IB Abnormal Psychology – Flashcards

DSM-IV: diagnostic and statistical manual of mental disorders -> handbook used by US psychologists to diagnose based on factors such as clinical/medical conditions (bio), psychosocial stressors (socioc), and extent to which mental state (cogn) interferes with daily life. Biological: - The medical model - assumes that abnormal behaviour is of a physiological origin - Reductionist approach - Szazs argues that it is a problem with living not "mental illness", thus went against organic pathology and indicated that abnormal behaviour =/= brain disease -> Supported by Frude (1998): few disorders have identifiable organic pathology => ! Progress in brain invest.: possible chemical abnormality in temporal cortex correlated to schizo. (Pilowsky, 2006) - brain scans don't infer causation, just correlation SEE ETIOLOGIES

Concepts of normality and abnormality; ethical considerations Rosenhan: -> part 1; part 2 - all by 1 staff, 19/41 by staff + psychiatrist ---------------------------------------------- Well supported studies showing reliability/validity issues The Great Ormond Street Hospital -> DSM-IV: 64% (most raters couldn't make any diagnosis so inter-reliability value increased), ICD-10: 36%, GOS-system: 88% Beck et al. (1962) -> 2 psychologists, 153 patients = 54% reliability Cooper et al. (1972) -> Clinical interview video, Inter-rater reliability: NY - London psychologists: NY - 2x more likely to diagnose schizophrenia, LNDN: 2x more likely to diagnose mania/depression Di Nardo et al. (1993) -> Reliability for DSM-III for anxiety disorders 267 ppl seeking treatment for anxiety/stress disorders. Two clinicians - reliability: 80% OCD, 57% general anxiety disorder Lipton and Simon (1985) -> 131 patients retested in NY hospital, (re-diagnosis: original diagnosis) 16:89 -schiz., 50:15 -mood disorder ---------------------------------------------- Diagnosis -> prejudice/discrimination; ecological validity Langer and Abelson (1974) ->young man talking to old man job applicant vs. patient -> attractive, conventional looking vs. frightened by own aggressive impulses; defensive; dependent Activates schema processing - people in study - ecological validity - demand characteristics care is to be taken in diagnosing, but necessary for improvement ---------------------------------------------- Cultural considerations/biases Jenkins-Hall and Sacco (1991) -> African American women and European American women compared by European American therapists -> watched video of clinical interviews, depressed/non depressed groups, both with one A. Am. and one E. Am. -> rated fairly equally for AA and EA non-depressed, AA depressed more negative terms (+ sell socially competent) than EA depressed Eval: variable control - participant variability, may not be indication of cultural/racial bias because few participants in videos - not generalizable

Intro: hard to define, thus psychologists use standardised interviews, diagnostic models, and various other systems. -> Eval: do not come without limitations -> e.g. bases related to culture and norms -> studies: Rosenhan Body 1: Objective criterion are established in order to increase reliability and in order to establish the concepts of normality and abnormality 1) Statistical abnormality -> Eval. 2) 7 factors of normality and abnormality (Rosenhan and Seligman, 1984) 1. Suffering 2. Maladaptiveness 3. Irrationality 4. Unpredictability 5. Vividness and Unconventionality 6. Observer Discomfort 7. Violation of moral/ideal standards Eval: - 1-4: how person is living, 5: social judgement, 6 & 7: social norms -> fail to consider diversity - Maladaptive: extreme sports? Body 2: Jahoda's 6 mental health criteria - attempt to define normality in mental health context 1. Positive attitude toward oneself 2. Growth, development, self actualization 3. Integration 4. Autonomy 5. Accurate perception of reality 