Psychotherapy Psychological Therapies for Depression Overview Psychological Therapies

Psychotherapy Psychological Therapies for Depression: Overview

Psychological Therapies for Depression: Overview Aims and Objectives (from handbook) • To increase awareness of the psychological aspects of Depressive Disorder. • To have an introductory knowledge of the main psychological models for depression. • To have an overview of psychological treatments for Depression

Psychological Therapies for Depression: Overview To achieve this • • • Case Presentation Journal Club 555 Presentation Expert-Led Session MCQs • Please sign the register and complete the feedback

Psychological Therapies for Depression: Overview Expert Led Session Psychological Therapies for Depression: Overview Author: Dr. Adam Dierckx Consultant Medical Psychotherapist

What we will cover … • • Core psychological symptoms of depression Major models formulating depression Key aetiological factors Treatment and evidence base

Depression: Psychological Symptoms • Negative thoughts about: – Self – World – Future

Self • • • Worthless Guilty Persecuted Self-contempt Unwell Undeserving

World • • • Uninteresting / boring Corrupt Hostile Unchangeable Against me Dangerous

Future • • • Negative / pessimistic Hopeless Unchangeable Impending catastrophe Better without me Suicidal

Cognitive Model • Thoughts determine feelings • Thoughts are determined and reinforced by perceptions – Internal sensations – External events – (Mis-)interpreted

Cognitive Model Sensations Thoughts Feelings Behaviours

Cognitive Model • Thoughts are the most amenable to therapy • Thoughts can be distorted in characteristic ways • Automatic Negative Cognitive Distortions

Cognitive Distortions • • • Disqualifying the positive Catastrophizing Over-generalization Personalization Selective attention Bias

Cognitive Schema • Set of rules / generalizations to make sense of new situation quickly • Helpful most of time • Formed from previous experiences • Can prevent new learning

Psychoanalytic Model of the Mind Conscious Preconscious Unconscious

Defences • Defences are: • “Mental procedures that are designed to bring about a reduction in anxiety. ” • Normal / universal. • Can lead to symptoms & compromises.

Defences & Topographic model Transformed content Painful affect Conscious Defences Unconscious

Primitive Defences • Reduce awareness – Denial – Dissociation – Repression – Isolation – Intellectualisation – Rationalisation • Create symptoms – Idealisation – Denigration – Displacement – Introjection – Projection / PI – Reaction formation – Conversion – Sublimation – Humour

Conflict • Defensiveness a degree of conflict • Role of loss • Introjection of conflictual / hateful part of relationship – Freud: Mourning & Melancholia (1914)

Mental phenomena • Transference – Earlier feelings are transferred from their original object (typically a parent) to a current relationship, in therapy therapist/analyst. – Unconscious

Transference: relationship templates Early Relationships Current Relationships Relation to therapist

Counter-transference • Feelings you get that result from the influence the patient has on you. • Can be related to own difficulties • Can also be part of non-verbal communication • Can use diagnostically (with caution)

Behavioural Model • Different behaviours lead to emotional responses • Feeling low encourages certain behaviours – Coping strategies – Consequences of affect state • These behaviours reinforce mood state • Therapy seeks to change mood by acting differently – Reduce active mood harming behaviours e. g. drinking – Increase neglected helpful behaviours e. g. exercise

Systemic Model No man island, Entire of itself. Each is a piece of the continent, A part of the main. If a clod be washed away by the sea, Europe is the less. As well as if a promontory were. As well as if a manor of thine own Or of thine friend's were. Each man's death diminishes me, For I am involved in mankind. Therefore, send not to know For whom the bell tolls, It tolls for thee. John Donne (1624)

Systemic Model Mother Family System Daughter Son

Systemic Model Patient Care team Family Work Clinical System Friends

Aetiology of Depression • Biological • Psychological – The other two become psychological due to being ‘experienced’ by the patient • Social

Aetiology of Depression • Family History, Temperament & Vulnerability • Early relationships – Events e. g. loss – Character / quality of relationships • Attachment • Life events • Social factors • Psychological triggers – Losses – Meaning of those losses

Psychological Treatment • Cognitive therapy / CBT • Psychodynamic therapy • Systemic interventions

Evidence Base • CBT, RCTs & NICE – The standard EBM model • Otherapies, other trials and guidance – Problems with the EBM model • Real life practice …

Evidence for Psychotherapy • Falk Leichsenring • E. g. Effectiveness of LTPP JAMA (2008) 300(13): 1551 -1565 • E. g. Effectiveness of STPP Arch Gen Psychiatry (2004) 61: 1208 -1216

Any Questions?

Summary • • Core psychological symptoms of depression Major models formulating depression Key aetiological factors Treatment and evidence base

Psychological Therapies for Depression: Overview MCQs 1. NICE guidance (CG 90): A. B. C. D. E. Recommends Computerised CBT for mild-moderate depression Recommends Psychotherapy for severe depression Advises not combining medication with psychological therapies Recommends Cognitive therapy for relapse prevention Defines Short-term Psychodynamic Psychotherapy as 10 -15 sessions over 3 -4 months

Psychological Therapies for Depression: Overview MCQs 1. NICE guidance (CG 90): A. Recommends Computerised CBT for mild-moderate depression B. Recommends Psychotherapy for severe depression C. Advises not combining medication with psychological therapies D. Recommends Cognitive therapy for relapse prevention E. Defines Short-term Psychodynamic Psychotherapy as 1015 sessions over 3 -4 months

Psychological Therapies for Depression: Overview MCQs 2. Cognitive Therapy: A. Is originally based on the work of Judith Beck B. Identifies Cognitive Errors that lead to or maintain depressive thoughts C. Focuses on non-conscious thought content D. Is enhanced by concurrent antidepressant treatment E. Should not be used in older patients

Psychological Therapies for Depression: Overview MCQs 2. Cognitive Therapy: A. Is originally based on the work of Judith Beck B. Identifies Cognitive Errors that lead to or maintain depressive thoughts C. Focuses on non-conscious thought content D. Is enhanced by concurrent antidepressant treatment E. Should not be used in older patients

Psychological Therapies for Depression: Overview MCQs 3. Psychodynamic Therapies: A. Have no evidence base for effectiveness B. Are based on the model of the mind put forward by Freud C. Seek to eradicate a patient’s defences D. Were among the first to link depression to loss E. Focus on the past

Psychological Therapies for Depression: Overview MCQs 3. Psychodynamic Therapies: A. Have no evidence base for effectiveness B. Are based on the model of the mind put forward by Freud C. Seek to eradicate a patient’s defences D. Were among the first to link depression to loss E. Focus on the past

Psychological Therapies for Depression: Overview MCQs 4. Psychological factors in the aetiology of depression include A. Parental indifference B. Social circumstance C. Maternal Depression D. Cognitive biases or distortions E. Bereavement

Psychological Therapies for Depression: Overview MCQs 4. Psychological factors in the aetiology of depression include A. Parental indifference B. Social circumstance C. Maternal Depression D. Cognitive biases or distortions E. Bereavement

Psychological Therapies for Depression: Overview MCQs 5. Evidence of effectiveness in the treatment of depression exists for: A. Psychoanalytic therapy B. Interpersonal Therapy C. ‘Low intensity’ therapy in IAPT D. Mentalization based CBT E. EMDR

Psychological Therapies for Depression: Overview MCQs 5. Evidence of effectiveness in the treatment of depression exists for: A. Psychoanalytic therapy B. Interpersonal Therapy C. ‘Low intensity’ therapy in IAPT D. Mentalization based CBT E. EMDR

Psychological Therapies for Depression: Overview Any Questions? Thank you.