Affective Disorders A-Level Abnormal- Bipolar & Related Disorders

Affective Disorders A-Level Abnormal- Bipolar & Related Disorders
AICE Psychology Syllabus Seth M. Alper, Ph.D.

AICE Syllabus Content Bullet 1: Characteristics of Bipolar & Related Disorders Definitions & characteristics of abnormal affect Types- depression (unipolar) and mania (bipolar) Measures- Beck Depression Inventory (BDI) Bullet 2: Explanations of Depression Biological- genetic and neurochemical (Oruc et al., 1997) Cognitive (Beck, 1979) Learned helplessness/attributional style (Seligman,1988) Bullet 3: Treatment & Management for Depression Biological- chemical/drugs (MAO, SSRIs) ECT Cognitive Restructuring (Beck, 1979) Rational Emotive Therapy (Ellis, 1962)

Bullet 1: Characteristics of Bipolar & Related Disorders
Definitions & characteristics of abnormal affect Types- depression (unipolar) and mania (bipolar) Measures- Beck Depression Inventory (BDI)

Characteristics of Bipolar & Related Disorders
Affective Disorders in General Psychological disorders characterized by emotional extremes which cause impaired cognitive, behavioral, and physical functioning Different than normal moods based on duration, intensity and absence of cause Broken down into Unipolar and Bipolar Disorders Unipolar- depression only (aka major depressive) Lasts on average 6 months Bipolar- depression followed by episodes of mania (aka manic-depressive) Lasts on average 4 months (can range from 1 week to 5 months)

Unipolar Characteristics Unipolar (major depression)- A mood disorder in which a person, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities Must meet 5 of 9 criteria for DSM 5 Dx *Depressed mood most of the day nearly every day Diminished interest or pleasure in almost all activities (anhedonia) Significant weight loss (more than 5%) or significant decrease or increase in appetite Insomnia or hypersomnia nearly every day

Unipolar Characteristics Noticeable psychomotor agitation or retardation *Fatigue or loss of energy nearly every day *Feelings of worthlessness or excessive guilt nearly every day *Diminished ability to think, concentrate or make decisions nearly every day Recurrent thoughts of death or suicidal ideation *Note- the symptoms are NOT better explained by something else- such as death of loved one or as a result of substance abuse

Other Unipolar Disorders Dysthymic Disorder- similar to Major Depressive Disorder, yet less severe and with periods of normal moods intertwined with the depression. Seasonal Affective Disorder (SAD)- similar to Major depressive disorder with a seasonal (winter) pattern. Mania Normal Depression DYSYTHMIA

Unipolar Characteristics Diagnostic features 12 month prevalence in the US is about 7% of the pop. 18-29 year olds are 3x likely than individuals 60 and older Can occur at any age, but rates go up with the onset of puberty and seem to peak in the 20’s Women 2-3 x more likely to have a Dx

Bipolar Characteristics Bipolar (aka manic depressive)- A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania These shifts in state are involuntary- may occur very quickly or over an extended period of time Due to the rush of exhilaration, creativity, purpose, and euphoria, many affected by the disorder cannot conceive that anything is “wrong” with them Close friends & family members are usually the 1st to notice the dramatic changes

Bipolar Characteristics Characteristics of mania may include Euphoria, and excitement Out-of-character energy/activity, rapid fire speech and little need for sleep Wildly inflated self esteem, grandiose beliefs bordering on the delusional Mixed Episodes- at least 1 week in which the criteria for manic episode and major depressive disorder are both met

Bipolar Characteristics Criteria for Mania A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week and present nearly every day. 3 or more of the following symptoms are present: Inflated self-esteem or grandiosity Decreased need for sleep More talkative Flight of ideas Distractibility Increase in goal directed activity Excessive involvement in risky behaviors (spending money, using drugs or engaging in risky sex)

Bipolar Characteristics Differential Diagnosis Bipolar I (more serious)- At least 1 Manic or Mixed Episode often with Major Depressive Episode Must meet the criteria for mania for at least 1 week whereas Bipolar II the person is hypomanic in that they only meet the criteria for 4 days Bipolar II- At least 1 more major depressive episodes with at least 1 hypomanic episode

