IB Psychology – Abnormal Psychology Studies – Flashcards

1962 -argue that psychological normality and abnormality are culturally defined concepts, which are not based on objective criteria. -argue that it is not possible to identify biological correlates of mental illness. Therefore, psychological disorders should rather be seen as "problems of living"

1988 -argue that the view that a psychologically healthy person is one that maintains close contact with reality is not in line with research findings. Generally people have "positive illusions" about themselves and they rate themselves more positively than others.

1972 'The US-UK Diagnostic Project' aim: investigate reliability of diagnosis of depression and schizophrenia method: researchers asked American and British psychiatrists to diagnose patients by watching a number of videotaped clinical interviews findings: -British psychiatrists diagnosed patients in the interview to be clinically depressed 2x as often; American psychiatrists diagnosed the same patients to be schizophrenic 2x as often -the same cases didn't result in similar diagnosis in the two countries -points towards problems of reliability and cultural differences in interpretation of symptoms and thus in diagnosis

1991 'Diagnosis is a social process and it is not objective -clinical assessment, classification and diagnosis can never be totally objective because of VALUE JUDGMENTS involved -the diagnostic process in psychiatry is not the same as making a medical diagnosis -problems in understanding symptoms from individuals in different cultures

2009 'Meta-analysis of validity of diagnosis of depression' -41 clinical trials (50,000 patients) that used semi-structured interviews to assess depression -GP's had 80% reliability in identifying healthy individuals and 50% reliability in diagnosis of depression -Many GP's had problems making a correct diagnosis for depression -GP's more likely to identify false-positive signs of depression after first consultation -Mitchell argued GP's should see patients at least 2x before making a diagnosis as accuracy of diagnosis was improved in studies that used several examinations over an extended period Evaluation: + meta-analysis can combine data from many studies - possible to generalise - meta-analysis may suffer from publication bias; data from many diff. studies are used, may be problems of interpretation of the data b/c it isn't certain that each study uses exactly the same definitions

1973 'On being sane in insane places' aim: to test reliability and validity of diagnosis in a natural setting. Rosenhan wanted to see if psychiatrists could distinguish between 'abnormal' and 'normal' behaviour procedure: covert participant observation -8 participants (5M/3F) -follow same instructions and present themselves to 12 psychiatric hospitals in the USA results: -all participants were admitted to various psych wards and 7 diagnosed with schizophrenia, 1 diagnosed with manic depression -all pseudo-patients behaved normally b/c they were told they would get out if staff perceived them to be well enough -pseudo-patients took notes - interpreted as symptom of illness -took 7 to 52 days before participants were released -came out with diagnosis (schizophrenia in remission) - they were labeled -follow-up study: staff at a specific hospital told that impostors would present themselves and 41/193 were identified as impostors while there were none evaluation: -40 years ago -sparked discussion of diagnosis for patients -development of diagnostic manuals increased reliability and validity although they are flawed -method raised ethical issues -justified since results provided evidence of problems that could benefit others -serious ethical issues in follow-up study, as patients may not have had the treatment they needed 1975 'Stigmatization' -psychiatric diagnosis carries a personal, legal, and social stigma -diagnosis of serious mental illness could be based on limited information -psychiatric diagnosis often associated with significant consequences - considered 'deviant' (social stigma)

2001 suggest that variations in diagnosis across cultures don't necessarily reflect social or medical reality -there may be unknown factors influencing diagnosis (e.g. diff. methods of clinical assessment, diff. in classification, lack of culturally appropriate instruments such as standardised clinical interviews, or problems in relation to translation of the clinical interviews) -diagnosis is therefore linked to cultural variation in the prevalence of disorders

2001 -DSM-IV includes suggestions for a cultural interpretation of disorders -but DSM-IV represents Western concepts of illness -may not be easily applied to other cultures

1999 -diagnostic systems are necessary for comparisons between different cultures -necessary to define concepts of depression in accord with psychiatric and indigenous belief systems

1998 -investigated sample of Indian women in general practice in London -Doctors weren't likely to detect depression if the women didn't disclose all their symptoms

