ABNORMAL PSYCH ERQ

Major depressive disorder

Major depressive disorder (MDD) is a mental condition characterized by a persistently depressed mood and long-term loss of pleasure or interest in life, often with other symptoms such as disturbed sleep, feelings of guilt or inadequacy, and suicidal thoughts. 

Biological treatments

• Assumes that the cause of the disorder is biological.

• One type of biological treatments is the use of antidepressants, which are drugs that modify the level of neurotransmitters that are associated with depressive symptoms.

• For example tricyclic antidepressants and selective serotonin reuptake inhibitors.

• These drugs inhibit the reuptake of neurotransmitters, including serotonin, as well as norepinephrine in tricyclic antidepressants, in the synaptic gap, thus increasing the amount of serotonin available in the synapse.

• This increased availability allows serotonin to interact with receptors and influence mood and other mental functions

Psychological treatment

• Cognitive Behavioral Therapy (CBT) is an evidence-based psychological treatment commonly used for managing MDD.

• It is grounded in Aaron Beck’s cognitive theory of depression, which proposes that depression arises from dysfunctional and negative patterns of thinking, often referred to as cognitive distortions.

• According to Beck, individuals with depression tend to develop a negative cognitive triad, which consists of pessimistic and irrational views about the self, the world, and the future.

• These automatic negative thoughts influence emotions and behaviors, often leading to a cycle of withdrawal, inactivity, and further negative thinking.

• CBT aims to identify, challenge, and modify these distorted thought patterns and the maladaptive behaviors that accompany them, helping individuals develop more realistic and balanced ways of thinking.

• By doing so, CBT empowers individuals to manage their symptoms more effectively and reduce the risk of relapse.

AIM: Elkin et al (1989)

The aim of this study was to investigate whether there were significant differences in the effects of the 3 major treatments for major depressive disorder (MDD).

SAMPLE: Elkin et al (1989)

 A total of 250 patients with MDD and no other mental conditions.

PROCEDURE: Elkin et al (1989)

• Participants were randomly assigned to one of four treatment conditions for four months: interpersonal psychotherapy, cognitive behavioral therapy (CBT), the drug imipramine, or a placebo pill.

• They were assessed before, 4 weeks into, and a year and a half after the study.

• The investigation was additionally a double blind study, meaning that neither the participants nor the researchers knew the condition allocations

FINDINGS: Elkin et al (1989)

• It was found that there were no significant differences in the reduction of depression or improvement of functioning between CBT, IPT, and imipramine

• Around 50% of patients recovered from each treatment group, however, were for the most part superior to the placebo group

• Only around 29% of patients recovered in the placebo group

• Imipramine was the fastest treatment to reduce depressive symptoms

• By the end of the 16 weeks of therapy, the two psychotherapies had caught up with the drug.

• Less-severely-depressed placebo patients were doing as well as any of the treatment groups by the end of the end

• Severely depressed patients in the placebo condition did not show much improvement. 

  
  

STRENGTHS: Elkin et al (1989)

• One key strength of the Elkin et al. (1989) study is its use of data triangulation, incorporating both pharmacological and psychological treatment conditions, which enhances the reliability and validity of the findings.

• The double-blind design minimized bias from both participants and researchers

• The large sample size (n=250) increased the statistical power and generalizability of the results to individuals with MDD.

• Furthermore, because biological treatments like imipramine were used, demand characteristics were minimized, as participants could not easily manipulate or control their responses to medication.

LIMITATION: Elkin et al (1989)

• The findings may lack generalizability, as the study excluded participants with multiple conditions (common in real-world depression cases)

• MDD symptoms can vary significantly across individuals, making it difficult to apply conclusions universally.

AIM: Riggs et al (2007)

The aim of this study was to investigate whether CBT works well with SSRIs or placebos for treating teenage depression.

SAMPLE: Riggs et al

• The sample incorporated 126 adolescents ages 13-19 who were all suffering from depression

• were mainly samples from social service and juvenile justice systems.

PROCEDURE: Riggs et al (2007)

• Participants were separated into two conditions either CBT with SSRI or CBT with a placebo pill.

• The treatment lasted four months.

• The investigation was additionally a double blind study, meaning that neither the participants nor the researchers knew the condition allocations

FINDINGS: Riggs et al (2007)

• It was found that 67% of participants and the placebo pill group were assessed to have ‘very much improved’, or ‘much improved.

• Meaning that CBT and placebo pills were assessed to be as effective as CBT with SSRI.

• Participants self-reported that the depressive symptoms and behavioral problems had decreased.