Mania Normal Depression Bipolar I Mania Normal Depression Bipolar II

Bipolar Characteristics Differential Diagnosis Cyclothymia- numerous periods of hypomania and depressive symptoms not rising to the level of Bipolar II. Rapid Cycling – can be used to describe either Bipolar I or Bipolar II 4 or more mood episodes in a 12 month period 5-15% of BPII patients are rapid cyclers Prevalence and course 12 month prevalence in the US is .6% for BPI and .3% for BPII Mean age of onset for the 1st manic episode is 18 for BPI, mid 20’s for BPII Women and men have equal occurrences More common for high income families

Beck Depression Inventory (BDI) (Beck, 1996) 21-item self-report measure that assesses attitudes & symptoms of depression Most widely used diagnostic tool (currently used is the BDI-II from 1996) Each item has at least 4 statements which the person completes to the best of their ability about the past week or two Each statement has a related point value (0-3) Scores range from 0-63, higher score= more likely having depression 1-10 These ups and downs are considered normal 11-16 Mild mood disturbance 17-20 Borderline clinical depression 21-30 Moderate depression 31-40 Severe depression 40+ Extreme depression

Beck Depression Inventory (BDI) (Beck, 1996)

Beck Depression Inventory (BDI) (Beck, 1996) Original BDI developed in 1961 and since revised in 1996 Current one now includes increase/decrease in appetite and fatigue as a symptom Has been adapted to use with kids under 13 years of age as well Research over the decades has shown that the BDI is reliable and valid This psychometric test provides quantitative data that is easy to measure Allows the therapist to ‘track’ a patient’s progress Keep in mind that this is only one diagnostic tool as other signs of depression can come into play Though research supports the BDI, there are drawbacks Issues of self-report (such as validity of completing it) Based on DSM criteria (not ICD-10 as well) Based on cultural norms in the US only

Sex Differences & Depression Women are up to 5x more likely to be diagnosed with depression than men This Dx was found to be globally occurring and for all subtypes of depression Why does this difference exist? Possible because women have different hormones and these hormones fluctuate more However studies that have examined this (Nolen-Hoeksema, 1990) found no such connection *Women may be more likely to seek medical help than men Possible bias among male doctors may make them more likely to diagnose a woman Possible due to men-dominated societies in numerous cultures Possible ‘expression’ of depression b/w the genders Males tend to suppress signs (such as crying) and instead more likely to show anger and/or revert to self-medicating LEAST likely to seek help- try to ‘man up’ & deal with it in their own way (anger, drinking, distractions, etc.) Females tend to amplify signs (such as crying, overthinking, withdrawing) and are more likely to seek help MORE likely to go to friends and share feelings with others

Sex Differences & Depression Research Findings Nolen-Hoeksema (1987) Conducted a meta-analytic review of sex differences in depression in terms of prevalence & potential explanations All of the studies revealed a difference in the prevalence of depression amongst women In some studies women were up to 4.6 x likely to have this Dx Examined income differences among women listed in 2 of the studies but found no significant correlation Also no evidence to suggest that this is due to the fact that women are more likely to report their symptoms

Sex Differences & Depression Research Findings Nolen-Hoeksema (1990) and Whiffen & Clark (1997) both investigated the theory that because many societies are patriarchal (male-dominated), women view themselves as having less control over negative events in their life The feelings may come from poverty, discrimination in the workplace, imbalance of power in relationships and high rates of sexual, physical and emotional abuse amongst women, dual roles of employee/mother and less control over factors of attractiveness valued by men (beauty) These studies (and others) have found a link between these factors and depression in women

Sex Differences & Depression Research Findings Nolen-Hoeksema (1987, 1990) looked at the difference b/w how men and women deal with depression Males tend to be more ACTIVE in their responses Suppress signs (such as crying) and instead more likely to show anger, revert to self-medicating, or use distractions LEAST likely to seek help- try to ‘man up’ & deal with it in their own way (anger, drinking, supression, etc.) Females tend to be more COGNITIVE in their responses May amplify signs (such as crying, overthinking, withdrawing) and are more likely to seek help Also more prone to ruminate (dwell upon) on the depression, increasing symptoms as it also tends to bring up past negative experiences and increases the vicious cycle of depression MORE likely to go to friends and share feelings with others Suggestions that future research should look at the therapeutic benefit of training females to use distraction to address depression

