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Psychology & Neuroscience of Affective Disorders > Psychological therapies for mood disorders > Flashcards

Psychological therapies for mood disorders Flashcards

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1
Q

What are the most common types of psychological therapies for mood disorders?

A
  • CBT
  • Interpersonal therapy (IPT)
  • Behavioural activation
  • Behavioural couples therapy
  • Mindfulness (MBCT, MBSR)
  • Psychodynamic therapy
  • Counselling
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2
Q

What is the current evidence and use of CBT?

A
  • Very common
  • Extensively researched and strong evidence base
  • Involved in many different forms to treat numerous psychological disorders
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3
Q

What is the current evidence and use of interpersonal therapy (IPT)?

A
  • Strong evidence base
  • Rarely used in UK
  • More popular in EU and US
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4
Q

What is the current evidence of behavioural activation?

A
  • Less evidence base compared to CBT and IPT

- Can still be effective

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5
Q

What are the advantages of behavioural activation?

A
  • Simple
  • Minimal training/experience required to administer
  • Favours patient engagement: can be used to initially engage patients before using another therapy
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6
Q

What is the theory underlying behavioural couples therapy?

A

> Systemic tradition:
- problem and solution don’t exist within the individual, but also involves their wider system (social network) (i.e. family, friends, colleagues)

> Focus on the person with depression and their partner

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7
Q

What are the two therapies within the mindfulness approach?

A

> Mindfulness Based Cognitive Therapy (MBCT)
- from Zindel Segal, Mark Williams, and John Teasdale

> based on: Minfullness Based Stress Reduction Program (MBSR)

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8
Q

What is the current evidence and use of Psychodynamic therapy?

A

Also called Dynamic interpersonal therapy (DIT)

  • one of oldest forms of therapy
  • based on Sigmund Freud
  • lack of research support
  • can take several years
  • short form: 16 sessions
  • more research taking place
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9
Q

What does counselling refer to?

A

“Systematic process which gives individuals an opportunity to explore, discover and clarify ways of living more resourcefully, with a greater sense of wellbeing”

  • most often delivered in primary care settings by GPs
  • person-centered, looking at individual’s circumstances
  • drawing on therapeutic approaches
  • can be mixed-approaches
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10
Q

What are the different types of depression?

A

> Subthreshold depression

> Mild moderate depression

> Moderate severe depression

> Chronic depression

> Treatment-resistant depression

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11
Q

What is depression?

A

A heterogeneous condition that can take different forms

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12
Q

What characterises subthreshold depression?

A
  • Low mood
  • Low esteem
  • Important to detect and treat early
  • Associated with increased risk of other mental health problems
  • Under the clinical threshold for depression diagnosis
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13
Q

What characterises mild moderate depression?

A
  • Most common form
  • Low mood/esteem
  • Loss of pleasure
  • Changes in appetite
  • Sleep disturbance and fatigue
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14
Q

What characterises moderate severe depression?

A
  • Similar symptoms to mild-moderate depression
  • Severe impact on day-to-day functioning
  • Feelings of worthlessness and death
  • Suicidal ideation
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15
Q

What characterises chronic depression?

A
  • Many episodes of depression

- Multiple relapses

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16
Q

What characterises treatment resistant depression?

A
  • Moderate to severe symptoms

- No improvement despite 2 or more courses of antidepressants

17
Q

What does CBT consist of?

A

> Active approach focused on identifying and understanding links between thoughts, feelings, behaviour, and physical reactions

> Thoughts triggered by situations and life events

  • > identify and monitor distressing thoughts/beliefs (schemas)
  • > develop coping skills

> Activity schedule for behaviour
- increase person’s engagement by reinforcing activities
- identify avoided activities
(avoidance can be key in maintenance of depression)

18
Q

What does behavioural activation consist of?

A

> Takes behavioural elements of CBT, but doesn’t address cognitive issues

> Patient encouraged to identify effects of their behaviour on current symptoms and emotional states

> Functional analysis: ABC
- also applicable to avoidant behaviour

> Important to schedule pleasurable activities (mastery and achievement)

19
Q

Why can behavioural activation be referred to as a “sticking plaster therapy”?

A

Can patch a person up, making them feel better

BUT high risk of relapse
- you’re not addressing the underlying thought patterns

20
Q

What does the functional analysis in behavioural activation consist of?

A

Analysis of:
1. Antecedent: before the behaviour

  1. Behaviour: its function and form
  2. Consequences: results after behaviour
21
Q

What does Mindfulness based cognitive therapy (MBCT) consist of?

