Implementing Treatment

1. Implementing Treatment Group Treatments For Major Depressive Disorder

2. The IB Syllabus Says: • Examine biomedical, individual and group approaches to treatment. • Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder. • Discuss the use of eclectic approaches to treatment. • Discuss the relationship between etiology and therapeutic approach in relation to one disorder.

3. Group Approaches to the treatment of depression The relationship between Treatment and Etiology: • Group therapy can both be based on the principles of Cognitive Behavioral Therapy which proposes that the modification of maladaptive thought patters is crucial in treating depression. • Group therapy can also follow a psychodynamic approach which places emphasis on traumatic experiences during childhood • However, most group therapies are eclectic in nature taking elements of both CBT and Psychodynamic approaches

4. Group Approaches to the treatment of depression: Marital Therapy Background: • In the treatment of depression, most group therapy is actually “couples therapy” due to the strong link between depression and marital problems. • Marital therapies for depression focus on teaching couples to communicate and problem solve more effectively, while increasing positive, pleasurable interactions and reducing negative interchanges. Research Support for Marital Therapy: • Jacobson et al. (1989) have found that this form of group therapy has shown to be just as effective as other forms in treating the symptoms of depression, but is more effective in improving the quality of the marital relationship. • Couples therapy has been most successful in whom suffering from depression related to marital distress.

5. Group Approaches to the treatment of depression: Eclectic Approaches In group therapy the group context and group processes are used as a means of developing, exploring and examining the nature of the relationships people have within the group itself and with those outside the group. Group therapy can also help people to develop skills in a supportive environment. Below are some key principles of group therapy: Key Principles of Group Therapy: Catharsis • Catharsis is the experience of relief from emotional distress through the free and uninhibited expression of emotion. When members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt. Group Cohesiveness • It has been suggested that this is the primary therapeutic factor from which all others flow. Humans are herd animals with an instinctive need to belong to groups, and personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance, and validation.

6. Key Principles of Group Therapy: Altruism • The group is a place where members can help each other, and the experience of being able to give something to another person can lift the member's self esteem and help develop more adaptive coping styles and interpersonal skills. Shared Experiences • The recognition of shared experiences and feelings among group members and that these may be widespread or universal human concerns, serves to remove a group member's sense of isolation, validate their experiences, and raise self-esteem Modeling • One way in which group members can develop social skills is through a modeling process, observing and imitating the therapist and other group members. For example, sharing personal feelings, showing concern, and supporting others.

7. Group Approaches to the treatment of depression: Research Support • The beneficial effect that a therapy group can have on an individual have long been recognized, but until recently there was a lack of high quality studies comparing the effectiveness of individual and group therapy, for clients with similar characteristics. • Toseland and Siporin (1986) carried out a meta-analysis of 74 studies comparing individual and group treatment. Group treatment was found to be as effective as individual treatment in 75% of cases, and more effective in the remaining 25%. In no case was individual treatment found to be more effective than group treatment. Group treatment was more cost effective than individual therapy in 31% of the studies.

8. Group Approaches to the treatment of depression: Research Support • McDermot et al (2001) carried out a meta-analysis on the effectiveness of group psychotherapy in the treatment of depression. Of the 48 studies examined: • 43 studies showed statistically significant reductions in depressive symptoms following group psychotherapy • 9 studies showed no difference in effectiveness between group and individual therapy. • 8 studies showed individual CBT to be more effective than group therapy.

9. Group Approaches to the treatment of depression: Research Support • Why is there a difference in these two meta-analysis? • Yalom (2005) who is one of the fathers of group therapy, argues that obtaining scientific data to assess the effectiveness of group therapy is highly problematic since group dynamics presents so many more variables than individual therapy.

10. Group Approaches to the treatment of depression: Psychodrama General Info: • This is a group therapy where group members act out dramatic roles as if they were participating in an improvised play. • Moreno (1965) developed this therapy and believed that people learn better if they helped each other through group work, and therapy should be an active experience. Theoretical Background: • Moreno believed that: - every human is an actor, playing many roles in their everyday lives, and a psychologically healthy person can switch roles easily – but if we are rigidly fixed in one role then that can become dangerous. He also believed that everyone was capable of being their own savior. • This form of therapy is influenced by psychoanalysis as clients act out their internal conflicts and past events that cause them trauma.

11. Group Approaches to the treatment of depression: Psychodrama The structure of the therapy: • A group is of 10-15 people – one member of the group will chose to act out a scenario, or drama from a chosen problem in their life. Sessions can last for hours. Everyone is then assigned one of the following roles: • The director – the person trained in psychodrama – monitors the drama unfolding and intervenes to offer guidance and provides a summary at the end • The protagonist – the volunteer who is electing to play out their drama • The auxiliary egos – significant people in the drama – the protagonist chooses these from the group. The director can ask the protagonist to move into an auxiliary egos position to experience their position if necessary • The double – the inner voice of the protagonist– it will mirror what the protagonist is doing – so the protagonist can observe aspects of their own self they had previously been unaware of

12. Group Approaches to the treatment of depression: Psychodrama Group CBT Combined with Psychodrama no better than Group CBT alone for treating depression. Aims: Hamamci (2006) compared the effects of psychodrama integrated with cognitive behavioral therapy and cognitive behavioral group therapy in the treatment of depression. Procedures: 31 university students with moderate depression participated in this study. After the participants were randomly assigned to experimental and control groups, group therapies were conducted for 11 sessions over a period lasting nearly 3 months. The control group received no treatment. The Beck Depression Inventory (BDI), the Automatic Thoughts Questionnaire (ATQ) and the Dysfunctional Attitude Scale (DAS) were administered to the participants at three different occasions: pre-treatment, post-treatment, and 6-month follow-up. Findings & Conclusions: The results indicated that both psychodrama integrated with cognitive behavioral therapy, and cognitive behavioral group therapy alone, led to reduction in the level of depression, negative automatic thoughts, and dysfunctional attitudes of participants. However, there were no significant differences between the two treatments in terms of their effectiveness.

13. An Evaluation of Group Therapy: • Cost: group therapy is cheaper than individual therapy (NHS, 2008) • The Diminishing Role of the Therapist: Group therapy diminishes the role of the therapist allowing the client to be less dependent on the therapist • Confidentiality: People must trust that they can speak freely in the group, otherwise this can raise ethical issues. • Promoting Social Skills: Group therapies help to promote social skills and allows clients to role play in a safe and supporting environment. • The Skill level of the Therapist – must be empathetic and highly skilled for a cohesive group.

14. An Evaluation of Group Therapy: • Group Therapy Dependence – in some cases group therapy can lead to the individual depending on the group, and feeling they cannot survive without the support of group meetings. • Overdependence on the therapist – group members may feel that they are not getting enough attention from the therapist, and become overly attached to the therapist. This is also an issue in individual therapies. But group dynamics can also play an important role in making this problematic. • A Biological Etiology? – Depression may have a biochemical etiology, in which case perhaps biomedical treatments would be the most direct way to help a client to get better.