Comer, Fundamentals of Abnormal Psychology, 3e 1 Chapter 9 Treatments for Mood Disorders Slides &...

Comer, Fundamentals of Abnormal Psychology, 3e

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Chapter 9

Treatments for Mood Disorders

Slides & Handouts by Karen Clay Slides & Handouts by Karen Clay Rhines, Ph.D.Rhines, Ph.D.

Seton Hall UniversitySeton Hall University


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Treatments for Mood Disorders

• Mood disorders – as extraordinarily painful and disabling as they tend to be – respond more successfully to more kinds of treatments than do most other forms of psychological dysfunction– This diversity of successful treatments has

affected individuals with depression in both positive and negative ways


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Treatments for Unipolar Depression: Psychological

Approaches• Psychological approaches to treating

unipolar depression come from the three main models:– Psychodynamic – Widely used despite no

strong research evidence of its effectiveness– Behavioral – Primarily used for mild or moderate

depression but practiced less than in past decades

– Cognitive – Has performed so well in research that it has a large and growing clinical following


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Approaches• Psychodynamic therapy

– Believing that unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people, psychodynamic therapists seek to bring these issues into consciousness and work through them

– Psychodynamic therapists use the same basic procedures for all psychological disorders:

• Free association• Therapist interpretation


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Approaches• Psychodynamic therapy

– Despite successful case reports, researchers have found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression

– Two features may be particularly limiting:• Depressed clients may be too passive or weary to fully

participate in clinical discussions• Depressed clients may become discouraged and end

treatment too early when treatment doesn’t provide fast relief

– Short-term approaches have performed better than traditional approaches


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Approaches• Behavioral therapy

– Lewinsohn, whose theory tied a person’s mood to his/her life rewards, developed a behavioral therapy for unipolar depression in the 1970s:

• Reintroduce clients to pleasurable activities and events, often using a weekly schedule

• Appropriately reinforce their nondepressive behaviors

– Use a contingency management approach

• Help them improve their social skills


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Approaches• Behavioral therapy

– The behavioral techniques seem to be of only limited help when just one of them is applied

• When treatment programs combine two or three of the techniques, as Lewinsohn had envisioned, depressive symptoms (especially mild symptoms) seem to be reduced


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Approaches• Cognitive therapy

– Beck views unipolar depression as resulting from a pattern of negative thinking that may be triggered by current upsetting situations

• Maladaptive attitudes lead people to the “cognitive triad”

– Negatively viewing oneself, the world, and the future

• These biased views combine with illogical thinking to produce automatic thoughts


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– Beck’s cognitive therapy – the leading cognitive treatment for unipolar depression – is designed to help clients recognize and change their negative cognitive processes

– This approach follows four phases and usually lasts fewer than 20 sessions

– Phases:1. Increasing activities and elevate mood2. Challenging automatic thoughts3. Identifying negative thinking and biases4. Changing primary attitudes


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– Over the past three decades, hundreds of studies have shown that cognitive therapy helps unipolar depression

– Around 50%–60% of clients show a near-total elimination of symptoms

– This treatment has also been used in a group therapy format


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Treatments for Unipolar Depression: Sociocultural

Approaches• Theorists trace the causes of unipolar

depression to the broader social structure in which people live, and the roles they are required to play

• The most effective sociocultural approaches to treating unipolar depression are interpersonal psychotherapy and couple therapy– The techniques used in these approaches

borrow from other models


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Treatments for Unipolar Depression: Sociocultural

Approaches• Interpersonal therapy (IPT)

– This model holds that four interpersonal problems may lead to depression and must be addressed:

• Interpersonal loss• Interpersonal role dispute• Interpersonal role transition• Interpersonal deficits

– Studies suggest that IPT is as effective as cognitive therapy for treating depression


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Treatments for Unipolar Depression: Biological Approaches• Biological treatments can bring great relief

to people with unipolar depression

• Usually biological treatment means, antidepressant drugs, but for severely depressed persons who do not respond to other forms of treatment, it sometimes includes electroconvulsive therapy


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Treatments for Unipolar Depression: Biological Approaches• Electroconvulsive therapy (ECT)

– The use of ECT was -- and is -- controversial• It is now used frequently but only in severe cases

– The procedure consists of targeted electrical stimulation to cause a brain seizure

• The usual course of treatment is 6 to 12 sessions spaced over two to four weeks

• Treatment may be bilateral or unilateral


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– The discovery of the effectiveness of ECT was accidental and based on a fallacious link between psychosis and epilepsy

– The procedure has been modified in recent years to reduce some of the negative effects

• For example, patients are given muscle relaxants and anesthetics before and during the procedure

– Patients generally report some memory loss


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– ECT is clearly effective in treating unipolar depression• Studies find improvement in 60%–70% of patients

– The procedure seems particularly effective in cases of severe depression with delusions, but it has been difficult to determine why ECT works so well

– Although effective, the use of ECT has declined since the 1950s, because of the memory loss caused by the procedure and the emergence of effective antidepressant drugs


