yoga - significantly more effective at reducing levels of depression than treatment as usual. Similar responses were seen between yoga and antidepressant medication
IPT
Interpersonal Psychotherapy - A therapy that uses a medical model to understand interpersonal conflicts and transitions as they relate to depression.
12-16 weekly sessions
Identify the source of client’s interpersonal dysfunction:
1) interpersonal disputes
2) role transitions
3) Grief
4) Interpersonal deficits
What is the evidence for their utility in Unipolar Depression?
Study: Treatment of depression collaborative research program, compared CBT, IPT, imipramine (antisdepressant), and placebo. Results showed no difference between CBT,IPT and med, but all active treatments significantly superior to placebo.
Study of “Maintenance” IPT found that monthly sessions following the remission of depression were effective in preventing depression relapse over 3-5 years
While found that IPT did not differ from CBT in terms of relieving depression symptoms, each worked for different people, suggesting that they have different mechanisms of action
Medication:
Study concluded that fluozetine (prozac) produces modest effects and SSRI’s are now newer antidepressants but none of them work any better than the old ones, patients can just tolerate their side effects better.
No antidepressant has been developed since TCA’s has been found to have greater efficacy but they are rarely used in first line treatment bc of their many side effects
SSRI’s are the first line of treatment in uniploar depression b/c of relatively mild side effects, their high safety profile and ease of administration
What is the evidence for their utility in Panic Disorder?
Panic-
-Barlow’s panic control treatment
-CBT is most well studied and empirically supported and as effective as benzo’s and antidepressants in short term
-CBT is cost effective (need to stay on med’s to maintain therapeutic gains)
-50-80% are panic free by end of CBT treatments and gains tend to be maintained
-CBT more superior than other forms of psychotherapy
-interoceptive exposure in particular may be the key component of CBT in panic disorder
What is the evidence for their utility in Specific Phobias?
Pharmacological interventions offer little benefit and in fact can interfere with exposure based treatments
Main form of treatment is in-vivo exposure - approx 80-90% effectively treated
-more short term , but intensive treatments are also successful ( 2hour intensive session for spider phobia study)
-Virtual reality seems to be affective for a number of specific phobias - may be just as effective as in-vivo
What is the evidence for their utility in Social Anxiety Disorder?
CBGT (Cognitive behavioural group therapy), integrates both Cognitive restructuring and exposure therapy
One study suggested that cognitive interventions may be more important than exposure in treatment of social anxiety - but more research is needed. Regardless data continues to support CBGT
-Very few differences has be shown between CBGT and medications in terms of response, but individuals with CBGT appear to be better protected against relapse than those in pharmacotherapy alone.
-D-cyclosine (antibiotic drug) can enhance the learning that takes place in exposure therapy
What is the evidence for their utility in GAD?
Bezo’s commonly used to treat GAD, this class of med’s have shown 65-70% efficacy on symptoms in the short term. Long term shows an increase in symptoms while on med’s and relapse.
CBT more highly recommended psychological treatment for GAD. It has been instrumental in developing the notion of intolerance of uncertainty (IU). Improving IU appears to be effective in alleviating anxiety symptoms by reducing worry
CBT results in significant reduction of pathological worry
What is the evidence for their utility OCD and Body dismorphia
Main psychological treatment is ERP, a form of CBT.
Exposure and ritual prevention altars faulty appraisals and beliefs in OCD
Research shows supportive results of medication, especially serotonin based for OCD
CBT for BDD is effective and found that symptom improvements are maintained for up to several months after treatment. However, currently SSRI’s are considered first line of treatment
What is the evidence for their utility for PTSD?
-Imaginal or in vivo exposure
-CPT
-NET (narrative exposure)
-CBCT (conjoint)
Imaginal exposure or in-vivo exposure - by doing so the patients begin to realize that these are memories rather than on-going events and can make sense of them and integrate them with other aspects of their lives.
Good evidence for the efficacy of cognitive processing therapy (CPT). Overall imaginal exposure and cognitive reprocessing strategies are effective on PTSD.
Studies of effective treatment for PTSD support the use of NET (narrative exposure therapy), though more research is needed to determine whether it is superior to other approaches
Cognitive-Behavioural Conjoint therapy (CBCT) evidence is promising
Virtual reality shows comparable efficacy to traditional approaches, such as imaginal expsoure
What is the evidence for their utility for biploar?
Most effective treatment for biploar is medication, but even with maximum dosages, they are at high risk for relapse. For this reason, researchers have sought to develop psychological treatments that can be added to pharmcotherapy.
-Family focused therapy
-Interpersonal and social ryhtym therapy (IPSRT)
-CT (similar to CBT in unipolar depression) - significantly fewer relapses and significant fewer hospitalizations and significant higher levels of psychosocial functioning, fewer symptoms of depression and less fluctuation in manic symptoms.
Medications:
Litium was used based on the theory at the time linking mental disorders back to uric acid, but now thinking it may work on multiple brain systems. Approx 40% of patients do not respond to litium.
-Anticonvulsant drugs to help control mania (plays inhibitory role on the brain)
-Antipsychotics to control psychotic symptoms and used a sedative to help with insomnia and agitation
-Antidepressants risk triggering mania
What is the theoretical justification for use or IPSRT?
IPSRT - based on theory that disruptions in daily routines and conflicts in interpersonal relationships can cause relapses in bipolar episodes
What are the major treatments for anxiety disorders?
Medication and Psychological interventions: CBT is first line of treatment
-Pharmacotherapy
-Cognitive restructuring
-Exposure Techniques
-Problem Solving
-Relaxation
-Other techniques; mindfulness based, virtual reality, EMDR
Pharmacotherapy for anxiety
-Benzodiazapines - best used to temporary relief of distress for infrequent anxiety provoking situations
-Anti-depressants - TCAs, specifically Chlomipramine for OCD, and SSRI’s (most well prescribed anxiolytics), SNRI’s
-Anticonvulsant pregablin - recently recognized as 1st line pharmacological treatments for GAD and social anxiety