6. Environmental mastery Eval: - few people fulfil criteria - (Taylor and Brown, 1988): Depressed people -> more accurate perception of reality. Most people require a degree of self-delusion to function adequately. Unreasonable optimism seems beneficial for many. Body 3: Medical model - Physical illnesses are easy to recognise using objective criteria, but psychological are not - Medical model suggests organic pathology (there are biological correlates to behaviour) - Reductionist approach -> Szasz "problems with living" not "mental illness" -> Frude (1988): few disorders have identifiable organic pathology => Pilowsky, 2006: Possible correlation with abnormalities of temporal cortex and schizophrenia. Correlation =/= causation Conclusion: since we cannot identify organic pathology as causation, other objective criteria is needed Body 4: Classification systems - Used in attempt to make classification of mental illnesses objective -> DSM-IV: diagnostic and statistical manual of mental disorders -> ICD: international classification of disorders --> Change with revisions: abnormal psych = social construction evolved over time with no prescriptive and regulating definitions? --> Culture/gender biased? Culture blindness, reporting bias, culture-bound syndromes, overpathologisation - Jenkins-Hall and Sacco --> reliability/validity is low even when using "objective" criteria - The Great Ormond Street Hospital -> DSM-IV: 64% (most raters couldn't make any diagnosis so inter-reliability value increased), ICD-10: 36%, GOS-system: 88% - Lipton and Simon (1985) -> 131 patients retested in NY hospital, (re-diagnosis: original diagnosis) 16:89 -schiz., 50:15 -mood disorder Body 5: Distinguishing between normality and abnormality - institutionalisation & overpathologisation & confirmation bias - Rosenhan (1973) Conclusion: Attempt at forming objective criteria for what is normal and abnormal. Abnormality is often seen as mental illness, yet might just be a social construct. In all studies presented we see that definitions of abnormality are difficult to objectify and are prone to biases; shown through lack of validity and reliability. Culture differences.

Intro: problems with validity and reliability because different perceptions of normality and abnormality Body 1: Different perceptions of normality and abnormality - Rosenhan and Seligman - Jahoda - ABCs, clinical interview, classification systems Body 2: Classification systems The Great Ormond Street Hospital -> DSM-IV: 64% (most raters couldn't make any diagnosis so inter-reliability value increased), ICD-10: 36%, GOS-system: 88% Beck et al. (1962) -> 2 psychologists, 153 patients = 54% reliability Cooper et al. (1972) -> Clinical interview video, Inter-rater reliability: NY - London psychologists: NY - 2x more likely to diagnose schizophrenia, LNDN: 2x more likely to diagnose mania/depression Di Nardo et al. (1993) -> Reliability for DSM-III for anxiety disorders 267 ppl seeking treatment for anxiety/stress disorders. Two clinicians - reliability: 80% OCD, 57% general anxiety disorder Lipton and Simon (1985) -> 131 patients retested in NY hospital, (re-diagnosis: original diagnosis) 16:89 -schiz., 50:15 -mood disorder Body 3: Culture -> Culture-bound syndromes and racial/ethnic biases, overpathologization Neurasthenia Jenkins-Hall and Sacco Rack: - minority ethic group exhibits same symptoms as British - assumed same disorder, might not be - stigma Marsella: might actually be different due to different stress sources etc. -> Culture blindness - not norm in Clinician's own culture fixes: - bilingual eval - get to know culture (Sattler) - local clinician Body 4: institutionalization, confirmation bias, distinguishing between normality and abnormality - Rosenhan Conclusion: never agreement, can only be one true "diagnosis", thus low reliab = low valid. Though evaluations, 'tis clear that there isn't an agreement.

