Psychological management of major depression

1. Psychological management of major depression

2. Managing Depression • Two (of many) management methods to consider for major depression are: • Cognitive Behavioural Therapy (CBT) • Psychodynamic Psychotherapy

3. Cognitive Behavioural Therapy (CBT) • Looks at identifying and changing the thought processes & behaviour responsible for maintaining symptoms of major depression. • People with depression generally think in a biased way with many negative automatic thoughts • Negative automatic thoughts immediately go through a person’s mind when a situation triggers a negative emotional response. EG ‘I’ve failed that exam’

4. These thoughts can lower a person’s mood, and this increase the chance of more negative thoughts. • Specific behaviour can result from such thoughts EG going home and not celebrating the end of exams

5. Negative Automatic thoughts… • Automatic – ‘pop’ into mind, without conscious thought • Involuntary – not chosen, difficult to avoid • Distorted – not always accurate • Unhelpful – keep the person in a depressed mood • Plausible – not challenged, accepted as facts • There is a link between the number of negative automatic thoughts and the severity of the depression symptoms

6. Cognitive Biases • These can influence the day-to-day functioning of a person with general depression • A cognitive biases (or distortions) are a predisposition to think in a certain way: • Over-generalisation • Selective abstraction/perception • Dichotomous thinking – all or nothing thinking • Personalisation • Arbitrary interference

7. Aaron Beck - cognitive biases of people with major depression become apparent in a cognitive triad • 3 ways of perceiving and feeling that influence each other • self • world & environment • the future

8. How does the CBT work? • Identifying negative automatic thoughts - Keeping a ‘thought diary’ – what they think and how it makes them feel • Evaluating how realistic the thought is - Looking for factual evidence for their beliefs • Replacing these negative thoughts with more realistic, balanced thoughts.

9. Activity -

10. Behavioural techniques • Used to maximise mood-elevating activities and minimise behavioural inactivation symptoms – lethargy, lack of motivation, anhedonia. • Activity scheduling – designed to increase the activity levels and experiences of pleasure for a person with major depression • Reintroducing client to pleasurable activities

11. CBT • Can be as effective as drugs for treating depression, plus, new thinking patterns learnt decrease the likelihood of people becoming depressed again.

12. Psychodynamic Psychotherapy • Psychodynamic explanations for depression - Freud – • Similarities between depression and the response to the death of a loved one. EG loss of appetite, disturbed sleep etc.. • Caused by a unconscious grief over real of imagined ‘losses’. Self-hatred is turned inwards – result is depression.

13. Psychodynamic psychotherapy • Based on the assumption that mental disorders are caused by unresolved psychological conflicts that occur in the unconscious part of the mind • Early traumas in childhood (separation from an adult –divorce, death –therefore feeling unlovable) can make people more susceptible to depression as an adult. • Aims to help people by bringing underlying issues to consciousness and work through them. • Use a range of techniques to manage major depression

14. Psychotherapies include - • Free association – client encouraged to say what ever comes to mind. Psychotherapist will look for themes in words produced by patient • Dream interpretation – dreams symbolically represent information stored in the unconscious mind – common themes for depression: loss, defeat & deprivation • Defence mechanisms – identification of EG, denial, displacement & repression - which can worsen depressive symptoms if used long term. • Looking for transference– the shifting of unresolved conflicts or fantasies to therapist. The therapist can use this position to help the client regain ‘normal’ feelings.