Depression

1. Symptoms 2. Prevalence 3. Etiology and therapeutic approach

Symptoms of depression:

Prevalence of depression

Etiology and therapeutic approach

If you think the etiology is biological:
http://www.youtube.com/watch?v=t whvtzd6gXA

Biological etiology and therapy:

Go to realvideo

Cognitive etiology:
Two big names in cognitive therapy: Albert Ellis (1956) Aaron Beck(1967)

Albert Ellis and Rational Emotive Therapy

A-B-C theory of dysfunctional behavior

A B C
A = Activating Event B = Beliefs, Thoughts, Attitudes, Assumptions C = Consequences, Feelings, Emotions, Behaviors, Actions

Example of Irrational Thinking: leads to Emotional Disturbance

A= Fail exam B= Im stupid, Ill never be able to pass this

course and I will fail this course C=depression

Example of Rationale Thinking

A= fail a midterm examination B=Its unfortunate that I failed-I did not study
hard enough and I must make sure that I study harder for the final C=no consequences or emotional disturbance

Rational Emotive Therapy

Identify patients irrational beliefs Add D and E to A-B-C theory Teach the patient to dispute the beliefs and substitute logical and rational beliefs Evaluate the effects of disputing their irrational beliefs

Ellis List of Common Irrational Ideas

I absolutely must have sincere love and approval almost all the time from all the significant people in my life I must be thoroughly competent, adequate and achieving in all respects, or I must at least have real competence or talent at something important; otherwise I am worthless. People who harm me or who do a bad thing are uniformly bad or wicked individuals, and I should severely blame, damn, and punish them for their sins and misdeeds

Irrational beliefs, continued

When things do not go the way I would like them to go, life is awful, terrible, horrible, or catastrophic Unhappiness is caused by external events over which I have almost no control. I also have little ability to control my feelings or rid myself of feelings of depression and hostility.

Albert Ellis and Rational Emotive Therapy

A-B-C theory of dysfunctional behavior

A B C
A = Activating Event B = Beliefs, Thoughts, Attitudes, Assumptions C = Consequences, Feelings, Emotions, Behaviors, Actions

Aaron Becks theory of depression:

Depressed people have a negative view of: Themselves The world The future Depressed people have negative schemas or frames of reference through which they interpret all events and experiences

Example of negative schema:

Person with negative schema involving rejection will become depressed when a partner leaves him or her

Becks therapeutic approach:

Identify and changing maladaptive thoughts
First sessions: therapist explains cognitive theory of emotional disorders (negative cognitions contribute to distress) Middle Sessions: Client is taught to identify, evaluate and replace negative automatic thoughts were more positive cognitions Therapist is a collaborator (fellow scientists in therapy) Final Sessions: solidify gains, focus on prevention of recurrence

Ellis and Beck (and cognitive therapy in general):

Rely on a partnership / relationship between patient and therapist Intelligence of patient is not a factor Short-term (good for insurance!) May be combined with drug therapy

Limitations of cognitive therapy:

Treatment terminology is too vague Does not focus all that much on the patient's past history Sometimes called a "band-aid" rather than a permanent solution and may only have short-term results Criticized for overlooking the patient's broader clinical issues

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Group Approaches to Treatment Advantages Less expensive than individual treatment Provides a support group for the client and reduces dependency on therapist Helps clients realize that they are not alone (lessens feelings of abnormality) Helps foster social skills and confidence

Disadvantages to group therapy

1. It may not allow patient to get to the root of their problem 2. Some individuals do not want to disclose in a group 3. Confidentiality might be an issue 4. Certain individuals may be heard more or less than others or perceive that they are heard more of less than others. 5. May not be appropriate for all cultures due to gender roles, deference to group members based on age or status and /or the misinterpretation of therapy as a social activity

The Eclectic Approach- biological, cognitive and social combined

Example: A suicidal depressive who is not in a state in which he can discuss his cognitive processes may be put on antidepressants until his mood improves and then enter cognitive therapy to tackle the thoughts that triggered and reinforced his attempt

Strenths
One type of therapy may be more effective in a particular treatment Klerman et al (1994) have shown that a combination of therapeutic approaches is moderately more effective than either psychotherapy or drugs alone