Sex Differences & Depression Research Findings Findings that sex differences may manifest itself in adolescence There is evidence that the development of secondary sex characteristics (such as breasts for females & facial hair for males) is more difficult to deal with for females Body dissatisfaction for females tends to go up at this time whereas it tends to diminish for males Numerous findings on how there is a greater pressure on females due to sex role socialization in which girls interpret as a need to be subservient and less abled Studies show a positive correlation in women where higher IQ = higher Dx rates of depression In comparison, a negative correlation exists with males when looking at IQ & depression Dx

Assignment As we watch Demi Lovato’s documentary about her ongoing battle with bipolar disorder, outline her experiences, symptoms, age of onset, triggering events, genetic/family history, etc. (all main ideas) 1 FULL PAGE MINIMUM- upload to Google Classroom Extra Credit Opportunity Discuss cultural differences that exists from the US perspective and that of the depressives in this documentary on depression in the Muslim community.

Bullet 2: Explanations of Depression
Biological- genetic and neurochemical (Oruc et al., 1997) Cognitive (Beck, 1979) Learned helplessness/attributional style (Seligman,1988)

Explanations of Depression
Biological Explanation Genetic Causes Research has shown a genetic link among depression (more so for bipolar) The strongest evidence for a genetic link comes with Bipolar Disorder with an estimated heritability rate of 80% (Bertelsen, Harvald & Hague, 1977) Pedigree studies have shown a concordance between family members and a Dx of depression Plomin et al. (1997) found higher prevalence of mood disorders in first degree relatives Other studies have found that family members have a 20% chance of also having depression Significantly greater than the rate in the general population

Biological Explanation Genetic Causes Plomin et al (1997) reviewed 5 different twin studies and found that when an identical twin is diagnosed with unipolar depression the other twin has a 4x likely diagnosed as compared to fraternal twins However, Plomin found also noted that this may be due to varied definitions of depression across the studies McGufin et al (1996) studied 214 pairs of twins where at least one of the twins were being treated for depression. Found concordance rates of 46% for mz twins vs 20% for dz twins. Katz & McGuffin (1993) found that the rate of Bipolar in 1st degree relatives of someone with a Bipolar Dx was 9% or 9 x higher than in the general population

Biological Explanation Biochemical Causes In 1960s/70s, the role of certain monoamine neurotransmitters (like Serotonin) thought to lead to depression Led to the monoamine hypothesis for depression that said a lack of these neurotransmitters or a problem in processing them was to blame Scientific research does NOT support this and instead some research suggest that it is actually the opposite, that high levels of these neurotransmitters causes depression Studies have shown that when a person takes antidepressants, the levels of monoamines actually drop at about 2 weeks out when the pills actually start to work

Biological Explanation Genetic/Neurochemical Causes Research has shown that serotonin plays a vital role and exists in low levels for BOTH depression & mania *Oruc et al. (1997)- examined the DNA polymorphisms of serotonin genes of 42 bi-polar patients compared to 49 healthy controls (matched for gender and age) 16 of the bipolar Ps also had at least one 1st degree relative with a major affective disorder polymorphism- variation in gene expression from a normal population (not a mutation) Serotonin polymorphisms chosen as research has shown a link to depressive disorders Also can be sexually dimorphic- can show male or female patterns of genetic material Though there was no overall difference in results, when looking at gender specifically, it can be concluded that polymorphisms in these serotonin genes may lead to an increase in bipolar Dx in females only

Cognitive Explanation Beck’s Cognitive Theory (1979) Beck believed that the cognitive symptoms of depression might actually be the most important It follows that if someone believes that they are unworthy of love that they might become depressed Beck focuses on the way that we think about/dwell on/jump to conclusions of our negatives Beck identifies the ‘Negative Cognitive Triad’ as an explanation of depression The person has negative thoughts about the self “I am ugly,” “I am worthless,” etc… Negative thoughts about the interactions with the world “No one loves me.” Negative thoughts about the future “Things will never change.”

Cognitive Explanation Beck’s Cognitive Theory (1979) Beck focused on DYSFUNCTIONAL BELIEFS (aka depressogenic schemas) For example, if a person believes that everyone “must” like him/her and s/he is confronted with the fact that someone doesn’t like him/her, this dysfunctional belief can lead to depression Self-blame schema makes the person feel responsible for everything that goes wrong Ineptness schema makes a person feel like they will be a failure every time they try something All or none reasoning- person tends to be a perfectionist- anything less than perfect leads to depression Selective abstraction- focusing on only the negative of the day while discounting the positive Arbitrary inference- jumping to conclusions based on minimal evidence Such as “My wife yelled at me today… she must be getting ready to file for divorce” Overgeneralization- Making broad generalizations from one instance Such as thinking that after one mistake, “I am always going to be a failure.”