1997 -carried out focus group interview with Punjabi women in London -women knew the term 'depression' -older women used terms like 'weight on heart' or 'pressure on the mind' -talked about symptoms of 'gas'/'heat' -in accordance with traditional Indian medicine models of hot and cold

People may not be able to distinguish between emotions and physical symptoms. 1998 -1980's: 4/5 psychiatric patients in China diagnosed with neurasthenia -reported survey in 12 regions in China in 1993 where 16/19,223 people said to have suffered from a mood disorder sometime in their life

1970 -Chinese are very concerned with body -tend to manifest neurasthenic symptoms such as exhaustion, sleep problems, concentration difficulties, and other symptoms similar to physical aspects of depression and anxiety

1982 'Neurasthenia at a psychiatric hospital in China' aim: investigate if neurasthenia in China could be similar to depression in DSM-III method: -interviewed 100 patients diagnosed with neurasthenia using structured interviews based on DSM-III diagnostic criteria findings: -87% could be classified as depressed -Depressed moods only given as main complaint in 9% of the cases -90% complained of headaches -78% complained of insomnia (sleep problems) -73% complained of dizziness -48% complained of various pains -somatization is the cultural mode of distress in China, in the west it is psychologization -implications: Western clinicians should pay attention to somatization when they work with Chinese patients; but they should be careful not to overdiagnose depression just b/c of complaints of pain

1991 'Ethnicity bias in diagnosis?' -presented videotapes of a person in therapy to a number of European American male and female therapists -videos presented different situations: patient male/female, black/white, depressed symptoms or non-depressed symptoms -results: white therapists more likely to make false-positive diagnosis if the patient was black (black patient diagnosed as depressed in the absence of depressed symptoms)

1970 'Gender bias in diagnosis' -argued many psychiatrists are males whose perspective is situated within normative gender roles (patriarchal culture) -if a women is unhappy about her role as housewife and mother b/c she is stressed and bored, a male psychiatrist could diagnose her with depression -example of overdiagnosis

2003 lifetime prevalence of depression varies across cultures (e.g. 3% in Japan and 17% in USA)

2009 found an overall prevalence rate of depression in Chennai, South India of 15.9 (25,455 participants) -self-report instrument (The Patient Health Questionnaire) -Depressed mood 30.8% and fatigue 30% most common symptoms -Depression rates higher in low income group (19.3%) compared to high income group (5.9%) -Prevalence of depression higher among divorced (26.5%) and widowed (20%) compared to married respondents (15.4)

1993 lifetime prevalence for major depression -women: 21.3% -men: 12.7% 2005 -National Comorbidity Study 1994: prevalence for lifetime major depression in the USA was 17.1%

1980 bulimia nervosa -affected 1-2% of young women in the USA and UK -APA (200) estimated 1-3% young adult females to have bulimia -much less frequently in men

1988 Conducted telephone survey with a representative sample of 1007 male and female students in the USA. Found that 1% women and 0.2% men classified as bulimic.

2003 Meta-analysis of research on bulimia nervosa -increase in people diagnosed with bulimia from '70 to '93 -no incidence data for bulimia prior to '70 -diagnostic criteria for bulimia have become more stringent - resulted in increase in incidences -self-report surveys tend to produce higher estimates of bulimia nervosa prevalence than structured clinical interviews

1967 Serotonin hypothesis suggests that depression is caused by low levels of serotonin

2005 SSRI drugs to treat serotonin hypothesis is an example of backward reasoning -assumptions about causes of depression are based on how people respond to a treatment -logically problematic

1996 -performed experiments where they reduced serotonin levels in healthy individuals to see if they would develop depressive symptoms -results didn't support that levels of serotonin could influence depression