Intro: Essential to consider ethical and cultural consideration in diagnosing because diagnosis determines treatment and has a life-long effect -> Szasz: labelling carries ethical issues -> Conceptions of abnormality differ among people and cultures, and may thus affect the validity of diagnosis Body 1: Labelling can affect a person's conception of themselves and the way others treat them, therefore it is important to consider ethical implications before labelling someone as "mentally ill" -> Scheff: self-fulfilling prophecy --> Doherty, reject label -> faster improvement -> Exclusion/people stimagtized -> Prejudice and discrimination - Langer and Abelson Eval: study control group, low ecological validity Body 2: racial, ethnic, and confirmation biases along with ethical considerations relating to institutionalisation and powerlessness and depersonalisation are important to take into consideration. -> Racial/ethnic biases --> Jenkins-Hall and Sacco Evaluation: cross-cultural, few participants - stereotypes, overpathologization, labelling, treatment --> Rosenhan, institutionalisation, powerlessness and depersonalisation, ethical concerns of study Body 3: Culture bound syndromes, reporting bias, and culture blindness are important cultural considerations -> CBS: neurasthenia -> Reporting bias -> Culture blindness fixes: - bilingual eval - get to know culture (Sattler) - local clinician Conclusion: failing to recognise cultural differences and implications can lead to unethical treatment. the low reliability and validity of diagnoses also has ethical implications because diagnosing a patient is a label for life and determines treatment. promotes exclusion, prejudice, improvement, etc.

Affective disorder: Major Depressive Disorder Symptoms such as the following interfere with normal life activities such as work and relationships. MDD can be diagnosed after 2 weeks of depressed mood, loss of interest &pleasure, in combination with four additional symptoms. Symptoms: > Affective: - guilt - sadness - lack of enjoyment or pleasure in familiar activities or company > Behavioural: - passivity - lack of initiative > Cognitive: - frequent negative thoughts - faulty attribution of blame - dichotomous thinking - low self-esteem - suicidal thoughts - irrational hopelessness - possible difficulties with concentration and inability to make decisions > Somatic: - loss of energy - insomnia - weight loss/gain - diminished libido Prevalence Lifetime prevalence: 15% (Charney and Weismann, 1988) ~1/4 of psych hospital admissions in 1980s in UK (Department of Health, 1990) - 2-3x more common in women than in men - more frequent among members of lower socio-economic groups - Most frequent in young adults (onset age) - Levav (1977) - prevalence rate is above average in Jewish males, no difference between Jewish men and women - Difference could suggest that some groups are more vulnerable to depression, but could also be - problem with reliability - reporting bias - overpathologization - confirmation bias - problems interpreting symptoms - 80% of people experience subsequent episode lasting 3-4 months - average episodes = 4 - In approx 12% of cases, depressions becomes chronic with duration of about 2 years ---------------------------------------------- Eating Disorder: Bulimia Symptoms: > Affective: - guilt, disgust (in relation to binge = ego-dystonic behaviour) - shame (because behaviour causes stress to those who love them, and waste of food) - inadequacy > Behavioural: - recurrent episodes of binge eating; use of compensatory methods to avoid weight gain: vomiting, laxatives, exercise, dieting to control weight > Cognitive: - negative self-image - poor body image - tendency to perceive events as more stressful than most people would (Vanderlinden et al, 1992) - perfectionism > Somatic: - swollen salivary glands - erosion of tooth enamel - stomach or intestinal problems - heart problems (extreme cases) Prevalence - lifetime prevalence in US: 2-3% women, .02%-0.03% men (National Institute of Mental Health) - Frude, 1998 - approx 10:1 female:male bulimia sufferers - lifetime prevalence: around 2% of all adults (similar found in Japan and some European countries such as Norway) - symptoms of bulimia have been reported in up to 40% of college women in western-centric cultures (Keel et al., 2006). - Typical onset age: late teens, early twenties - Prevalence rates appear to be increasing, but greater medical and public awareness may simple be resulting in increased reporting rate - Prevalence believed to be more common in industrialised countries, but appropriate studies have not been conducted in developed countries. - Lifetime prevalence in Tehran, Iran: 3.2%; Body dissatisfaction and a desire to be thin is common in this culture. - Women aged 15-29 prevalence rate in