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| Frage | Antworten |
| Depression 2: Implementing Treatment Biomedical Treatments of Depression - Antidepressants (AD). | LO: Describe the biological processes involved in drug treatment, specifically SSRI's & Tricyclics. |
| What is the biomedical approach? | This assumes that if a mental problem is caused by biological malfunctioning, the cure is to restore the biological system with drugs or other treatments which alter biological processes. |
| How do antidepressants work? | Normal brains- neurotransmitters (NT) are constantly released from nerve endings that stimulate neighbouring neurones. NTs linked to depression as low levels of Serotonin & Noradrenaline = the cause. Drugs work by; reducing rate of re-absorption (SSRI's) or blocking enzyme which breaks down serotonin. (TC) Same goal- increase the amount of NT. |
| Biomedical Treatments of Depression - Evaluating Antidepressants as a Biomedical treatment. | LO: Evaluate the use of drugs n terms of their effectiveness; describing research that identifies with success or failure of the treatments. |
| Do antidepressants work? Use a piece of research to explain. AMRC | Kirsch et al- M: Meta-analysis used clinical trials of 6 most used antidepressants. R: Overall effect of new generation AD medication (SSRI) was below recommended criteria for clinical significance, meaning placebo may be just as effective. C: SSRI's not as effective, depression's more cognitive than biological. |
| Rough TEETH paragraph outline for Kirsch et al. | TS: Using AD as a biomedical treatment has been found to be as effective in comparison with placebos. E: Meaning SSRI & TC may not be needed if placebos can be. E: Kirsch. T: According to researchers; placebo effect may account for any observed effect and are very sceptical about the increasing use of AD based on results of clinical trials. |
| Is there any increased risk of relapse (ROR) due to AD? Use a piece of research. AMRC | Neale et al. M: Meta-analysis of published studies about outcome of AD vs placebo. M: Focused on 1. patients who started w/ ADs then changed to placebo, 2. patients who only recieved placebo & 3. only took ADs. R: Don't take AD = 25% risk. 42+% been on medication and stopped. C: Ads may interfere w/ brains natural self regulation. Drugs affecting seretonin etc may increase ROR. Drugs reduce symptoms in short term but when they stopped being taken, depression may return as brains natural self-regulation is disturbed. |
| Rough TEETH outline for Neale et al. | TS: Evidence has shown limitations of AD linked to risk of relapse. E: Meaning AD can increase the risk of relapse of depression if a patient stops taking them. E: Neale. T: AD can have side effects and effect the brains natural self-regulation leading to ROR. |
| Biomedical Treatments of Depression - Appropriateness of AD medication. | LO: Describe the level of appropriateness of each of the drugs in terms of ethics, side effects and the use of placebos. |
| Are there any side effects of antidepressents? Use research. | Ferguson - review of studies into SSRI vs placebo found those treated w/ SSRI's were 2x as likely to commit suicide. General points- ✓ drugs can be cheap & effective at reducing symptoms. ✕ drugs don't constitute a cure & various reviews- Kirsch, demonstrated drugs aren't more effective than placebos & should therefore not be used unless patient's severely depressed or if alternatives have failed. |
| Biomedical Treatments of Depression - ETC. | LO: Describe the biological process involved with ETC. |
| When is ECT used? | ECT's used when treating severely depressed patients when psychotherapy & medication's been ineffective or schizo & manic symptoms. It's often used when there's risk of suicide in patients as results are often quicker than drugs. NICE- ''ECT should only be used when all other treatments have failed or when condition's considered to be life threatening. |
| How does ECT work? | ECT's assumed to work as a result of the induced seizure that appears to restore the brain's ability to regulate mood. It may do this by enhancing the transmission of neurochemicals or by improving blood flow in the brain. |
| Evaluating ECT as a Biomedical Therapy. | LO: Identify the side effects associated with ECT & evaluate the use of ECT in terms of effectiveness; describing research that identifies the success or failure of the treatment & identify key ethical issues involved in such treatment and support with research. |
| What is the effectiveness of ECT? Use a piece of research. | There's contradictory research as to if ECT works or not. this is tested by comparing it with ''sham ECT'' (patient anaesthetised but doesn't get treatment). Gregory - significant difference in outcome in favour of real ETC. Scott - review of 1144 patients comparing ECT w/ ADs showed ECT's more effective in short term. But, no comparisons been made between newer ADs (SSRI). |
| What's the appropriateness of ECTs? Use a piece of research. | Rose et al- 1/3 patients complained of memory loss. However, such side effects can be reduced. Using unilateral ECT minimises cognitive problems associated with ECT. Sackheim et al - unilateral ECT's less likely to cause cognitive problems than bilateral, yet may be just as effective. |
| Biomedical Treatments of Depression - Cognitive Behavioural Therapy (CBT). | LO: Describe the processes involved in CBT. |
| What is the aim of CBT? | To change negative thinking patterns (cognitive restructuring). |
| What is the first step of CBT? | 1. Identify and correct faulty cognitions & unhealthy behaviour (Cognitive part of the therapy). Therapist encourages client to identify thinking patterns associated with depressive feelings. These false beliefs are challenged (reality testing) to give the client the possibility to correct them (cognitive reconstruction). The faulty cognitions appear to fall in 6 Patterns of Faulty Thinking. |