• Suggesting that CBT is a better option for treatment, and drug therapies should only be added if ineffective. 

STRENGTHS: Riggs et al (2007)

• A strength of the Riggs et al. (2007) study is firstly that it’s double-blind design, which helped minimize researcher and participant bias, increasing the internal validity of the findings.

• The inclusion of both a placebo group and SSRI group alongside CBT allowed for a clearer comparison of the effects of combining pharmacological and psychological treatments.

LIMITATIONS: Riggs et al (2007)

• The sample is composed mainly of adolescents from social services or juvenile justice systems, which reduces the applicability of the findings to the broader population.

• The use of self-report measures introduces the risk of response bias, as participants may underreport or overreport symptoms, consciously or unconsciously.

• There is also the potential for demand characteristics, since participants were aware they were being observed by researchers, therapists, and physicians, which could have influenced their behavior and responses during treatment.

CONTRAST: Thinks to consider

• Which one is the most effective

• Which has greater scientific credibility

• Which can be adapted to be more culturally responsive

• Which one is most cost effective

• Which one is more ethical

• Which one can be tailored to suit individual differences 

• Which one is better for treating severe depression 

• Which one encourages the person to be more self-reliant.

CULTURE: Define

Culture is defined as the common rules that regulate the interactions as well as behaviors of individuals within a group, in addition to the shared values and attitudes in the group, that which generate a sense of safety and belonging Culture plays an important role in the treatment of mental disorders.

CULTURE: cultural barriers to mental health

• Cultural barriers to mental health care can be grouped into cognitive, sociocultural, and affective categories.

• Cognitive barriers involve differences in beliefs about the causes and nature of mental illness.

• Sociocultural barriers include stigma, social norms, and expectations that influence how individuals seek help.

• Affective barriers relate to emotional responses such as fear, shame, or mistrust.

• These barriers vary widely across cultures, shaped by distinct interpretations of mental disorders and attitudes toward treatment.

AIM: Kinzie et al (1987)

Researchers wanted to investigate cultural barriers to treatment for depression.

SAMPLE: Kinzie et al (1987)

41 South-east Asian patients with depression who had been prescribed tricyclic antidepressants in U.S. clinics.

PROCEDURE: Kinzie et al (1987)

Carried out blood tests participants, which were intended to measure compliance with prescribed treatment.

FINDINGS: Kinzie et al (1987)

• The results demonstrated no sign of medication usage was detected in the blood of 61% of the patients.

• Only 15% of patients had therapeutic levels of antidepressants in their blood, indicating they were taking the medication often enough for it to be helpful.

• Then, after a discussion session was held with patients, in which the benefits and side effects of medication were explained, compliance rates increased.

  
  

STRENGTHS: Kinzie et al

• Kinzie et al.’s study offers valuable insights into cultural barriers in mental health treatment.

• A major strength is the use of blood tests to objectively measure compliance, avoiding the bias of self-reported data, and the improvement in compliance after a culturally sensitive discussion highlights how education and communication can enhance treatment outcomes

LIMITATIONS: Kinzie et al (1987)

• However, the study is limited by a small sample size (41 participants), which reduces generalizability.

• The lack of a control group makes it hard to confirm that the discussion alone caused the change, and this is  a methodological limitation within the anti-depressant used.

• It could be that this antidepressant is not very effective in general, which would undermine the aim and results of the study, meaning there could be a flaw in the medication or an unexplained cultural resistance to medication.

SAMPLE: Zhang et al (2002)

143 Chinese patients with Generalized Anxiety Disorder (GAD)

PROCEDURE: Zhang et al (2002)

• Participants were randomly assigned to one of three treatment groups: CTCP only, benzodiazepines (anti-anxiety drugs) only, or a combination of the two.

• Patients were evaluated before the study, after one month and then again after six months of treatment.

FINDINGS: Zhang et al (2002)

• They found that benzodiazepines produced better results after one month.

• However, after six months those patients in the CTCP group had a greater reduction of symptoms.

• Those in the combined treatment group had the greatest symptom reduction with a low chance of relapse.

• They found that CTCP helped patients to reduce perfectionism and improve their coping skills. Although the treatment was slower, the treatment appears to be more successful than drug treatment.

  
  

STRENGTHS: Zhang et al (2002)

• A key strength of the study is its randomized design and long-term follow-up, which improve reliability and validity.

• It also highlights how culturally adapted therapy can build coping skills and reduce underlying issues like perfectionism

LIMITATIONS: Zhang et al (2002)

• potential researcher bias in culturally specific treatment

• lack of generalizability to non-Chinese populations.