Early Experiences Formation of Dysfunctional Beliefs Critical Incidents Beliefs Activated Negative Automatic Thoughts Symptoms of Depresion Cognitive Affective Behavioral Somatic Motivational

Cognitive Explanation Evaluating Beck’s Cognitive Theory (1979) It is has shown to be very useful in that it created a very efficacious form of the therapy through the cognitive approach We address one’s negative thoughts in hopes of changing their outlook and thus depression Theory has been supported by numerous research findings Clark & Steer (1996) found that the negative thinking patterns described by Beck was found in all subtypes of depression Mathews & MacLeod (1994) found that depressed people show a cognitive bias towards remembering negative information compared to non-depressed persons who have a bias towards positive information However, there has yet to be significant support for Beck’s Negative Triad

Cognitive-Behavioral Explanation Learned helplessness/attributional style (Seligman,1988) Based on Seligman and Groves (1970) work with dogs not being able to escape a shock, sitting and taking the shock, and still not trying to escape it when the opportunity was there This sparked research into ‘learned helplessness’ in numerous aspects of psychology Theory has been adjusted in current research to be known as attribution-helplessness Similarities between learned helplessness in animals and depression in people Both show lowered initiation of voluntary responses (known sometimes as ‘paralysis of will’) Both show cognitive deficits Both show a lack of aggression and a loss of appetite This is based on life experiences teaching us to develop trust/mistrust of our surroundings, leading us to develop patterns of thinking about ourselves and the world

Cognitive-Behavioral Explanation Learned helplessness/attributional style (Seligman,1988) In Seligman’s (1988) study, 51 Ps (39up/12bp)were found to be much more pessimistic and have negative attributional styles compared to the controls If we feel that (a) something is out of our control + (b) it is our fault= depression develops This is especially true if these attributions are global, stable, and internal Everything about my life is bad (global) It is going to be bad for the foreseeable future (stable) It is all my fault (internal)

Cognitive-Behavioral Explanation Evaluating Learned helplessness/attributional style (Seligman,1988) Many studies have supported the findings that this attributional style is common among depressed people (Abramson et al., 1995) Idea behind can be tested with changing ones thoughts to change ones behaviors This attributional style tends to diminish or disappear as depressed patients recover Some postulate that attributional style is a symptom rather than a cause of depression (Abramson et al 1995)

Bullet 3: Treatment & Management for Depression
Biological- chemical/drugs (MAO, SSRIs) ECT Cognitive Restructuring (Beck, 1979) Rational Emotive Therapy (Ellis, 1962)

Treatment & Management for Depression
Biochemical Treatments Typically, this is the most used treatment option for many as it can be a ‘fast fix’ However, many argue that we are not getting to the root of the problem, only putting a ‘band-aid’ on it Should really be only for those with moderate to severe depression MAOIs - monoamine oxidase inhibitors- like Marplan & Nardil- used as last resort today Introduced in the 1950s, they were the 1st round of drugs to target depression (and anxiety disorders) Work by inhibiting monoamine oxidase from breaking down serotonin, norepinephrine, & dopamine One’s mood is elevated as these neurotransmitters instead stay at a higher level Problem is that there are sever side effects if one stays on MAOI drugs for an extended time The most common side effects of MAOIs include: Interactions with other drugs/foods/drinks and even serotonin syndrome (super-elevated levels) Dry mouth Nausea, diarrhea or constipation Headache Drowsiness Insomnia Dizziness or lightheadedness Involuntary muscle jerks Low blood pressure Weight gain Difficulty starting a urine flow Muscle cramps

Biochemical Treatments SSRIs- Selective Serotonin Reuptake Inhibitors- Prozac & Zoloft- most commonly prescribed Nemeroff & Schatzberg (1998) metanalysis found that SSRIs are efficacious in treating depression Rucci et al (2011) found that these drugs tend to reduce suicidal ideation SSRIs work by stopping serotonin from being reabsorbed or broken down in the synapse They usually take several weeks to take effect (some people will stop taking them because the change does not occur fast enough) Some stop taking them after 3-4 months as the drugs are working and they feel better However, if the depression itself hasn’t been treated, these patients will often dip back into depression and take the normal 6-9 months to recover Frank et al (1990) found that those who continue to take moderate doses after the depression subsides will reduce the likelihood of a recurrence from 90% down to 20%

Biochemical Treatments SSRIs- Selective Serotonin Reuptake Inhibitors How SSRIs Work: Dangers of SSRIs:

Biochemical Treatments Lithium and other mood stabilizers Called mood stabilizing because they tend to impact both depression and mania Maintenance on lithium has been shown to reduce the recurrence of mania Nemeroff & Schatzberg (1990) found that those who went off the meds were 28x more likely to have an episode than those on a maintenance program. Many people report significant side effects including lethargy and decreased motor coordination.

