In-depth Notes on Depression and Anxiety Disorders

SESSION PLAN

  • Defining depression and anxiety disorders

  • Cognitive-behavioural models:

    • Psychological disorders in general

    • Depression and anxiety disorders

  • Cognitive-behavioural assessment, formulation, and treatment:

    • Psychological disorders in general

    • Specific approaches for depression and anxiety disorders

MOOD DISORDERS

  • Mood Disorders: Group of diagnoses where a disturbance in mood is the main underlying feature.

  • Two groups based on presence of manic or hypomanic episodes:

    • Depressive disorders

    • Bipolar disorders

MAJOR DEPRESSIVE DISORDER

DSM 5 Diagnostic Criteria (APA, 2013)

  • Five or more symptoms have been present during the same two-week period and represent a change from previous functioning.

  • At least one symptom is:

    • Depressed mood

    • Loss of interest or pleasure

  • Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Symptoms of Depressive Disorders

  • Depressed mood most of the day nearly every day (e.g., feeling sad, empty, hopeless).

  • Diminished interest or pleasure in most activities nearly every day.

  • Significant weight loss (not dieting) or weight gain.

  • Insomnia or hypersomnia nearly every day.

  • Psychomotor agitation or retardation nearly every day.

  • Fatigue or loss of energy nearly every day.

  • Feelings of worthlessness or excessive guilt.

  • Diminished ability to think or concentrate nearly every day.

  • Recurrent thoughts of death, suicidal ideation, or a suicide attempt.

BIPOLAR AND RELATED DISORDERS

Types of Bipolar Disorder

  • Bipolar I Disorder

  • Bipolar II Disorder

  • Cyclothymic Disorder

  • Substance/Medication-Induced Bipolar

  • Bipolar Disorder Due to Another Medical Condition

Symptoms of Bipolar Disorder

Depressive Periods (The Lows)

  • Sadness

  • Loss of energy

  • Feelings of hopelessness

  • Loss of enjoyment

  • Difficulty concentrating

  • Changes in sleep

  • Thoughts of death or suicide

Manic Episodes (The Highs)

  • Excessive happiness, hopefulness, excitement

  • Sudden mood shifts: joyful to irritable

  • Restlessness, rapid speech, increased energy

  • Poor judgment and impulsivity

ANXIETY DISORDERS

Understanding Anxiety

  • Anxiety is a normal response to stress and can manifest as fear or unease.

  • It is a vital reaction to perceived threats, leading to freeze, fight, or flight responses.

Anxiety vs. Fear

  • Anxiety: Anticipation of future threat

  • Fear: Emotional response to real or perceived imminent threat

Core Components of Anxiety Disorders

  • Excessive fear and anxiety leading to significant distress/interference in functioning.

  • Four components:

    1. Physical: Activation of the sympathetic nervous system

    2. Cognitive: Unrealistic thoughts about danger

    3. Emotional: Terror and panic

    4. Behavioral: Avoidance

DSM 5 Most Frequently Occurring Anxiety Disorders

  • Specific Phobia

  • Social Anxiety Disorder

  • Panic Disorder

  • Agoraphobia

  • Generalized Anxiety Disorder

  • Separation Anxiety Disorder

PANIC DISORDER

Panic Attacks

  • Abrupt surge of intense fear or discomfort with symptoms such as:

    • Palpitations, sweating, trembling, shortness of breath.

    • Fear of losing control, fear of dying.

Agoraphobia

  • Anxiety about being in situations where escape might be difficult or help unavailable in panic-like symptoms.

COGNITIVE BEHAVIOURAL MODELS

Behavioral Approach

  • Focus on learned behaviors from life experiences.

  • Core principles include:

    • Classical conditioning: Learning associations between stimuli

    • Operant conditioning: Behaviors reinforced by rewards or punishments

Cognitive Approach

  • Psychological problems stem from irrational beliefs and dysfunctional ways of thinking.

  • Emotions and behavior influenced by cognition.

Cognitive Behavioral Therapy (CBT) Principles

  • Behavioural Principle: Behavior influences psychological states.

  • Here and Now Principle: Focus on current issues.

  • Empirical Principle: Evaluate therapy effectiveness.

CBT INTERVENTIONS

Steps over the Course of Treatment

  1. Assessment

  2. Formulation

  3. Discuss alternative explanations

  4. Set goals

  5. Specific treatment strategies (e.g., cognitive restructuring)

  6. Generalization

  7. Relapse prevention

  8. Follow-up

Behavioral Techniques

  • Behavioral Activation: Focus on reducing avoidance and increasing engagement in meaningful activities.

  • Graded Exposure: Exposure to feared stimuli in a controlled manner to reduce fear responses over time.

THOUGHT RECORDS AND BEHAVIORAL EXPERIMENTS

Thought Records

  • Framework for clients to identify thoughts and feelings.

  • Key stages include identifying events, connecting feelings, evaluating “hot thoughts.”

Purpose of Behavioral Experiments

  • Test the validity of cognitive beliefs and develop new adaptive beliefs.

  • Enable clients to confront their fears and practice new behaviors.

SPECIFIC CBT APPROACHES FOR DEPRESSION

Focus Areas

  • Address social withdrawal and avoidance behaviors.

  • Identify activities aligned with personal values and goals.

CBT FOR ANXIETY DISORDERS

Key Approaches

  • Addressing threat interpretations.

  • Reducing safety behaviors and avoidance.

  • Cognitive restructuring to challenge unhelpful beliefs.

SUGGESTED READING

  • Carr, A. & McNulty, M. (Eds.) (2016). The Handbook of Adult Clinical Psychology

  • Cromby, J., Harper, D. & Reavey, P. (2013). Psychology, Mental Health and Distress

  • Davey, G. (2014). Psychopathology: Research, Assessment and Treatment in Clinical Psychology

  • Kennerley, H., Kirk, J. & Westbrook, D. (2016). An Introduction to Cognitive Behaviour Therapy: Skills and Applications