2. Cognitive explanations: Beck et al Q, What do we mean by cognitive distortions and can you give examples?

3. Aim To understand cognitive distortions in patients with depression.

4. Depression Q, What is depression, how do we get it and how is it different to bi-polar?

5. Method Clinical interviews with patients who were undergoing therapy for depression.

6. Issues Q, What issues must we consider straight away that may affect the findings?

7. Participants 50 patients diagnosed with depression Aged 18 – 48 Middle to upper class At least average intelligence

8. Design Independent design Compared with 31 non-depressed patients All undergoing psychotherapy Matched on age, sex, social position

9. Procedure Face to face interviews Included retrospective reports of patients thoughts Spontaneous thoughts during the session Some patients brought diaries that they had kept

10. Procedure Records of non-depressed patients verbalisations also kept for comparison

11. Findings Certain themes appeared more in depressed patients that did not appear in non-depressed.

12. Themes Low self-esteem Self-blame Overwhelming responsibilities Anxiety caused by thoughts of personal danger Q, How are these cognitive distortions?

13. Findings Inferior to others (social and occupational groups). Unlovable and alone Illogical self-blame

14. Conclusions Patients have cognitive distortions These distortions deviate from realistic and logical thinking Seen even in mild depression Related only to depression

15. Group task

16. Treatments Task: List a range of possible treatments and explain (behavioural, biological and cognitive): Which disorders these treatments best suit S&W of the treatments

17. Behavioural (3.1) Study by McGrath Successful treatment of a noise phobia

18. Aim Treat a 9 year old girl (Lucy) with noise phobias Using systematic desensitisation

19. The participant had: A fear of sudden loud noises Balloons, party poppers, guns, cars backfiring and fireworks Lower than average IQ Not depressed, anxious or fearful Tested with psychometric tests

20. Issues?

21. Design Single-participant

22. Procedure Consent given by parents Lucy went to therapy sessions (playful environment) Session one, participant constructed a hierarchy of feared noises (doors banging etc) Lucy taught breathing and imagery to relax (at home on her bed with her toys)

23. Procedure Lucy used a fear thermometer to rate her level of fear (1 – 10) Stimulus of the loud noise paired with relaxation technique (deep breathing and bedroom with toys) Relaxation techniques made her feel calm Associated noise with feeling calm

24. Procedure After 4 sessions felt calm when stimulus presents Did not need to imagine she was playing with her toys in her bedroom

25. Findings

26. By the end of session one Reluctant to let balloons be bust (even far away, corridor) When balloon burst Lucy cried and was had to be taken away Encouraged to breath deeply and relax

27. By the end f session four: Lucy was able to have he balloon burst 10 meters away Using fear thermometer only showed mild anxiety

28. By the end of session five: Lucy was able to pop the balloon herself

29. Over the next three sessions Party poppers were introduced To start with Lucy did not allow them in the room Eventually, Was able to pop one herself if held by therapist

30. Scores by tenth session (final) Balloons: 7/10 to 3/10 Party poppers: 9/10 to 3/10

31. Conclusions Systematic desensitisation successful in children Control is the key factor Use of inhibitors also key (relaxation & playful environment)

32. Treatments Biological (3.2) Karp & Frank (1995) Review article Considers the effectiveness of drug therapies for depression

33. Title Combination therapy and the depressed women

34. Method Review article. Considers previous research into the effectiveness of single treatments and combined drug and psychotherapeutic treatments for depression.

35. Participants Research reviewed concentrated on women diagnosed with depression.

36. Design Majority of research used an independent design. Patients had: -Single drug treatment -Single psychological treatment -Combined treatments -Sometimes placebo groups.

37. Procedure Depression was analysed (using a range of psychometric tests and questionnaires) Patients were generally tested prior to treatment, after treatment (and in some cases after a period of time as a follow up)

38. Is depression caused by a chemical imbalance in the brain? Depression may be caused by a chemical imbalance in the brain. According to the chemical imbalance theory, low levels of the brain chemical serotonin lead to depression depression medication works by bringing serotonin levels back to normal. However, researchers know very little about how antidepressants work. There is no test that can measure the amount of serotonin in the living brain no way to even know what a low or normal level of serotonin is let alone show that depression medication fixes these levels.

39. Drugs used in depression Antidepressant medication may relieve some symptoms. Prozac increase serotonin levels in the brain They come with their own side effects and dangers. Recent studies have raised questions about their effectiveness.

40. Side effects Nausea Insomnia Anxiety Restlessness Decreased sex drive Dizziness Weight gain or loss Tremors Sweating Sleepiness Fatigue Dry mouth Diarrhea Constipation Headaches Suicidal risks

41. Psychological treatment for depression Psychotherapy can assist the depressed individual in several ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognise which life problems are critical, and which are minor. Helps to develop positive life goals, and a more positive self- assessment. Third, problem solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression (work, relationships)

42. Findings A lot of research suggested adding psychological treatments to drug therapy did not increase the effectiveness of drug therapy.

43. Findings Some research suggested less attrition (withdrawal) when combination therapies were used. Therefore more people were likely to continue the treatment if cognitive therapy was given in addition to drug therapy.

44. Conclusions Two treatments are not necessarily better than one Drug therapy is not effective within the treatment of depression

45. Treatments Cognitive (3.3)

46. Ellis (1991) Identified the ABC of rational emotive therapy A, Activating events (failing an exam) B, Your beliefs (you think you are not intelligent as you failed the exam) C, Consequences (you may continue to have this illogical thinking)

47. Beck et al Comparing the effectiveness of drug therapy and cognitive therapy.

48. Aim To see which therapy leads to better treatment for depression.

49. Methodology Controlled experiment Ps allocated to one of two conditions

50. Design Independent design Random allocation a condition

51. Participants 44 Ps (patients) Diagnosed with moderate to severe depression (major issue) Attending psychiatric outpatients clinic

52. Procedure P’s assessed with 3 self reports One method was Beck Depression Inventory (a 21-question multiple-choice self-report inventory) The questionnaire is designed for individuals aged 13 and over Composed of items relating to symptoms of depression such as hopelessness and irritability, cognitions such as guilt or feelings of being punished.

53. Procedure 12 week programme Condition 1: One hour cognitive therapy session twice a week Condition 2: 100 Imipramine (antidepressant medication) capsules (prescribed by visiting doctor for 20 minutes once a week)

54. Procedure Cognitive therapy sessions were suited to the individuals needs (individual differences considered) Were all controlled Therapists observed to increase reliability

55. Findings Both groups = Significant decrease in depressive symptoms on all 3 rating scales Cognitive treatment showed significantly greater improvements in self-reports and observer based ratings 78.9% increase in cognitive treatment 20% increase in drug treatment

56. Findings Drop-out rate = 5% in Cognitive Therapy Drop-out rate = 32% in Drug Therapy

57. Conclusions Cognitive Therapy leads to better treatment of depression Also better adherence