Japan = 3.79% Fallon and Rozin, 1985 There seems to be a gender difference in the perception of body images. US undergraduates were shown figures of their own sex and asked to indicate the figure that looked most like their own shape, their ideal figure, and the figure they thought would be most attractive to the opposite sex. Men selected very similar figures for all three body shapes. Women chose ideal and attractive body shapes that were much thinner than the shape they indicated as representing their own shape. Women tended to choose thinner body shapes for all three choices (ideal, attractive and current) compared to the men. Jaeger et al. 2002 Studied body dissatisfaction 1751 medical + nursing students across 12 nations (western/non-western) Self-report Shown 10 body images to assess Mediterranean countries > Northern Europe Westernized ^ Suggests that body dissatisfaction results from "idealized" body image displayed in media. Westernized countries more exposed. EXPLANATIONS OF DISORDER MUST BE CONSIDERED AT A MACRO-LEVEL (society) RATHER THAN AS ORIGINATING SOLELY WITHIN THE INDIVIDUAL (micro-level). Eval: - ignores genetics - natural experiment, culture was not under control of experimenter - causation cannot be inferred - not representative sample

Intro: Depression and bulimia Depression Related to many factors such as: genetic predisposition, personality and early history, cognitive style, coping skills, and the level of social support available. Generally a combination of factors. ---------------------------------------------- BLOA: 1) Genetic predisposition can partially explain depression. - Nurnberger and Gershon (1982) -> meta-analysis of 7 twin studies Average concordance rates for depression: MZ: 65%, DZ: 14% Concordance rate for MZ far below 100%, indicating that bio may predispose but not cause. Duenwald (2003), short variant of 5-HTT gene associated with higher risk of depression. -> plays role in serotonin pathways which scientists think are involved in controlling mood, emotions, aggression, sleep, and anxiety --> Data - correlational. Caspi et al. (2003) suggest that genetic factors could moderate responses to environmental factors, and warn that speculation about clinical implications of these findings is premature. ------------------ 2) The catecholamine hypothesis -> The serotonin hypothesis -> Catecholamine hypothesis was suggested by Schildkraut (1965) - depression is associated with low levels of noradrenaline. --> Developed into serotonin hypothesis - i.e. serotonin is neurotransmitter responsible. Researchers have attempted to identify how biochemical changes could induce depression. Drugs that decrease noradrenaline tend to produce depression-like symptoms. ---> Janowsky et al. (1972) Participants given drug called physostigmine - became profoundly depressed and experienced feelings of self-hate and suicidal wishes within minutes of having taken the drug. - Fact that a depressed mood can be artificially induced by certain drugs suggests that some cases of depression might stem from a disturbance in neurotransmission. Furthermore, drugs that increase the available noradrenaline tend to be effective in reducing the symptoms of depression. ---> DELGADO and MORENO (2000) found that patients with MDD had abnormal levels of noradrenaline and serotonin. ---> Rampello et al. (2000) patients with MDD have imbalance of several neurotransmitters including noradrenaline, serotonin, dopamine, and acetylcholine. Eval: - Symptoms not always indicative of depression, - Confirmation bias - Abnormal levels of neurotransmitters might not CAUSE depression, but depression might in fact influence the production of neurotransmitters. - Burns (2003) says that although he has spent many years of his career researching brain serotonin metabolism, he has never seen any convincing evidence that depression results from a deficiency of brain serotonin; not possible to test in living humans. - Lacasse and Leo (2005) support ^, brain = complex and poorly understood. --> focus of research is more so on neurotransmission now, than neurotransmitters The cortisol hypothesis - cortisol = major hormone in stress system, regulates efficiency of certain neural pathways (serotonin, noradrenaline, etc). can predispose person to psychological/physical disorders - patients with MDD as well as stressed people have high levels of cortisol; correlation btwn LT-stress & MDD? --> stress MDD Similarly, the effect of drugs is seen in patients with cushing's syndrome; there is a high prevalence of depression among people with Cushing's syndrome - a disease which results in excessive production of cortisol. When given a drug that normalizes cortisol levels, these people's depression disappears. This is seen as evidence of a link between cortisol and depression