| What are the 6 Patterns of Faulty Thinking? | 1. Arbitrary Interference, drawing wrong conclusions about oneself by making invalid connections. 2. Selective Abstraction, drawing conclusions by focusing on a single part of a while. 3. Overgeneralisation, applying a single indecent to all similar ones. 4. Exaggeration, overestimating the significance of negative events. 5. Personalisation, assuming others behaviour;s done w/ intention of hurting/humiliating you. 6. Dichotomous Thinking, an all-or-nothing approach to viewing the world. |
| What's the goal of the first step of CBT? | The goal's to record the thoughts, usually into 3 columns, and the therapist will teach techniques for challenging and replacing them with more realistic thoughts. |
| What is step 2 of CBT? | Increase activity & learn alternative problem solving strategies. (*Behavioural part of the therapy) Therapist encourages clients to gradually increase activities that could be rewarding, e.g. sort or meeting new/old friends. This' known as behavioural activities *. Being active physically & socially leads to rewards, giving the patients the opportunity to challenge negative schemas that have previously biased their thinking. Therapists set new goals & diffuses any ''I can't do that'' thoughts. |
| What have recent developments suggested about CBT? | It;s making people aware of their thoughts and the effects these have that's important rather than changing their thoughts. Teasdale - important feature in cognitive therapy may be to teach the client meta-awateness - the ability to think about own thoughts. Thoughts & feelings are seen as mental events that can be examined objectively + changed if necessary. Aim of therapy's to teach clients to monitor thought processes & then test them against reality so they can eventually change their behaviour. |
| Biomedical Treatments of Depression - Evaluation for CBT as an Individual Therapy. | LO: Evaluate use of CBT in terms of its effectiveness; describing research the identifies the success or failure of the treatment & evaluate the level of appropriateness of each of CBT in terms of suitability for certain client groups. |
| Give research supporting the effectiveness of CBT using a piece of research. Robinson (TEETH) | Robinson- TS: Research evidence supports effectiveness of CBT in the treatment of depression. E: Meaning depression can be substantially decreased through CBT. E: Found CBT was superior to non-treatment control groups. T: Effective treatment. |
| Give research against the effectiveness of CBT using a piece of research. Kuyken Tsvirikos (TEETH) | TS: Despite research supporting effectiveness of CBT, it;s been found that success or failure of treatment relies heavily on the competence of the therapists. E: Could be variation in how effect CBT is depending on the therapist. E: KT found as much as 15% of the variance in outcome may be attributable to therapists competence. T: Meaning depending on how '''good'' the therapist is will affect if the depression is helped or not. |
| Give research limiting the effectiveness of CBT using a piece of research. Elkin. | It's only likely to be effective with those willing to change. As a result of stigma or feelings of failure often people w/ depression are more willing to accept a biological explanation for disorder as it removes blame from 'themselves'. Elkin found people w/ this thought pattern w/ high levels of dysfunctional beliefs are often reluctant to acknowledge the role of their own thoughts & are therefore resistant to change. Meaning treatment's unlikely to be effective in these groups of people. |
| Give research supporting the effectiveness of CBT using a piece of research. Riggs et al (TEETH) | TS: Research supporting use of CBT alongside placebo or SSRI's. E: Using 2 ways of treating depression that targets both cognitive and biological increases chance of reducing it. E: Found out of 126 adolescents with depression & substance use/conduct disorder, 67% of those CBT & placebo group complied w/ treatment and CBT + SSRI, 76% were described as much improved. T: Meaning especially helpful for those patients described by Alkin. Targets 2 features of depression. |
| Biomedical Treatments of Depression - Group Approached to Treatment of Depression - Mindfulness Based Cognitive Therapy (MBCT) | LO: Describe the process involved in MBCT. |
| How might MBCT help someone with depression? | It's another option for people with depression, people who may not hear or share when they're alone w/ a therapist may be encouraged to participate in discussion when surrounded by others, perhaps with the same disorder. There's a chance they can learn vicariously through the experience of others and become more optimistic about own chances for recovery if they meet others who've improved. |
| Who came up with MBCT, what's the aim, process and goal of it? | Developed by Segal et al, psychosocial group therapy. Aims to prevent relapses of depression after successful treatment for MDD. It's based on a Buddhist meditation + relaxation techniques that help people to direct their focus & concentrate so they're able to observe intrusive thoughts and gradually become able to prevent the escalation of negative thoughts. The goal's to teach people to recognise signs of depression and adopt a ''decentred' perspective, where people see thoughts as 'mental events' rather than something central to their self-concept or as accurate reflections of reality. |
| Biomedical Treatments of Depression - Evaluating MBCT as a Group Therapy of Depression. | LO: Evaluate use of MBCT in terms of its effectiveness; describing research that identifies the success or failure of the treatment. |
| Give research supporting the effectiveness of MBCT using a piece of research. Kuyken (TEETH) | TS: Researches have tried to support the effectiveness of group therapy for those with recurring episodes of depression. E: TMT there's support for MBCT reducing depression. E: Kuyken found relapse rate of a control group that had a history of 3+ episodes of depression who were continued medication was 60% but relapse rate in experimental group where they attended a MBCT course & gradually diminished medication had 47% relapse rate. T: MBCT can help depression in the long term therefore reducing the risk of relapse. |
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