2002 -publication bias in research on effectiveness of SSRI in depression -placebo effect accounted for 80% of the anti-depressant response -of the studies funded by pharmaceutical companies, 57% failed to show statistically significant difference between anti-depressant and natural placebo 2008 -meta-analysis used clinical trials of 6 most used anti-depressants approved between 1987 and 1999 Result: overall effect of new-generation anti-depressant medication (SSRI) was below the recommended criteria for clinical significance -indicates that placebo may be just as effective -highest effect of medication was in the most severe cases of depression -but researchers speculate whether this is a real effect or due to a decrease in responsiveness to placebo rather than an increase in responsiveness to medication -placebo effect may account for any observed effect and they are very sceptical about increasing use of anti-depressants on the basis of the results of the clinical trials

1982 -reviewed 7 twin studies on major depression -results indicated that genes could be a factor in depression; supports theory that genetic factors could predispose people to depression -MZ twins - 65% concordance rate -DZ twins - 14% concordance rate -since concordance rate is far below 100% nothing definite can be said about genetic inheritance except that environmental and psychological factors could also play an important role in etiology -problem with comorbidity: people suffering from depression often suffer from other psychological disorders (anxiety, bulimia, etc.)

2000 -meta-analysis of twin studies, including 21,000 twins to investigate the genetic influence on major depression -MZT 2x likely to develop major depression if their co-twin had depression compared to DZT -genetic influence in developing depression was 31%-42% -non-shared environmental factors also important -conclusion: depression is a familial disorder, w/strong genetic component, complex disorder resulting from interaction of genetic and environmental influences

1976 'Cognitive theory of depression (negative cognitive triad)' Depression - caused by inaccurate cognitive responses to events in the form of negative thinking about oneself and the world. -people's conscious thoughts are influenced by negative cognitive schemas about the self and the world (depressogenic schemas) -automatic negative thoughts and dysfunctional beliefs -contradicts traditional theories about depression where negative thinking is the symptom and not the cause Diathesis-Stress Model of Depression -depressogenic schemas (depressive thinking/beliefs) assumed to develop during childhood and adolescence as a function of negative experiences with parents/other important people -depressogenic schemas -> vulnerabilty (diathesis) influences an individual's reaction when faced with stressors (e.g. negative life events, rejection) -> negative automatic thoughts (cognitive biases) based on the negative cognitive triad Negative Cognitive Triad: 1. negative thoughts about self 2. negative thoughts about the world 3. negative thoughts about the future

2001 -investigated Beck's theory and found significant correlation between amount of negative automatic thoughts and severity of depression -duration of depression was influenced by frequency of negative cognitions -difficult to determine whether cognitive distortions caused depression or if depression resulted in cognitive distortions

2001 -negative thinking, dissatisfaction with oneself and high levels of life stressors preceded episodes of depression -longitudinal prospective study with 1,500 adolescents -participants who started out with high levels of dysfunctional beliefs were more likely to develop major depression after a stressful life event -confirms that dysfunctional beliefs/cognitive vulnerability plays roles in triggering depression after major stress -participants who scored low/medium in dysfunctional beliefs didn't develop depression after a stressful life event

1978 'Social factors in depression' aim: to investigate how depression could be linked to social factors and stressful life events in a sample of women from London (vulnerability-stress model of depression) procedure: London, 458 women surveyed on their life and depressive episodes -used interviews where they addressed particular life events and how women had coped results: -37 women (8% of all women) had been depressed -33/37 (90%) of these had experienced an adverse life event or a serious difficulty -working-class women with children were 4x more likely to develop depression than middle-class women with children -vulnerability factors such as lack of social support, more than 3 children under 14 yrs, unemployment and early maternal loss + acute/ongoing serious social stressors = were likely to provoke depressive episodes evaluation: -showed social factors (not only personality factors) involved in development of depression -important in understanding depression -gender bias (women only), not possible to generalise

1991 'Twin research to study genetic vulnerability in bulimia nervosa' aim: investigate risk factors and genetic inheritance in bulimia nervosa procedure: -sample: 2,163 female twins -one of the twins in each pair had developed bulimia -longitudinal, conducted interviews with the twins to see if the other twin would develop bulimia and if concordance rates were higher in MZT than DZT findings: overall concordance rate for bulimia -MZT 23% -DZT 9% evaluation: -results indicate heritability of 55%, but leaves 45% for other factors -genetic vulnerability may predispose an individual but other factors trigger the disorder -important to investigate environmental factors that might interact with genetic predisposition -'natural experiment' - not possible to establish a cause-effect relationship -participants were all women - not generalizable to men -does not take environmental factors into account (could be that twins both grew up in a dysfunctional environment) -difficult to find out the relative importance of genetic inheritance and environmental factors