A

> Important in preventing relapse and recurrence of depression

> Evidence from early trials: only works if you’ve had 3 or more episodes of depression

> Format:

  • 8 weeks
  • group based
  • mindfulness meditation practices are taught
  • recap of CBT skills

> Focus on helping patient recognise “autopilot mode”

  • when same thought process persists
  • meditation used to step outside of it
  • decentre from thoughts and feelings
  • respond more objectively, with healthier ways
  • develop compassion and kindness
22
Q

What does interpersonal therapy consist of?

A

> Derived from interpersonal model of affective disorders

  • depression occurs as response to loss from interpersonal difficulties
  • relationships affect our mood

> Focus on interpersonal conflict (e.g. grief)

  • > help patients examine social skills and improve them
  • draw links between interpersonal conflict and feelings

> Learn to cope with and resolve interpersonal difficulties more effectively

23
Q

What does couples therapy consist of?

A

> Interpersonal focus (like IPT)

> Limited to an individual and a partner
- must have a partner who is willing to engage in the sessions

> Can be vey effective when appropriate

> Focus on understanding the effects of interactions as factors in development and maintenance of depression
- then look at changing those interactions: increase supportive behaviours, decrease behaviours causing conflict

> Lot takes place between sessions, including set tasks to try at home

24
Q

What does psychodynamic therapy consist of?

A

> Derived from analytical model of Sigmund Freud

> Emphasis on past patterns of behaviour and relationships and how they play out in session

> Transference and countertransference in therapeutic relationship
-> enabling revisit of past conflicts, conscious and unconscious

> Can take years to complete -> costly

> Dynamic interpersonal therapy (DIT)
- short form, in 16 sessions

25
Q

What should be considered when offering therapy?

A
  1. Effectiveness
    - short and long term
    - refer to NICE guidelines
  2. Types of depression
    - mild, moderate, severe
    - suitability to patient(s)
  3. Availability
    - location
    - waiting lists
  4. Duration and trajectory of symptoms
  5. Previous treatment
    - what was their response?
    - adverse effects?
  6. Patient treatment preferences and priorities
  7. Risk
    - suicide
    - inpatient care might be preferable (manage risks)
26
Q

What is the executive public body NICE ?

A

National Institute for Health and Care Excellence

27
Q

What characterises the NICE?

A

> Executive public body of the UK Department of Health

> Based on research

> Help clinicians choose the best therapies

> Important health economics component
- economically successful: selection of cost-efficient therapies

> Guidelines for physical and mental health

28
Q

What do the NICE guidelines cover?

A

Physical and mental health

29
Q

What are the critics raised on the NICE treatment guidelines?

A

If a patient wants a particular therapy BUT it is not listed in the guidelines
-> not available to UK based patients under NHS

30
Q

What are the advantages of the NICE guidelines?

A
  • Draws together all available evidence

- Helps clinicians make informed decisions

31
Q

What does the stepped care model outlined by the NICE guidelines propose for depressive disorders?

A

> Step 1: All known and suspected cases of depression
-> GP care

> Step 2: Persistent subthreshold depressive symptoms; mild to moderate depression
-> low intensity interventions and medication

> Step 3: Persistent subthreshold depressive symptoms or mild to moderate depression with inadequate response ; moderate and severe depression
-> medication and high intensity interventions

> Step 4: Severe and complex depression; risk to life; severe self-neglect
-> medication, high intensity interventions, ECT, crisis care

32
Q

What are the low intensity interventions for affective disorders in the NICE recommendations?

A

> Guided self help

  • receive support material
  • limited support
  • guide themselves

> Computerised CBT

  • delivered via DVD or internet
  • limited support

> Group CBT

  • strong psychoeducational component
  • focus on techniques and coping strategies
33
Q

Which high intensity interventions for affective disorders in the NICE recommendations have a strong evidence base?

A

> CBT

  • 16-20 sessions over 3-4 months
  • twice a week for 2-3 weeks, prior to 3-4 session over 3-6 months

> IPT
- 16-20 sessions over 3-4 months

> Behavioural couples therapy
- 15-20 sessions over 5-6 months

34
Q

Which high intensity interventions for affective disorders in the NICE recommendations have a weak evidence base?

A

> Behavioural activation therapy

  • 16-20 sessions over 3-4 months
  • twice a week for 3-4 weeks, prior to 3-4 sessions over 3-6 months

> Counselling
- 6-10 sessions over 8-12 weeks

> Short term psychodynamic psychotherapy
- 16-20 sessions over 4-6 months

35
Q

What are the relapse prevention interventions for affective disorders presented in the NICE recommendations?

A

> Individual CBT

  • arguably has longer lasting effect compared to medication
  • teaches long lasting skills

> MBCT

  • groups of 8-15 participants
  • weekly 2 hour meetings over 8 weeks, followed by 4 follow up sessions in 12 months post-treatment

Psychology & Neuroscience of Affective Disorders (16 decks)

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