Psychological therapies for mood disorders Flashcards
What are the most common types of psychological therapies for mood disorders?
- CBT
- Interpersonal therapy (IPT)
- Behavioural activation
- Behavioural couples therapy
- Mindfulness (MBCT, MBSR)
- Psychodynamic therapy
- Counselling
What is the current evidence and use of CBT?
- Very common
- Extensively researched and strong evidence base
- Involved in many different forms to treat numerous psychological disorders
What is the current evidence and use of interpersonal therapy (IPT)?
- Strong evidence base
- Rarely used in UK
- More popular in EU and US
What is the current evidence of behavioural activation?
- Less evidence base compared to CBT and IPT
- Can still be effective
What are the advantages of behavioural activation?
- Simple
- Minimal training/experience required to administer
- Favours patient engagement: can be used to initially engage patients before using another therapy
What is the theory underlying behavioural couples therapy?
> 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
What are the two therapies within the mindfulness approach?
> Mindfulness Based Cognitive Therapy (MBCT)
- from Zindel Segal, Mark Williams, and John Teasdale
> based on: Minfullness Based Stress Reduction Program (MBSR)
What is the current evidence and use of Psychodynamic therapy?
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
What does counselling refer to?
“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
What are the different types of depression?
> Subthreshold depression
> Mild moderate depression
> Moderate severe depression
> Chronic depression
> Treatment-resistant depression
What is depression?
A heterogeneous condition that can take different forms
What characterises subthreshold depression?
- 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
What characterises mild moderate depression?
- Most common form
- Low mood/esteem
- Loss of pleasure
- Changes in appetite
- Sleep disturbance and fatigue
What characterises moderate severe depression?
- Similar symptoms to mild-moderate depression
- Severe impact on day-to-day functioning
- Feelings of worthlessness and death
- Suicidal ideation
What characterises chronic depression?
- Many episodes of depression
- Multiple relapses
What characterises treatment resistant depression?
- Moderate to severe symptoms
- No improvement despite 2 or more courses of antidepressants
What does CBT consist of?
> 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)
What does behavioural activation consist of?
> 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)
Why can behavioural activation be referred to as a “sticking plaster therapy”?
Can patch a person up, making them feel better
BUT high risk of relapse
- you’re not addressing the underlying thought patterns
What does the functional analysis in behavioural activation consist of?
Analysis of:
1. Antecedent: before the behaviour
- Behaviour: its function and form
- Consequences: results after behaviour
What does Mindfulness based cognitive therapy (MBCT) consist of?
> 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
What does interpersonal therapy consist of?
> 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
What does couples therapy consist of?
> 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
What does psychodynamic therapy consist of?
> 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
What should be considered when offering therapy?
- Effectiveness
- short and long term
- refer to NICE guidelines - Types of depression
- mild, moderate, severe
- suitability to patient(s) - Availability
- location
- waiting lists - Duration and trajectory of symptoms
- Previous treatment
- what was their response?
- adverse effects? - Patient treatment preferences and priorities
- Risk
- suicide
- inpatient care might be preferable (manage risks)
What is the executive public body NICE ?
National Institute for Health and Care Excellence
What characterises the NICE?
> 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
What do the NICE guidelines cover?
Physical and mental health
What are the critics raised on the NICE treatment guidelines?
If a patient wants a particular therapy BUT it is not listed in the guidelines
-> not available to UK based patients under NHS
What are the advantages of the NICE guidelines?
- Draws together all available evidence
- Helps clinicians make informed decisions
What does the stepped care model outlined by the NICE guidelines propose for depressive disorders?
> 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
What are the low intensity interventions for affective disorders in the NICE recommendations?
> 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
Which high intensity interventions for affective disorders in the NICE recommendations have a strong evidence base?
> 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
Which high intensity interventions for affective disorders in the NICE recommendations have a weak evidence base?
> 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
What are the relapse prevention interventions for affective disorders presented in the NICE recommendations?
> 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
