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Abnormal Psych Test 2 Notes Chap 8

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Treatments for unipolar Depression
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Around half of persons with unipolar depression receive treatment froma mental health professional each year In addition, many other people in therapy experience depressed feelings as part of another disorder – thus, much of the therapy being done today is for unipolar depression A variety of treatment approaches are currently in widespread use These can be divided into psychological, sociocultural, and biological approaches
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Psychodynamic Treatment for Unipolar Depression
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Widely used despite no strong research evidence of its effectiveness
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Behavioral Treatment for Unipolar Depression
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Primarily used for mild or moderate depression but practiced less than in past decades
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Cognitive Treatment for Unipolar Depression
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Has performed so well in research that it has a large and growing clinical following
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Psychodynamic therapy
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Believe that unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people, psychodynamic therapists seek to bring these issues into consciousness and work through them Psychodynamic therapists use the same basic procedures for all psychological disorders: Free association Therapist interpretation Review of past events and feelings
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Psychodynamic Therapy Part 2
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Despite successful case reports, researchers have found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression Two features may be particularly limiting: Depressed clients may be too passive or weary to fully participate in sublte therapy discussions Depressed clients may become disocuraged and end treatment too early when treatment is unable to provide quick relief Short-term approaches have performed better than traditional approaches
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Behavioral Therapy
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Most behavioral treatment for unipolar depression is modeled after the interventions proposed by Lewinsohn: Reintroduce clients to pleasurable activites and events, often using a weekly schedule Appropriately reinforce their depressive and nondepressive behaviors Use a contingency management approach Help them improve their social skills
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Behavioral Techniques
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Behavioral techniques seem to be of only limited help when just one of them is applied When two or more of the techniques are combined, behavioral treatment does seem to reduce depressive symptoms, particularly if mild It is worth noting that Lewinsohn himself has comibined behavioral techniques with cognitive strategies in recent years
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Cognitive Therapy
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Beck viewed unipolar depression as resulting from a pattern of negative thinking that may be triggered by current upsetting situations Maladaptive attitudes lead people to the “cognitive triad” Repeatedly viewing oneslef, the world, and the future in negative ways Those biased views combine with illogical thinking to produce automatic thoughts
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Cognitive Therapy Phases
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Increasing activities and elevating mood Challenging automatic thoughts Identifying negative thinking and biases Changing primary attitudes
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Cognitive Therapy Statistics
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Over the past several decades, hundreds of studies have shown that cognitive therapy helps unipolar depression Around 50%-60% of clients show a near total elimination of symptoms It is worth noting that a growing number of today’s cognitive-behavior therapists disagree with Beck’s propsition that individuals must fully disregard negative cognitions These therpaists guide clients to recognize and accept their negative cognitions
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Mood Tracking
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Cognitive and other therapists who work with depressed clients often instruct the clinets to keep track of their mood changes – hour by hour, day by day – and to also note the situations and thoughts that cause their moods to change Mood tracking apps for smartphones are gaining in popularity
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Sociocultural Approaches
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Theorists trace the causes of unipolar depression to the broader social structure in which people live and to the roles they are required to play Two groups of sociocultural treatments are now widely applied multicultural approaches and family-social approaches
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Multicultural treatments
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Culture-sensitive approaches increasingly are being combined with traditional forms of psychotherapy to help maximize the likelihood of the minority clients overcoming their disorders It also appears that the medication needs of many depressed minority clients are inadequately addressed
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Family-Social Treatments
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Interpersonal Therapy This model holds that four interpersonal problems may lead to depression and must be addressed: Interpersonal loss Interpersonal Role Dispute Interpersonal Role Transition Interpersonal Deficits Studies suggest that IPT is as effective as cognitive therapy for treating depression
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Family-Social Treatments – Couple Therapy
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The main type of couple therapy is behavioral marital therapy Focus is on developing specific communication and problem-solving skills If marriage is filed with conflict, BMT is as effective as other therapies for reducing depression
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Treatments For Unipolar Depression: Biological Approaches
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Biological treatments can bring great relief to people with unipolar depression Usually biological treatment means antidepressant drugs, but for severely depressed individuals who do not respond to other forms of treatment, it sometimes includes electroconvulsive therapy or brain stimulation
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Electroconvulsive Therapy
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One of the most controversial forms of treatment The procedure consists of targeted electrical stimulation to cause a brain seizure
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Length of Treatment for ECT
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The usual course of treatment is 6-12 sessions spaced over 2-4 weeks Treatment may be bilateral or unilateral
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ECT
