Friday, 18 April 2014

Psychological Therapies for Depression

 Beck's Cognitive Behavioural Therapy (CBT) aims to challenge and alter negative thoughts and beliefs through changing dysfunctional behaviours that are affecting the client and maintaining their depression.
 The therapy is separated into two parts: The cognitive part involves identifying faulty cognitions or irrational thinking processes that are affecting the client. This is done through the client giving examples of situations and what they would think and do in each. The therapist will then develop ideas on how to challenge and alter these irrational thoughts. The behavioural part involves setting homework for the client designed to help them challenge their own irrational beliefs. For instance, someone with anxiety disorder may not be able to cope in a certain situation; the homework would involve putting themselves in this situation in order to prove themselves wrong. This is known as 'thought stopping', where the client will identify the negative thoughts, challenge them, and replace them with positive thoughts. The client may also be asked to keep a journal during the therapy to monitor their thoughts, which would be reviewed in later sessions. 

 CBT has shown to be highly effective, with recovery rates of 60% for a 12 week programme. However, the success rate may depend on the skill of the therapist, as well as the type of person receiving the therapy. It is very time consuming and those with rigid attitudes who are resistant to change may not have such an effective outcome.
 CBT is often combined with drug therapy, and whilst drugs are said to be more effective in the acute phase of depression, CBT is more effective in the latter phase. To validate this, psychologist Keller analysed  the effect of CBT and found that drugs alone had a 55% success rate in the reduction of symptoms, whereas CBT alone had a 52% success rate. Both used in conjunction with one another however resulted in an 85% success rate, which is a remarkably clear improvement. Even so, an important issue to consider from this is that, considering CBT is often undertake after drug therapy, or possibly something else, it is hard to determine how much of the success and effectiveness is purely due to the therapy rather than any other treatment. Nevertheless, studies have shown it to be very effective in reducing symptoms of depression and preventing relapse.

 Rational Emotive Behavioural Therapy (REBT) builds on the methods of CBT and is very similar. It is an attempt to replace irrational thoughts with rational thoughts. The therapists task is to make the client aware of the irrational, negative or self-defeating ways of thinking. The therapist will challenge negative thoughts through argument and confrontation to defeat these irrational thoughts, and the result should be a significant increase in self-esteem. 

 The issues surrounding REBT are very similar to those surrounding CBT. Like CBT its effectiveness may be due to the skill of the therapist and the client's attitude towards the therapy, rather than the therapy itself.
 Furthermore, the success of REBT may also be due to the 'Hawthorne effect'; when people are being studied they may alter and improve their behaviour due to the increased attention. This may therefore change the end results and account for the success of the treatment. 
 There are several factors that make CBT a more appropriate treatment than REBT. In CBT, the client plays a more active role, and must gradually take control in order to manage things, whereas in REBT the therapist will play a more active, controlling role and the client is more passive, which may not be preferable to many undertaking or considering to undertake the treatment.
 Moreover, a major and concerning weakness with REBT is that those doing the evaluation of the clinical trials supporting or going against the therapy may have a biased view of the treatment. This therefore makes the findings potentially unreliable and forces one to question the overall effectiveness of the therapy.

 Interpersonal Therapy (IPT) is a psychodynamic therapy for depression which was devised by Harry Sullivan in the 1970s, and focuses on the individual's relationships with others, communication difficulties and how ones mood can influence how they relate to people close to them. 

 IPT aims to treat depressive symptoms by resolving interpersonal conflicts and to encourage the individual to make the best use of any available social support. 
 The first stage of IPT involves identifying the client's major problems in order to create a treatment contract. Clear measurable goals are then set by the therapist for the client to fulfil by the end of the treatment.
 Secondly comes the intermediate stage which involves working through the problems identified with the therapist, and resolving the conflict which is stopping the person from moving on. Similar to the other therapies the patient will also be set homework to complete.
 Lastly comes the termination stage, which involves consolidating what has been learnt and looking forward to how these techniques and coping strategies will be applied in the future.

 Overall, a problem with these psychological therapies is that it is often difficult to measure the progress a patient is making. To increase access to more psychological therapies, the NHS is aiming to make practice more measurable and objective. Patient reported outcome measures (PROMs) have been introduced which involve patients completing a questionnaire based measure at each session, which records their current mental and physical state. This will lead to a clearer indication of the patient's progress, as well as the effectiveness of the therapies they are undertaking.

(For the exam, you'll probably only need to know two of these therapies at max if a question about this comes up, which is why I've spent less time on IPT, that and because I find it hardest to remember.) 

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