Slides & Handouts by Karen Clay Rhines, Ph.D.
Seton Hall University
Chapter 9
Treatments for Mood Disorders
Comer, Fundamentals of
Abnormal Psychology, 3e
1
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
Comer, Fundamentals of
Abnormal Psychology, 3e
2
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
Comer, Fundamentals of
3
Abnormal Psychology, 3e
following
Treatments for Unipolar
Depression: Psychological
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
Comer, Fundamentals of
Abnormal Psychology, 3e
4
Treatments for Unipolar
Depression: Psychological
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
Comer, Fundamentals of
Abnormal Psychology, 3e
5
Treatments for Unipolar
Depression: Psychological
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
Comer, Fundamentals of
Abnormal Psychology, 3e
6
Treatments for Unipolar
Depression: Psychological
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
Comer, Fundamentals of
Abnormal Psychology, 3e
7
Treatments for Unipolar
Depression: Psychological
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
Comer, Fundamentals of
Abnormal Psychology, 3e
8
•
Treatments for Unipolar
Depression: Psychological
Approaches
Cognitive therapy
–
–
–
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.
2.
3.
4.
Increasing activities and elevate mood
Challenging automatic thoughts
Identifying negative thinking and biases
Changing primary attitudes
Comer, Fundamentals of
Abnormal Psychology, 3e
9
Treatments for Unipolar
Depression: Psychological
Approaches
• Cognitive therapy
– 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
Comer, Fundamentals of
Abnormal Psychology, 3e
10
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
Comer, Fundamentals of
Abnormal Psychology, 3e
11
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
Comer, Fundamentals of
Abnormal Psychology, 3e
12
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
Comer, Fundamentals of
Abnormal Psychology, 3e
13
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
Comer, Fundamentals of
Abnormal Psychology, 3e
14
Treatments for Unipolar
Depression: Biological Approaches
• Electroconvulsive therapy (ECT)
– 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
Comer, Fundamentals of
Abnormal Psychology, 3e
15
Treatments for Unipolar
Depression: Biological Approaches
• Electroconvulsive therapy (ECT)
– 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
Comer, Fundamentals of
Abnormal Psychology, 3e
16
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
Comer, Fundamentals of
Abnormal Psychology, 3e
17
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
Comer, Fundamentals of
Abnormal Psychology, 3e
19
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
Comer, Fundamentals of
Abnormal Psychology, 3e
20
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
Comer, Fundamentals of
Abnormal Psychology, 3e
21
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
Comer, Fundamentals of
Abnormal Psychology, 3e
22
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
Comer, Fundamentals of
Abnormal Psychology, 3e
23
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
Comer, Fundamentals of
Abnormal Psychology, 3e
24
How Do the Treatments for
Unipolar Depression Compare?
• Findings from a number of research
studies suggest that:
– behavioral therapy have shown less effective
than cognitive, interpersonal, or biological
therapy
Comer, Fundamentals of
Abnormal Psychology, 3e
25
How Do the Treatments for
Unipolar Depression Compare?
• Findings from a number of research
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
Comer, Fundamentals of
Abnormal Psychology, 3e
26
How Do the Treatments for
Unipolar Depression Compare?
• Findings from a number of research
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
Comer, Fundamentals of
Abnormal Psychology, 3e
27
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
Comer, Fundamentals of
Abnormal Psychology, 3e
28
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)
Comer, Fundamentals of
Abnormal Psychology, 3e
29
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
Comer, Fundamentals of
Abnormal Psychology, 3e
30
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
Comer, Fundamentals of
Abnormal Psychology, 3e
31
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 medicationbased) therapy
Comer, Fundamentals of
Abnormal Psychology, 3e
32
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
Comer, Fundamentals of
Abnormal Psychology, 3e
33