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The discovery of the effectiveness of ECT was accidental and based on a fallacious link between psychosis and epilepsy The procedure has been modified in recent years to reduce some of the negative effects For example, patients are given muscle relaxants and anesthetics before and during the procedure Patents generally support some memory loss
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Effectiveness of ECT
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ECT is clearly effective in treating unipolar depression Studies find improvement in 60%-80% of patients The procedure seems particularly effective in cases of severe depression with delusions, but it has been difficult to determine why ECT works so well Although effective, the use of ECT has declined since the 1950s because of the memory loss caused by the procedure, the frightening nature of the procedure, and the emergence of effective antidepressant drugs
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Antidepressant drugs
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In the 1950s, two kinds of drugs were found to reduce the symptoms of depression Monoamine oxidase inhibitors Tricyclics These drugs have been joined in recent years by a third group, the second generation antidepressants
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Antidepressant Drugs – MAOIs
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Originally used to treat TB, doctors noticed that the medication seemed to make patients happier The drug works biochemically by slowing down the body’s production of MAO MAO breaks down norepinephrine activity and a reduction in depressive symptoms Approximately half of patients who take these drugs are helped by them
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MAO Inhibitors Pose a Potential Danger
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People who take MAOIs experience a dangerous rise in blood pressure if they eat foods containing tyramine (cheese, bananas, wine) In recent years, a new MAO inhibitor in the form of a skin patch has become available Dangerous food interactions do not appear to be common a problem with this kind of MAO inhibitor
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Antidepressant Drugs – Tricyclics
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In searching for medications for schizophrenia, researchers disovered that imipramine relieved depressive symtpms Imiprine and related drugs are known as tricyclics because they share a three ring molecular structure Hundreds of studies have found that depressed patients taking tricyclics have improved much ore than similar patients taking placebos Drugs must be taken for at least 10 days before such improvement is seen About 60%-65% of patients find symptoms improvement
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Stop taking Tricyclics
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Most patients who immediately stop taking tricyclics upon relief of symptoms relapse within one year Patinets who take tricyclics for five additional months have a significantly decreased risk of relapse Patients who take antidepressant drugs for three more more years after initial improvement may reduce the risk of relapse even more
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Tricyclic are believed to reduce depression by affecting neurotransmitter reuptake mechansims
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To prevent an NT from remaining in the synapse too long, a pump like mechanism recaptures the NT and draws it back into the presynaptic neuron The reuptake process appears to be too efficient in some people, drawing in too much of the NT from the synapse This reduction in NT activity in the synapse is thought to result in clinical direction Tricyclics block the reuptake process, thus increasing NT activity in the synapse
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Evidence about Tricyclics
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There is growing evidence that when tricyclics are ingested, they initially slow down the activity of the neurons that use norepinephrine and serotonin After a week or two, the neurons adapt to the drugs and go back to releasing normal amounts of the NTs, and the reuptake mechanism begins to have the desired effect Today, tricyclics are prescribed more often than MAO inhibitors They do not require dietary restrictions Some patients show higher rates of improvement
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Antidepressant drugs – second generation
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A third group of effective antidepressant drugs is structurally differnt from the MAO inhibitors and tricyclics Most of the drugs in this group are labeled selective serotonin reuptake inhibitors These drugs increase serotonin activity specifically Selective norepinephrine reuptake inhibitoras and serotonin-norepinephrine reuptake inhibitors also now available
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Speed of Action Second Generation Antidepressant Drugs
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In effectiveness and speed of action of these drugs are on a par with the tricyclics, yet their sales have skyrocketed Clinicians often prefer these drugs because it is harder to overdoes on them than on other kinds of antidepressants There is no dietary restrictions like there are with MAO inhibitors They have fewer side effects than the tricyclics These drugs may cause some undesired effects of their own, including a reduction in sex drive
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Antidepressant Drugs
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As effective as antidepressant drugs are, it is important to recognize that they do not work for everyone Even the most successful of them fails to help at least 35 percent of clients with depression
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Brain Stimulation
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In recent years, three additional biological approaches have been developed Vagus nerve stimulation Transcranial magnetic stimulation Deep brain stimulation While such positive initial findings have produced cnsiderable enthusiasm in the clinical field, it is important to recognize and remember that, in the past, certain promising interventions later prove problematic and even dangerous upon closer inspection
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Vagus Nerver Stimulation
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Depression researchers surmised they might be able to stimulate the brain by electrically stimulating the vagus nerve through the use of a pulse generator implanted under the skin of the chest Research has found that the procedure brings significant releif to as many as 40% of those with treatment-resistant depression As with ECT, researchers do not yet know precisely why this technique reduces depression
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Transcranial Magnetic Stimulation
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Another technique designed to stimulate the brain without the undesired effect of ECT, TMS has been found to reduce depression when administered daily for 2 to 4 weeks
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Deep brain Stimulation
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Theorizing a depression switch located deep within the brain, researchers have successfully experimented with electrode implantation in the brain’s Brodman Area 25
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How Do the Treatments for Unipolar Depression Compare?