1962 -claimed that many patients with eating disorders suffer from the cognitive delusion that they are fat -when patients evaluate their own body size, they're influenced by emotional appraisal rather than perceptual experience

1985 -showed 9 pictures of different body shapes from very thin to very heavy to 475 US undergraduates -asked them to indicate the body shape 1. most similar to their own shape 2. most like their ideal body shape 3. the body shape of the opposite sex to which they would be most attracted -women indicated their current body shape was heavier than the most attractive -their ideal body shape was also much thinner than the one they had chosen as similar to their own shape -men chose very similar figures for all three body shapes -researcher concluded hat men's perceptions helped them stay satisfied with their body shape -women's perceptions put pressure on them to lose weight -these sex differences may be linked to a higher prevalence of dieting, anorexia, and bulimia among American women than American men

1997 -people with eating disorders had distorted weight-related schema and low self-esteem -distorted beliefs and attitudes towards body shape and weight develop partly because of high status given to looking thin and attractive -individuals strive to control body weight to stay thin, and base self-worth on being thin -weight-related self-schema that distorts the way they perceive and interpret their experiences -concerns and prioritisation of weight control may reflect a wider lack of self-esteem and a vulnerability to cultural messages about body weight -obsession with weight loss may lead to depression and lower self-esteem, as weight control becomes a major way of maintaining self-worth

1990 -body shape can be a major criterion in self-evaluation and evaluation of others -many people have prejudices against overweight people

1994 'Investigated the relationship between sociocultural factors and eating attitudes and behaviours' -385 middle school girls (10-14 y/o) in USA -answered questions -majority of respondents said to have received clear messages from fashion magazines, peers and family members that it's important to be slim -two important factors in the drive for thinness and disturbed patterns of eating: reading mags containing information about ideal body shapes and weight management, and weight-related or shape-related teasing/criticism by family -indicate that body dissatisfaction and weight concerns reflect sociocultural ideals of a female role -raises possibility that some adolescent girls live in a subculture of intense weight and body-image concern -places them at risk for a disordered eating behaviour i.e. bulimia nervosa

2002 'Conducted cross-cultural investigation of the relationship between body dissatisfaction and the development of bulimia nervosa' -1751 female medical and nursing students from 12 nations -participants saw 10 body silhouettes (designed to be culture-neutral) to measure body dissatisfaction -participants' BMI taken, and they answered questions on body dissatisfaction, self-esteem, and dieting behaviour Body dissatisfaction: -extreme body dissatisfaction: northern Mediterranean countries and northern European countries -intermediate amount of body dissatisfaction: countries in process of westernisation -lowest levels of body dissatisfaction: non-western countries -most important factor in dieting behaviour in most countries -independent of self-esteem and BMI -results indicated that body shapes represented in media could encourage dissatisfaction w body shape/dieting behaviour -culture used as a variable but it's impossible to say culture causes bulimia because culture is not a controlled variable -study only focused on sociocultural factors and other factors (biological) were not considered -cannot generalise to men

1996 -found cross-cultural variation in data from 10 countries -wide range of lifetime prevalence of depression -19% Beirut, Lebanon -1.5% Taiwan -2.9% Korea (2x Taiwan, though both in Asia) -16.4% Paris (close to Beirut, although Beirut experienced war for 15 years) -women higher prevalence in all countries -different risk factors, social stigma, cultural reluctance to endorse mental symptoms, and methodological limitations of the study may account for the differences