Biomedical Treatment Electroconvulsive Therapy (ECT) Sedated patients have electrodes placed on the head and then have about 1 second of low voltage electric current passed through the electrodes Results in a seizure, lasting about 1 minute (patients are fully conscious within 15 minutes) Seems to be very effective with patients who: are severely depressed and at imminent risk of suicide can’t or won’t take medications other medications have not worked Often followed with moderate doses of SSRIs as a maintenance procedure as ECT is short-term

Biomedical Treatment Research on Electroconvulsive Therapy (ECT) Geddes (2003) reviewed the results of 18 randomized trials including 1,144 patients Found that ECT was more efficacious than antidepressant medications including SSRI’s with an effect size of .80 One critique of this study is that it include some older studies that lacked stringent controls but the author concludes that the effect size is so large that it compensates for this problem Another critique is that it did not include client self report findings from ECT trials which omits a significant factor.

Biomedical Treatment rTMS –repeated Transcranial Magnetic Stimulation Send magnetic waves into specific sections of the brain May have less side effects because it targets a specific section of the brain rather than the whole brain like ECT Lacks significant research to support the efficacy of this treatment However, Bermlin (2013) found that ECT was significantly more effective than rTMS rTMS remains attractive however, because it is easier to administer from a logistical and regulatory standpoint It also has less of a negative association.

Cognitive Treatment Beck’s (1979) Cognitive Restructuring A form of one-on-one talk therapy between the therapist and patient Often falls under the same category of cognitive-behavioral therapy Keep in mind that these are not the same due to slightly different procedures of each The goal of is for the therapist to “gain entry intro the patients cognitive organization” (understand the patients illogical beliefs, monitor them, and then challenge these beliefs and negative thoughts)

Cognitive Treatment Beck’s (1979) Cognitive Restructuring Therapy involves 6 phases that are to allow the patient to be self-sufficient (as best as possible) Phase 1– Explain how the treatment works The therapist tries to find the theory of depression within the patient (the root cause of their depression) and then explains the negative, self-fulfilling cycle of the cognitive triad Phase 2– Taught to monitor negative thoughts and self-schema The patient must then be trained to observe and record their thoughts This will allow them to recognize irrational, inaccurate beliefs.

Cognitive Treatment Beck’s (1979) Cognitive Restructuring Therapy involves 6 phases that are to allow the patient to be self-sufficient (as best as possible) Phase 3– Taught to use behavioral techniques to challenge these thoughts The therapist explains the link between the patients thoughts, emotions, and behavior The patient must try to “catch” automatic, negative thoughts, record them, & refute them This sort of “automatic thought catch practice” should happen outside of therapy, in a real-world content, to maximize patent outcomes. Phase 4– Explore how the client responds to negative thoughts These negative thoughts can be discussed and challenged in therapy, to make it clear to the patient their reflections may not be accurate (reality testing) If their perspective is too negative, that could be worsening their depression

Cognitive Treatment Beck’s (1979) Cognitive Restructuring Therapy involves 6 phases that are to allow the patient to be self-sufficient (as best as possible) Phase 5– Dysfunctional beliefs are identified and challenged. The patient is meant to investigate and notice when their thinking is distorted The therapist can then help the patient reattribute the emotion by seeing if the cause of problems/failures is internal or external Patients can reframe their thinking, understand their level responsibility, and grow from the experience Phase 6– Finally, the clients have the tools to use the process alone in the future. The therapy concludes when the patient can independently practice cognitive restructuring on their own, essentially conducting self-maintenance.