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Treatments for Unipolar Depression: Biological Approaches• Antidepressant drugs

– In the 1950s, two kinds of drugs were found to be effective:

• Monoamine oxidase inhibitors (MAO inhibitors)• Tricyclics

– These drugs have been joined in recent years by a third group, the second-generation antidepressants


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Treatments for Unipolar Depression: Biological Approaches• Antidepressant drugs: MAO inhibitors

– Originally used to treat TB, doctors noticed that the medication seemed to make patients happier

– The drug works biochemically by slowing down the body’s production of MAO

• MAO breaks down norepinephrine• MAO inhibitors stop this breakdown from occurring• This leads to a rise in norepinephrine activity and a reduction

in depressive symptoms – About half of patients who take these drugs are helped by them


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Treatments for Unipolar Depression: Biological Approaches• Antidepressant drugs: Tricyclics

– In searching for medications for schizophrenia, researchers discovered that imipramine lessened depressive symptoms

• Imipramine and related drugs are known as tricyclics because they share a three-ring molecular structure


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Treatments for Unipolar Depression: Biological Approaches• Second-generation antidepressant drugs

– A third group of effective antidepressant drugs is structurally different from the MAO inhibitors and tricyclics

• Most of the drugs in this group are labeled selective serotonin reuptake inhibitors (SSRIs)

– These drugs act only on serotonin (no other NTs are affected)

• This class includes fluoxetine (Prozac) and sertraline (Zoloft)

– Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available


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Treatments for Unipolar Depression: Biological Approaches• Second-generation antidepressant drugs

– The effectiveness and speed of action of these drugs is on par with the tricyclics yet they boast enormous sales

• Clinicians often prefer these drugs because it is harder to overdose on them than on other kinds of antidepressants

• There are no dietary restrictions like there are with MAO inhibitors

• There have fewer side effects than the tricyclics

– These drugs may cause some undesired effects of their own, including a reduction in sex drive


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How Do the Treatments for Unipolar Depression Compare?• For most kinds of psychological disorders,

no more than one or two treatments, if any, emerge as successful– Unipolar depression seems to be the

exception, responding to any of several approaches


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How Do the Treatments for Unipolar Depression Compare?• Findings from a number of research

studies suggest that:– Cognitive, interpersonal, and biological

therapies are all highly effective treatments for mild to severe unipolar depression

– Although cognitive and interpersonal therapies may lower the likelihood of relapse, they are hardly relapse-proof


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studies suggest that:

– behavioral therapy have shown less effective than cognitive, interpersonal, or biological therapy


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studies suggest that:– Psychodynamic therapies are less effective

than other therapies in depression– A combination of psychotherapy and drug

therapy is modestly more helpful to depressed people than either treatment alone


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studies suggest that:– Among biological treatments, antidepressant

drugs and ECT appear to be equally effective for reducing depression, although ECT seems to act more quickly


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Treatments for Bipolar Disorders

• Until the latter part of the 20th century, people with bipolar disorders were destined to spend their lives on an emotional roller coaster– Psychotherapists reported almost no success– Antidepressant drugs were of limited help

• These drugs sometimes triggered manic episodes

– ECT only occasionally relieved either the depressive or the manic episodes of bipolar disorder


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Treatments for Bipolar Disorders: Lithium Therapy

• The use of lithium, a metallic element occurring as mineral salt, has dramatically changed this picture– It is extraordinarily effective in treating bipolar

disorders and mania– Determining the correct dosage for a given

patient is a delicate process• Too low = no effect• Too high = lithium intoxication (poisoning)


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Treatments for Bipolar Disorder: Lithium Therapy

• Lithium provides improvement for more than 60% of manic patients– Most patients also experience fewer new

episodes while on the drug– Lithium also is a prophylactic drug, one that

actually prevents symptoms from developing

• Lithium also helps those with bipolar disorder overcome their depressive episodes


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Treatments for Bipolar Disorder: Lithium Therapy

• Researchers do not fully understand how lithium operates– They suspect that it changes synaptic activity in

neurons, but in a different way from that of antidepressant drugs

• Although antidepressant drugs affect a neuron’s initial reception on NTs, lithium seems to affect a neuron’s second messengers

– Another theory is that lithium corrects bipolar functioning by directly changing sodium and potassium ion activity in neurons


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Treatments for Bipolar Disorder: Adjunctive Psychotherapy

• Psychotherapy alone is rarely helpful for persons with bipolar disorder

• Lithium therapy alone is also not always sufficient, either– 30% or more of patients don’t respond, may not

receive the correct dose, or may relapse while taking it

• As a result, clinicians often use psychotherapy as an adjunct to lithium (or other medication-based) therapy


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Treatments for Bipolar Disorder: Adjunctive Psychotherapy

• Therapy focuses on medication management, social skills, and relationship issues

• Few controlled studies have tested the effectiveness of such adjunctive therapy– Growing research suggests that it helps

reduce hospitalization, improves social functioning, and increases clients’ ability to obtain and hold a job

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