1995 -proposed that urban settings are associated with increased stress due to problems of housing, work, marriage, child rearing, security and other urban difficulties -urban crowding, poor working conditions or underemployment, chronic hunger, gender discrimination, limited education and human rights violations -weakens both individuals and the social support that could serve as buffers against mental health problems 2002 -depression is becoming the world's foremost psychiatric problem because of global challenges -war, natural disasters, racism, poverty, cultural collapse, ageing populations, urbanisations, and rapid social/technological changes -growing evidence that rates of depression are increasing

2009 -cultural variation in prevalence of major depression could be due to cultural differences in stress, standards of living, and reporting bias -people in some countries live harder lives -war, civil war, rapid political/economic changes, crime, discrimination -unemployment and standards of living also vary across cultural groups

1983 -found that there are substantial cultural differences in the stigma associated with mental health problems -individuals in cultures where psychological disorders are associated with stigma are more likely to report physical symptoms instead of psychological problems - somatisation -variation in symptoms could indicate that symptoms of depression can be culturally influenced (e.g. Kleinman, neurasthenia) -neurasthenia alternative diagnosis for depression - explains cultural variation in prevalence of depression

2001 -women 2x as likely than men to develop depression (USA; F-21.3%, M-12.7%) -not possible to find a variable that single-handedly can account for gender differences in depression -women are men experience same stressors but women are more vulnerable to develop depression because of gender differences in biological responses to stressors, self-concepts or coping styles -experiences of continuous stress could increase physiological/psychological reactivity to stress -> hyperactivity of stress system -> increase vulnerability to depression (diathesis-stress model) -women more likely to report physical and psychological symptom and to seek medical help -little scientific support that women are more depressed than men only because of differences in sex hormones Women's low power and status -women have less power/status than men in most societies -likely to experience sexual abuse, constrained choices, poverty, lack of respect -these can contribute to depression because they make women feel that they are not in control of their lives -higher rates of depression could be due to the fact that women face a number of chronic burdens in everyday life as a result of social status and roles

1999 -women are more likely than men to have a dysregulated response to stress because they are more likely to have been exposed to regular episodes of traumas in early life

1998 -marriage could have negative effects on women -women have limited choices after marriage -staying home and caring for small children is generally associated with higher levels of depression -related to role-strain hypothesis (social roles and cultural influences contribute to higher ratio of female depression; have to rely on role housewife for identity and self-esteem)

2004 -compared prevalence of eating disorders in Western and non-Western countries based on a review of published medical articles -prevalence rates in Western countries for bulimia nervosa ranged from 0.3% to 7.3% females to 0% to 2.1% in males -prevalence rates for bulimia in non-western countries ranged from 0.46% to 3.2% in females -prevalence of eating disorders appears to be increasing in non-western countries but it's still lower than in western countries

2000 The Westernization hypothesis -eating disorders seem to have become more common among younger females after WWII -female beauty ideals have gradually become thinner -reflected in the increase of articles on dieting in women's magazines in the same period as well as thinner icons of female beauty

1994 Used questionnaires to investigate eating attitudes -351 girls in secondary school in Egypt -1.2% of the girls fulfilled criteria for diagnosis of bulimia -3.4% qualified for partial diagnosis -results indicate that eating disorders are emerging in cultures that did not know such disorders in the past where a round female body was still considered attractive and desirable, and was associated with prosperity, fertility, success, and economic security -no society is truly immune to development of eating disorders bc of globalisation of culture through media

2002 'Impact of introduction of Western television on disordered eating patterns among Fijian adolescent girls' Aim: -field study investigating changes in eating patterns in 1995 after TV was introduced to a remote province in Fiji and again in 1998 -traditional Fiji body at the time was robust - no pressure to be thin was absent Method: -study used quantitative (survey) and qualitative methods (semi-structured interviews) on issues like TV viewing, dieting, body satisfaction, purging -adolescent girls from two secondary schools participated Findings: -results showed an increase in dieting and self-induced vomiting to control weight from 0% (1995) to 11.3% (1998) -increasing globalisation and exposure to western media could explain increase in symptoms related to eating disorders in non-western countries -combination of binge eating and purging to control weight (core symptom of bulimia nervosa) only appeared after introduction of TV -supports that bulimia as a culture-bound syndrome -questionnaires revealed clinical signs (vomiting and body dissatisfaction) associated with eating disorders and in particular bulimia Limitations: -did not use clinical diagnoses -tendency to report symptoms in anonymous self-reports but a clear diagnosis cannot be made -study only included girls (sample bias)

1991 Men are less likely to develop eating disorders perhaps due to less pressure on men to conform to an ideal body weight or shape.