Cognitive Treatment Research on Beck’s (1979) Cognitive Restructuring Studies show that cognitive restructuring is an efficacious treatment for managing depression, especially for those patients who cannot use drug treatment It can reduce symptoms of depression in patients who fail to respond to anti-depressants Dobson (1989)- compared patients receiving Cognitive Restructuring to controls receiving no therapy, those receiving antidepressants, and those receiving another form of psychotherapy Measured by scores on the BDI The cognitive restructuring group was 98% better than the controls, and 70% better than the antidepressant and other psychotherapy groups. Hans & Hiller (2013)- A meta-analysis of 34 studies that looked at group and individual CBT with at least a 6 month follow-up Found that CBT was effective and that the changes lasted at least 6 months.

Cognitive Treatment Research on Beck’s (1979) Cognitive Restructuring Hans & Hiller (2013) A meta-analysis of 34 studies that looked at group and individual CBT with at least a 6 month follow-up Found that CBT was effective and that the changes lasted at least 6 months Cuijpers et al (2014 ) A meta-analysis of 115 studies comparing CBT to other psychotherapies or drug therapies Found that CBT was effective However, when only “high quality” studies were included, this effect size dropped

Cognitive Treatment Ellis’ (1962) Rational Emotive Therapy(RET) Currently known as REBT- Rational Emotive Behavioral Therapy Basis is that we are not directly impacted by outside factors (‘he never called me like he said he would’), but rather we are impacted by our irrational perception of these outside factors (‘he doesn’t like me because I’m a failure at everything and I am going to be single forever’) Ellis believed that a person becomes depressed because of these faulty internal constructions Depression is not from the event itself, but we falsely and negatively perceive and internalize these events

Cognitive Treatment Ellis’ (1962) Rational Emotive Behavioral Therapy(REBT) Therapy is based on the ABC model (which has been expanded to D, E, [&F]) Activating event (event that took place, out of your control) Beliefs about the activating event (this is key as we distort the event to a negative of us) Consequences- cognitive (and emotional) response about the activating event Disputing one’s irrational beliefs during therapy Effects of successful disruption of irrational beliefs Feelings that are the new, rational ones

Cognitive Treatment Ellis’ (1962) Rational Emotive Behavioral Therapy(REBT)

Cognitive Treatment Ellis’ (1962) Rational Emotive Behavioral Therapy(REBT) Ellis argues that our negative ‘beliefs’ about the said event has the greatest impact on our emotional well-being and our behavioral tendencies People who constantly have these negative, irrational beliefs are at a greater risk for depression Musterbation- Ellis’ term in that we often setup our selves up for failure through illogical or irrational beliefs- “I must be accepted to this college” “Everyone must like me” etc. I-can’t-stand-it-it is- Ellis’ term that we make every setback or event into a disaster- “I failed that history test and now I’m never going to graduate… I’m dropping out!”

Cognitive Treatment Ellis’ (1962) Rational Emotive Behavioral Therapy(REBT) The goal is REBT is to help the individual create & maintain constructive, positive, rational patterns of thinking when someone doesn’t go their way To do so, we have to identify and change our thoughts that lead to these negative, guilty, self- defeating behavior Disputing- act of forcefully questioning one’s irrational beliefs by using a variety of methods (pending on the person & severity) in order to make him/her reevaluate their dysfunctional beliefs Such as ‘do you think that you are the only one who has ever been rejected by UF? That you will never be able to get a degree or work in the field that you want?’

Cognitive Treatment Ellis’ (1962) Rational Emotive Behavioral Therapy(REBT) This disputing aims to show the person that the consequences (C) (their behavior/emotions) are a result of their irrational/construed beliefs (B) rather than the activating event (A) The therapist focuses on replacing these beliefs (B) with new, healthier feelings (F) that should reduce the probability of constant negative thoughts that can lead to depression The focus on this change is on the here and now, rather than dwelling on past experiences In theory, REBT allows the individual to recognize their setbacks and choose how to react- this enables them to take control of their thinking and behavior Falls under the free-will side and dispositional side of the respective debates

Cognitive Treatment Research on Ellis’ (1962) Rational Emotive Behavioral Therapy(REBT) Lyons and Woods (1991) meta-analysis of 70 studies on REBT found that patients using this program showed significant improvements compared to other treatment groups and the controls Sava et al. (2008) compared REBT, CBT, and Prozac groups- though there were no statistical differences in BDI scores among the groups, REBT & CBT were said to be preferred treatments as there is less cost & possible side effects involved compared to drug therapy Iftene et al. (2015) concluded that both REBT & antidepressants are equally effective in treating depression

Affective Disorders A-Level Abnormal- Bipolar & Related Disorders

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