although researchers do not fully understand this link at present. ---------------------------------------------- CLOA: Cognitive theories of depression suggest that depressed cognitions, cognitive distortions, and irrational beliefs produce the disturbances of mood. 1) Cognitive style theory (Ellis, 1962) - irrational and illogical thinking often -> psychological disturbances Beck, 1976: cognitive DISTORTION theory - schema processing about self interfering with info processing. - Overgeneralization - Non-logical inference about the self - Dichotomous thinking --> negative cognitive schemas activated by stressful events; depressed person tends to overreact. - Attributional style: the way in which person makes cognitive appraisals of situations.- negative thinking creates cycle ---> longitudinal study, Alloy et al (1999) - sample of young Americans - evaluated and placed in "negative thinking group" / "positive thinking group". - 6 years later they were analyzed and it appeared that 17% NEGATIVE -> depression, 1% POSITIVE " " thinking group had developed depression. The results indicate that there may be a link between cognitive style and development of depression. cognitive style and depression can go either way, unclear which "causes" the other if there is in fact correlation ---------------------------------------------- SCLOA Brown (1978) - vulnerability model of depression life events can predispose to depression: - lacking employment away from home - absence of social support - having several young children at home - loss of mother at an early age - history of childhood abuse - Studied women sought help form their doctors, and women who received hospital treatment for depression (458 women 18-65) - 29 out of 32 who became depressed had experienced a life event o yet 78% of those who experienced a life event were non-depressed - pronounced social class effect: lower class ^ prevalence - having young children, divorce, etc. was seen to have an effect in increasing prevalence - about 20% who experience life event became depressed (majority did not) - suggests people differ in vulnerability - one of the most protecting factors against depression was found to be the presence of a partner --> In line with diathesis-stress model, interactionist approach: genetic predisp. + precipitating environmental events can lead to depression. --> did not include considerations of other life history of women. hard to trace etiology thus saying that became depressed as a result of event can be reductionist. maybe it was stress? Marsella (1979): affective symptoms less common in collectivist cultures with strong social networks -> could just be stigmas/reporting bias Conclusion: social factors can increase vulnerability to depression, and social support can offer protection against effects of potentially stressful events. Social factors interact with cognition and how person makes appraisals of situations. ---------------------------------------------- Conclusion: biological, cognitive, and sociocultural factors all interact. biological and socio are linked by diathesis-stress model, and cognition in the appraisal of precipitating life events. clear origin cannot be determined for patients.

MDD - 2-3x more common in women than in men - Levav (1977) - prevalence rate is above average in Jewish males, no difference between Jewish men and women - Difference could suggest that some groups are more vulnerable to depression, but could also be - problem with reliability - reporting bias - overpathologization - confirmation bias - problems interpreting symptoms ---------------------------------------------- Bulimia - lifetime prevalence in US: 2-3% women, .02%-0.03% men (National Institute of Mental Health) - Frude, 1998 - approx 10:1 female:male bulimia sufferers - Prevalence believed to be more common in industrialised countries, but appropriate studies have not been conducted in developed countries. - Lifetime prevalence in Tehran, Iran: 3.2%; Body dissatisfaction and a desire to be thin is common in this culture. - Women aged 15-29 prevalence rate in Japan = 3.79% Fallon and Rozin, 1985 There seems to be a gender difference in the perception of body images. US undergraduates were shown figures of their own sex and asked to indicate the figure that looked most like their own shape, their ideal figure, and the figure they thought would be most attractive to the opposite sex. Men selected very similar figures for all three body shapes. Women chose ideal and attractive body shapes that were much thinner than the shape they indicated as representing their own shape. Women tended to choose thinner body shapes for all three choices (ideal, attractive and current) compared to the men. Jaeger et al. 2002 Studied body dissatisfaction 1751 medical + nursing students across 