priscilla notes pt 2

learned helplessness (seligman)

think do not have control over rewards/punishments

helplessness theory (abramson)

not just behavioral; attribute reasons for negative evnts to be (depressed ppl view bad events as):

-internal (it is my fault)

-stable (i can never do better)

-global (i do this with everything)

hopelessness theory

belief that things will never get better

-most proximal predictor of depression and suicidality

depression etiology family factors

-parent-child attachment

-maternal depression

-family conflict (high expressed emotion)

behavioral and cognitive theories of depression

-learned helplessness (seligman)

-helplessness theory (abramson)

-hopelessness theory

parent-child attachment

internal working model= schemas about interpersonal relationships

-work → if I reach out for help, ppl will help me

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insecure attachment → more mood problems

-because when under stress, do not seek social support

-low self worth, self-confidence, contingent self-esteem

-less likely to seek out social support and isolate selves

Depression etiology peer factors

-acceptance vs rejection

-conflictual friendships

-stressful romantic relationships

Acceptance vs rejection

-physical and relational victimization → depression

-especially if have a depressogenic attributional style and place importance on peer relationships

Depression etiology social information processing

• 2 types of attributional biases among depressed children

Peer rejection and victimization → depression → attributional biases → social withdrawal → peer rejection and victimization

2 types of attributional biases in depressed children

-hostile intent attributions: he deliberately picks on me just to be mean

-internal and stable casual attributions (change attribution so that they can seek peer interactions): it’s my fault that he picks on me, I’m not very likable

Why gender difference?

-Keenan and hipwell model: excessive empathy, excessive compliance, problems w emotion regulation

-Hyde, mezelius, and abramson ABC model: biological vulnerability (those who develop late/early increases risk), affective vulnerability, cognitive vulnerability, negative life events

Depression treatment medication

• ssri’s

• Tricyclic antidepressants

Ssri’s

• target serotonin

• Slow rotate of serotonin, leads to increased time in synaptic cleft

• Prozac (fluoxetine) beats placebo, but small effect: 60% improved with SSRI and 49% improve with placebo

• Others have only limited evidence (Zoloft, Celexa) or no evidence (Paxil, Lexapro, Effexor)

• Safety concerns (FDA black box warning about suicide

• -medications work bottom-up; if still have a lot of (-) cognitions and a lot of energy, now you have energy to act on (-) cognitions

Tricyclic antidepressants (Tofanil, Elavil)

-target serotonin and norepinephrine selectively in adults

-Generally not used in adolescents

• 2 meta analysis suggests do not beat placebo, probably because of lack of brain matu.rity

• significant side effects: cardiac arrhythmia (14% of those who take it), increased suicidal behavior

depression treatment cognitive behavioral therapy

-several packages (group/individual; children/adolescents):

• CBT for children

• coping with depression for adolescents

• TADS manual

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-2 shared components:

behavioral:

• increase response-contigent reinforcement from social environment

• behavioral activation- schedule pleasurable activities

• increase social and communication skills

• reward self for accomplishments/attempts

cognitive:

• cognitive restructuring- challenge and change cognitive biases

• teach problem-solving skills- identify problem, generate solutions, evaluate solutions, select and implement, evaluate outcomes

• teach communication, conflict resolution skills

depression treatment therapy vs. meds

-treatment fpr adolescents with depression study (TADS, 2004, 2007)

-at 12 weeks:

• combo> meds> CBT = placebo

-at 24 weeks:

• combo > meds

• CBT = meds

-at 36 weeks:

• all converge

-upshot: combo, meds (works bottom up, targets neurotransmitter) faster than CBT alone (works top down, targets behavioral and cognitive patterns, more long-term progress)

-combo is protective against suicidal events

depression treatment IPT-A

-theory: depression results from interpersonal (IP) problems

-goal: increase IP functioning, should lead to elevated mood

-4 problem areas:

• grief/loss (not loss of relationship; death)

• IP role disputes (i shouldnt have to cave for my siblings; i should be able to stay out late)

• role transition (going to college, switching schools, getting worried, losing relationship)

• IP deficits (less robust social skills)

-well supported in adukts, beats placebo therapy

-more involvement of parents

Non-suicidal self-injury (NSSI)

definition: deliberate harm or destruction to one’s own body tissue in the absence of intent to die (not failed suicide attempt)

-eg: cutting (70-90%), burning (15-35%), hitting/banging(20-40%), multiple types common but ppl usually stick to one method (once habitual)

prevalence:

• girls tend to do more cutting and scratching

• boys do more hitting andbanging

• 1-6% of adults

• 13-29% of adolescents

-dabblers: harming doesnt really stick for them, it doesnt really help out

NSSI Four function model (?)

-generates desired feelings or stimulation

NSSI-specific vulnerability factors

• social learning hypothesis: learn from others- friends, family, media

• self-punishment hypothesis: self directed abuse learned from repeated abuse, criticism for others

• social signaling hypothesis: escalate to intense communication strategy when environment is not responsive or invalidating

• pragmatic hypothesis: fast and easily accessible (vs drugs, alcohol, etc)

• pain/analgesic/opiate hypothesis: little or no pain during NSSI, perhaps resulting from release of endorphins or endogenous opiates

• implicit identfication hypothesis: identify with being a self-injurer (identify with group and a primary coping strategy)

NSSI treatment

-dialecticl behavior therapy (miller et al)

• decrease black and white thinking by looking for the middle path

• increase emotion regulation skills: mindfulness, distress tolerance

-interpersonal effectiveness training (social skills):

• reduce impulsivity

• increase positive and appropriately assertive communication skills

-empiracally support, bt few studies (McCauley et al 2018 and Mehlum et al 2014, 2016)

NSSI Treatment: CBT

social problem solving training

-components:

• recognize cues there is a social problem

• define the problem

• generate solutions

• decide which to implement

• implement, evaluate solution

-mixed results

better resulsts for comprehensive CBT, but need more research

NSSI Integrated theoretical model (?)