1995 Men who develop eating disorders tend to resemble females in terms of dissatisfaction with their body.

-certain sub-populations of men with jobs that require weight restrictions (e.g. wrestlers) seem to be at increased risk of developing eating disorders -may be a link between male homosexuality and eating disorders bc of higher emphasis on attractiveness and slimness in gay subcultures

2005 -steady increase in diagnosis of bulimia nervosa in the UK from 1988-2000, but since 1996 there has been a decline -highest risk for bulimia is young women between 10-19 y/o -certain subpopulations such as ballerinas and models have been associated with increased risk due to pressure to be thin

Conducted meta-analysis of published studies on the outcome of anti-depressants vs. placebo. Study focused on 1. Patients who started with anti-depressants then changed to placebo 2. Patients who only received placebo 3. Patients who only took anti-depressants Findings: -patients who did not take anti-depressants have 25% risk of relapse -patients who have been on medication then stopped it have >42% risk of relapse -antidepressants may interfere with the brain's natural self-regulation -drugs affecting serotonin or other neurotransmitters may increase risk of relapse -drugs reduce symptoms in the short term but when people stop taking the drug, depression may return because the brain's natural self-regulation is disturbed

1999 Conducted a controlled trial of 158 patients who had experienced one episode of major depression -patients received antidepressant medication but some also received cognitive therapy -CBT group: relapse rate of 29% -cognitive therapy appears to be effective to prevent relapse, particularly in combination with medication

2004 Studied effectiveness of CBT in treatment of bulimia and binge eating. aim: meta-analysis to evaluate effectiveness of CBT, and CBT-BN (specific CBT for bulimia) findings: CBT was effective treatment for eating disorders -CBT was effective in group settings -CBT-BN was particularly effective in the treatment of bulimia but also other eating disorders that involve bingeing

1996 -55% participants in CBT programs no longer purged at the end of therapy, and those who continued to purge did so much less (86% reduction in purging)

1974 'Treatment of depression by drugs and/or psychotherapy' aim: controlled study to test efficacy of treatment with anti-depressants and psychotherapy; alone or in combination method: -150 females diagnosed with depression -divided into three groups: 1. anti-depressants 2. anti-depressants + psychotherapy 3. more psychotherapy (no meds) 4. placebo + no psychotherapy results: -relapse rates highest for placebo alone group (36%) -anti-depressants alone: 12% -psychotherapy (IPT) alone: 16.7% -drug + IPT: 12.5% -no significant difference between drug therapy alone or drug therapy with psychotherapy 1984 -developed IPT as a short-term, structured psychotherapy for depression (adapted for bulimia by Fairburn) -aim of therapy is to help clients identify and modify current interpersonal problems -these problems are assumed to maintain the eating disorder -therapy doesn't focus directly on eating disorders Elkin - found that IPT was effective in relieving major depression and to prevent relapse when treatment was continued after recovery Fairburn - compared IPT vs CBT and found that IPT was less effective than CBT at post-treatment; follow-up studies after 1 and 6 years found that the two treatments were equally effective

2001 Developed mindfulness-based cognitive therapy (MBCT) -psychosocial group based therapy which aims to prevent people from relapsing after successful treatment for major depression

2008 - 8 week mindfulness based intervention to treat 6 college-age women suffering from bulimia -participants interviewed individually before and after treatment -they all reported they could control emotional and behavioural extremes better after the treatment and had reached a greater self-acceptance -felt less emotional stress and more able to manage stress and symptoms of bulimia

