Cognitive therapies for mood disorders

• Beck believes that people have maladaptive attitudes that lead to the having an unrealisticaly negative view of the world, themselves and the future--> cognitive triad
• When combined with illogical thinking, individuals produce automatic thoughts which are always negative
• Beck developed a treatment that aimed to help people recognise their maladaptive thought processes
• Requires 12-20 sessions
• Tailored to deal with dysfunctional cognitive processes found in depression
• Follows four successive phases:

Phase 1- Increasing activity and elevating mood

• Patients encouragd to become more active and confident
• Goals tailored to individual for up coming week
• These actions will improve the individual's mood

Phase 2- Examining and invalidating automatic thoughts

• Therapist educates the patient on their negative thoughts
• Patient is encouraged to keep a diary of their thoughts which the therapist will challenge, making the patient justify their thoughts- the patient can't do this due to them being irrational thoughts

Phase 3- Identifying distorted thinking and negative biases

• Therapist tries to make the patient understand how their irrational, negative thoughts are contributing to their depression
• The patint is taught that these negative thoughts create a negative bias which must be changed by confronting these thoughts

Phase 4- Altering primary attitudes

• The therapist will help the patient to change their central belief that is at the root of their depression e.g. 'I can't be happy without a partner'--> Primary attitude
• The therapist gets the patient to challenge their primary attitude

Effectiveness

• Hundreds of studies have found that cognitive behavioural therapy does help patients with depression
• Mildly to severely depressed people who receive the therapy significantly improve compared to those who receive placebos/ no therapy
• Some research has found that 50-60% of clients make complete recovery
• Clients who respond display steady improvements in their cognitive functioning over the course of the therapy, including progressively less pessimism and positive changes in self-concept
• Research has suggested that the therapy is less effective in groups compared to on an individual basis

• A psychiatric treatment given to severely depressed patients where antidepressants have had no effect and there is a risk of suicide
• A brief electrical current is passed through the brain via electrodes placed at the temples, the current causes an epileptic seizure that lasts from around 30-60 seconds
• The patient is anaesthetised beforehand and is given an injection of muscle relaxant to minimise muscle spasms
• Research shows that it is the seizure that creates the antidepressant effect as opposed to the electical current
• 4 to 5 treatments usually have to be given before any significant improvement can be seen

Why does it work?

• Clinicians are unsure as to why it works- one of the reasons as to why it is so controversial
• One threory is that the ECT causes therelease of serotonin and noradrenaline into the synapses or causes the neurotransmitters to work more effectively
• Another theory is that ECT alters the blood flow to the brain, Nobler et al reported that the success of ECT was associated with reduced blood flow in the frontal-temporal regions

Side Effects

• Short term: headaches, aching mucles and confusion
• Long term: memory problems (some have reported it to be permenant) and personality changes
• The more ECT someone is given, the more likely is is that their memory will be affected

Ethical Issues

• Severe side effects of possible brain damage
• Unsure about how the treatment actually works
• Inhumane and degrading
• Consent- the patient may be so unwell that the treatment is given under the mental health act
• 2,800 people in England and Wales were given the treatment in the first 3 months of 1999 of which 59% received against their will
• Others argue that ECT saves the lives of suicidal people and therefore the benefits outweigh the risks- a 2003 meta analysis found that the number of people that found ECT beneficial ranged from 30-80%

• Based on the assumption that depressed individuals have difficulties with interpersonal relationships
• The aim is to alleviate depressive symptoms and improve interpersonal functioning, particularly with significant others, it does this by 'clarifying, refocusing, and renogotiating the interpersonal context associated with the onset of depression'
• 12-16 weeks of one to one sessions
• The therapist uses non directional exploration

Three phases

• Intial phase- Assessment and formulation of treatment goals, patient learns about depreesion as a illness
• Second phase- Identifies interpersonal problems that are thought to contribute to the depression
• Termination phase- Focuses on consolidating learning and on preparing for the use of the learnt skills in future difficulties

• Aim: To investigate the efficacy of different treatments for depression
• Method: 250 outpatients with major depression assigned to one of four treatments for 16 weeks- CBT, interpersonal therapy, drug therapy and the placebo group, 18 months a follow up analysis was carried out
• Results: Patients responded equally well to the active treatments with those with severe depression intially doing better on long term medication, recovery 36% for CBT- higher than the placebo group but similar to other condtions. After 18 months, te psychotherapy had maintained their improvemts above the medication and placebo groups
• Conclusion: CBT is at least as effective as medication, and there are no side effects, psychotherapy has a long term advantage over medication
• Evaluation: Contains a placebo group (control)- comparisons can be made

• Meta-analysis- cognitive-behavioural therapy was found to be more effective than any other therapy, including anti depressants, rates of relapse were reduced after therapy
• Relapse- Cognitive therapy addresses the issue that caused the depression to start off with therefore reducing relapse, medication on the other hand only addresses the symptomes rather that the intial cause meaning that when the patient comes off the medication there is an increased likelihood they will relapse
• Ethics- it is argued the therapist should not get to decide which beliefs are irrational/unacceptable
• Bipolar- this treatment is not suitable for bipolar patients and relies on the patient being both articulate and motivated to engage in treatment (people with learning difficulties/low IQ or haven't yet accepted their depression may struggle)
• Interpersonal therapy- this therapy has not been fully researched but intial studies have found that patients who received IPT stayed well longer tha those who received a placebo

• Smith and Glass- reviewed 400 studies of a wide variety of treatments and found that all were more effective than no treatment at all. They also found that patients that discontinue antidepressant medication have a 50% chance of relapse in the first 6 months after therapy unless it is folled by psychotherapy--> suggests and eclectic approach is most effective
• Relapse rates (12 weeks of...)- Drug therapy, no continuation--> 50%, Drug therapy, continued for 1 yr--> 32%, Cognitive therapy, no continuation--> 21%, Drug and cognitive, no continuation--> 15%
• Importance of drug therapy- elevate a seriously depressed patient's mood to enable them to function cognitive, behavioural or psychodynamic therapy sessions
• ECT- helpful for 50-80% of severely depressed, drug resistant individuals