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For most kinds of psychological disorders, no more than one or two treatments, if any, emergy as highly successful Unipolar depression seems to be an exception, responding to any of several approaches Findings from a number of treatment outcome studies suggest that: Cognitive, cognitive-behavioral, interpersonal, and biological therapies are all highly effective treatment for mild to severe unipolar depression Although cognitive, cognitive-behavioral, and interpersonal therapies may lower the likelihood of relapse, they are not completely relapse-proof A combination of psychotherapy and drug therapy is modestly more helpful to depressed people than either treatment alone
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Findings from a number of treatment outcome studies suggest that:
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When people with unipolar depression experience significant marital discord, couple therapy tends to be very helpful Depressed people who receive strictly behavioral therapy have shown less improvement than those who receive cognitive, cognitive-behavioral, interpersonal, or biological therapy Traditional psychodynamic therapies are less effective than other therapies in treating all levels of unipolar A combination of psychotherapy and drug therapy is modestly more helpful to depressed people than either treatment alone
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Treatments for Bipolar Disorder
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Until the latter part of the 20th century, people with bipolar disorders were destined to spend their lives on an emotional roller coaster Psychotherapists reported almost no success antidepressant drugs were of limited hlep ECT only occasionally relieved either the depressive or the manic episodes e Depressive symptoms managed in similar way as unipolar depression Lithium and other mood stabilizers Adjunctive Therapy
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Lithium and Other Mood Stabilizers
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Researchers do not fully understand how mood stabilizing drugs operate They suspect that the drugs change synaptic activity in neurons but in a different way from that of antidepressant drugs Although antidepressant drugs affect a neurons initial reception on NTs, mood stabilizers seem to affect a neuron’s second messengers These drugs also increase the production of neuroprotective proteins, which may decrease bipolar symptoms Another theory is that mood stabilizers correct bipolar functioning by directly changing sodium and potassium ion activity in neurons
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The use of Lithium and other mood stabilizers has dramatically changed this picture
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Lithium is extraordinarily effective in treating bipolar disorders and mania Determining the correct dosage for a given patient is a delicate process Too low = no effect Too high = lithium intoxication Given the effectiveness, around one-third of all persons with bipolar disorder seek treatment in a given year: another 15% are monitored by family physicians
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All manner of research has attested to the effectiveness of lithium and other mood stabilizers in treating manic episodes
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More than 60% of patients with mania improve on these medications Most individuals experience fewer new episodes while on the drug Findings suggest that the mood stabilizers are also prophylactic drugs, ones that actually help prevent symptoms from developing Mood stabilizers also help those with bipolar disorder overcome their depressive episodes to a lesser degree
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Adjunctive Psychotherapy
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Psychotherapy alone is rarely helpful for persons with bipolar disorder Mood stabilizing drugs alone are also not always sufficient 30% or more of patients don’t respond, may not receive the correct does, and/or may relapse while taking it As a result, clinicans often use psychotherapy as an adjunct to lithium therapy Medication Management Social Skills Relationship Issues
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Research Suggests that Psychotherapy may
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Reduce hospitalization Improves social functioning Increases clients ability to obtain and hold a job