2008 'Randomised controlled trial of MBCT and anti-depressive medication' aim: investigate the effectiveness of MBCT in a randomised controlled study method: -123 participants with a history of 3 or more episodes of depression -15 month study -all participants received anti-depressive medication -participants randomly allocated to two groups -control group continued their medication and experimental group participated in an MBCT course and gradually diminished their medication findings: -control group: 60% relapse rate -experimental group: 47% relapse rate -participants in the MBCT group overall reported a higher quality of life in terms of enjoyment of daily living and physical well-being -anti-depressive medication was significantly reduced in MBCT group and 75% of patients stopped taking the medication

2002 'Changes in brain function during treatment with placebo' method: -examined brain function in 51 patients with depressed who received either a placebo or an active medication -EEG used to compare brain function in the two groups -double-blind experiment over 9 weeks -study used two different SSRI which were randomly allocated to the participants findings: -significant increase in activity in the prefrontal cortex nearly from the beginning in the trial in prefrontal cortex nearly from the beginning in the trial in the placebo group -pattern was different from the patients who were treated with SSRI but patients in both groups got better -indicates that medication is effective but placebo seems just as effective conclusion -difference in brain activity indicates that the brain is able to heal itself, since there was a positive effect in both groups -believing they are being treated could be enough for some patients

2007 'Randomized controlled trial of IPT and CBT' aim: investigate the relative effectiveness of the two treatments for major depression method: -16-week therapy with 8-19 individual sessions attended by 177 patients diagnosed with major depression -patients randomly allocated to either CBT or IPT -did not receive medication, and those who eventually decided to use it weren't included in the study findings: -results shoed no difference in effect of the two forms of psychotherapy -CBT more effective in severe depression -20% patients with severe depression responded to IPT -57% patients responded to CBT -psychotherapy alone could relieve symptoms even with no drugs given -combination of behavioural techniques with cognitive restructuring in CBT seems to be effective, even in the absence of medication. Paykel et al. 1999 - combining medication with CBT have good results

1989 'Controlled outcome study of treatment for depression' method: -16 weeks -patients assessed at the start, after 6 weeks, and after 18 months -280 patients diagnosed with major depression who were randomly assigned to either: 1. Antidepressant drug + normal clinical management 2. Placebo + normal clinical management 3. CBT 4. IPT findings: -reduction of depressive symptoms of over 50% in the therapy groups and in the drug group -29% recovered in the placebo group -no difference in the effectiveness of CBT, IPT, or anti-depressant treatment -psychotherapy might be an alternative in some cases -recovery rate for therapy (psychological and drug) was only 50% so neither of the treatments can guarantee recovery for all patients

2001 'Meta-analysis on effectiveness of group therapy for depression' -meta-analysis based on 48 studies published between 1970-1988 -mean age: 44 -78% patients were women -all but one study included a cognitive and/or behavioural treatment group results: -45/48 studies reported that group psychotherapy was effective for reducing depressive symptoms -overall results showed that group psychotherapy was more effective than no treatment around 19 weeks after the end of treatment -9 studies showed that individual and group psychotherapy was equally effective conclusion: -there's empirical support that group therapy is effective for relieving depression symptoms -Truax (2001): group therapy should only be used when clients are positive about treatment in a group -meta-analysis didn't include severely depressed and suicidal patients in the study - not possible to conclude anything about this group

2004 50%-60% of depressed outpatients experience an improvement in mood to the first trial of anti-depressants, but only 1/3 will experience full recovery with no symptoms

2004 'Meta-analysis of efficacy of drug treatment alone vs. drug treatment and psychotherapy in depression' aim: analyze whether combining antidepressants and psychotherapy was more effective in the treatment of depression method: -16 randomized controlled studies -932 patients taking antidepressants only -910 receiving combined treatment -patients had been randomly allocated to treatments results: -combined treatment patients improved significantly more compared to those receiving drug treatment alone -particularly true in studies that ran over 12 weeks -significant reduction in dropouts conclusion: -clinicians should combine antidepressants with psychotherapy -combination leads to greater improvement -psychotherapy helps keep patient in treatment (there's always a risk patients stop taking their meds)