12 nations (western/non-western) Self-report Shown 10 body images to assess Mediterranean countries > Northern Europe Westernized ^ Suggests that body dissatisfaction results from "idealized" body image displayed in media. Westernized countries more exposed. EXPLANATIONS OF DISORDER MUST BE CONSIDERED AT A MACRO-LEVEL (society) RATHER THAN AS ORIGINATING SOLELY WITHIN THE INDIVIDUAL (micro-level). Eval: - ignores genetics - natural experiment, culture was not under control of experimenter - causation cannot be inferred - not representative sample ---------------------------------------------- Conclusion: more common in women, different cultures have different social-stressors etc. which could partially explain difference in prevalence rates

There is general belief that the biopsychosocial approach to treatment is the most efficient. In other words, a combination of drug treatment, individual therapy (e.g. cognitive therapy), or group therapy (e.g. family therapy) as well as help to handle risk factors in the environment such as stressful relationships. ---------------------------------------------- BIO Assumption: there are biological correlates to abnormal behaviour - a # of drugs used to treat various disorders based on theories of the brain chemistry involved, but this does not mean that there is a full understanding of how neurotransmitters and symptoms are linked - ECT: electroconvulsive therapy can be used in extreme cases to activate the brain and induces convulsive seizure Strengths: - Quickly has positive effects on a person's mood - Easy to take Limitations: - drug effect varies from person to person; reasons not fully known - sometimes drugs must be replaced, and appropriate dosage per person must be found - side effects - expensive - physical damage to brain ---------------------------------------------- INDIVIDUAL THERAPY Assumption: mental processes guide behaviour (therefore it is essential to change negative mental processes) - therapist works 1:1 with client Include COGNITIVE BEHAVIOURAL THERAPY (CBT) and INTERPERSONAL THERAPY (IPT) -> used to change negative thought patterns and schemas Strengths: - Rush et al. (1977) suggests the higher relapse rate for those treated with drugs arises because cognitive therapy programme teaches skills to cope with depression that the patients given drugs do not. A growing number of studies is showing that cognitive therapies are more effective than drug treatment alone at preventing relapse or recurrence except when drug treatment is continued long-term (Hollon and Beck 1994). - takes into consideration patient's background - treats patient as individual (not just member of a larger group) - less invasive, progress at own pace, not as harmful - helps individual on personal level - naturalistic Limitations: - biases due to clinician's own views - cognitive symptoms may not be portrayed - individual may not feel comfortable with sharing certain things ---------------------------------------------- GROUP THERAPY Assumption: humans are social animals and have the basic need to belong - group of clients meet with 1+ therapists -> goal is to learn vicariously and become more optimistic about recovery Strengths: - do not feel stigmatised, others are relatable to - less pressure because not 1:1 - positive environment - outside help may lead to stronger social network - less reliance upon therapist - less expensive Limitations: - discomfort sharing with others - does not focus enough on individual - slow process - negative effect from others not managing well - confidentiality - cultural considerations: --> Al Mutlaq and Chaleby (1995) have identified several problems with group therapy when applied in Arab cultures. ---> strict gender roles, deference to members in the group based on age/tribal status, misperception that therapy session = social activity

No such thing as cure - personal, unrealistic to say it is gone. ---------------------------------------------- Intro: Make an appraisal by weighing up the strengths and limitations - Biomedical - Individual - Group ---------------------------------------------- Body 1: Biomedical therapy Assumed: drugs restore systems of biological malfunctioning - Serotonin hypothesis: there is an inadequate amount of serotonin - Selective serotonin re-uptake inhibitors (SSRI): increase the level of serotonin by preventing it's reuptake in the synaptic gaps Evaluation Strengths: - Effective way to treat in the short-term, significantly helping 60-80% of ppl (Bernstein et al. 1994) - Reduces the number psychological inpatients being treated - quick positive mood changes Limitation: - Treat symptoms not cure - Side-effects (drawback): sexual problems, dry mouth, insomnia, ↑suicidal thoughts (some side-effects outweigh benefits) - Market for antidepressant drugs - ECT: Long term harm, brain damage, memory loss, reduces cognitive function Studies: > Kirsch et al. (1998): analysed results from 19 studies; 2318 patients treated with Prozac. Findings: antidepressants = 25% + effective than placebos, and no more effective than other kinds of drugs, such as tranquillizers. > Leuchter and Witte (2002): placebo/drug treatment -> both improved just as well > Blumenthal et al. (1999): - exercise = just as effective as SSRIs in elderly group of patients > Elkin et al (1989): best controlled outcome studies in depression - 28 clinicians; 280 patients diagnosed with MDD - individuals randomly assigned to: --> antidepressant drug --> interpersonal therapy --> cognitive-behavioural therapy --> control: given placebo and weekly therapy sessions Neither patients/doctors knew which was placebo/dug patients assessed at 16 weeks of treatment and 18 months RESULTS: +50% recovered in CBT, IPT, and drug group. 29% in placebo. Drug treatment = faster, but overall effectiveness not proven to be better than CBT/IPT. All treatment -> same result. Body 2: Individual therapy Cognitive-behavioral therapy: Group therapy: Couple therapy/marital therapy • Due to the high link between depression and marital problems • Teaches them communication and problem-solving • ↑ positive interactions and ↓ negative interchanges • Studies: this form is just as effective as other forms Strengths: • Toseland and Siporin: reviewed 74 studies comparing individual and group treatment o 75% of studies showed group therapy as effective as individual o 25% showed that it was more effective o Non showed that individual was more effective than group o 31% showed that group was more cost effective than individual therapy • less dependent on therapist •patient realizes that he/she is not alone Limitations: • Factors to consider o Group cohesion: no 1 different from the rest (all belong) o Exclusion: characteristics exclusion? (gays, health conditions) o Confidentiality: must trust others to speak freely o Relationship with therapist: showed show empathy and understand. • In case if a patient relapses. Conclusion Inconclusive for most effective treatment, many studies suggest that eclectic approach is best, but some suggest that there is no difference.

Concept of cure Eclectic approach used because not sure of etiology Approach that incorporates principles or techniques from various systems or theories. - Researchers evaluating treatment has demonstrated that there is most often a positive effect if people take action to cope with or change behaviour. - Taking drugs (biological), participating in group sessions (group therapy), and therapy sessions (individual therapy) may all positively contribute to increase mental health in suffering individuals. Body 1: Drug therapy alone often has significant relapse rates - CBT > drug alone, at preventing relapse unless drug-treatment is continued long-term (Hollon and Beck, 1994) - CBT/ITP + drugs = moderately more successful than by itself (Klerman et al., 1994) - higher relapse rate due to drugs (Rush et al., 1977) cause cognitive therapy teaches coping skills - drugs do not Body 2: Treatment could start with CBT/IPT alone, if no response, drug added. (Riggs et al., 2007 - CBT with SSRI) and (Parker, 2006 - drugs with IPT) Butler et al. (2006) Meta-analysis of CBT treatment, generally more effective along with drugs. Riggs et al. 2007 CBT + placebo/SSRI Randomized double-blind study ages 13-19 suffering from depression & substance use disorder & conduct disorder 67% of CBT+placebo, 76% SSRI+CBT "(very) much improved" after 4 months. Drugs+CBT not much more effective than Placebo+CBT. Treat should start out w. CBT, if no response -> SSRI. Body 3: All treatments have the same result Elkin et al (1989): best controlled outcome studies in depression - 28 clinicians; 280 patients diagnosed with MDD - individuals randomly assigned to: --> antidepressant drug --> interpersonal therapy --> cognitive-behavioural therapy --> control: given placebo and weekly therapy sessions Neither patients/doctors knew which was placebo/dug patients assessed at 16 weeks of treatment and 18 months RESULTS: +50% recovered in CBT, IPT, and drug group. 29% in placebo. Drug treatment = faster, but overall effectiveness not proven to be better than CBT/IPT. All treatment -> same result. Evaluation: How did they measure recovery and effectiveness? Problems with validity of diagnoses. Good control of researcher biases using double-blind control. Conclusion: No definitive cure, thus, all treatments are possibly just a way to cope, thus can be attributed to have the same results. Figures show that eclectic approach is generally more successful, but Elkin showed that there is not a vast difference.

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