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36 - IB Psychology - Abnormal Psych - 5.C.2 & 5.C.3Psych. Treat. of Depres. & Culture

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0% found this document useful (0 votes)
91 views45 pages

36 - IB Psychology - Abnormal Psych - 5.C.2 & 5.C.3Psych. Treat. of Depres. & Culture

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gcclar27
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Abnormal Psychology

Psychological Treatment and Role of


Culture
Psychological Treatment and Role of
Culture
• What you will learn: • Inquiry Questions:
- Cognitive Behavioral Therapy (CBT) and - Is psychological treatment a better or
features of CBT as a form of therapy. more effective approach than medication?
- Effectiveness of cognitive behavioral - Can cognitive behavioral therapy reduce
therapy: response, remission, relapse and prevent relapse into depression?
and brain changes.
- Are there physiological changes in the
- Group and individual cognitive brain caused by CBT?
behavioral therapy.
- Can an individual’s culture influence how
- Cultural factors appear to influence
effectively they will respond to treatment
treatment methods.
methods?
- Internal model of illness and creating
culturally sensitive treatments. - How can CBT be applied to cultures that
are less accepting to treatment?
Cognitive
Behavioral
Therapy
• Cognitive behavioral therapy (CBT) is
another method of treatment which
can be utilized when treating mental
health conditions.
• Cognitive behavioral therapy seeks to
change unhealthy or unhelpful
cognitive distortions and behaviors.
CBT aims to improve emotional
stability and develop coping
mechanisms in an attempt to make
behavior more rational and adjust to
the environment.
Cognitive Behavioral Therapy
• Cognitive behavior therapy differs from other forms of therapy in a
few keyways:
• The goal is to change the thinking of individuals (cognitive reconstruction)
and in turn demonstrate new behaviors (behavioral activation).
• The therapy method highlights and centers on well-defined problems.
• Patient participation is important for the success of the therapy.
Cognitive Behavioral Therapy
• Cognitive behavior therapy utilizes many different techniques. Below are
some tools used:
• Socratic questioning – A series of questions the therapist posses to the patient or
client which eventually lead the individual to realizing their beliefs are not rational
nor supported by evidence.
• Example: A therapist might ask, “you claim everyone is suspicious of you. Identify
specific examples that happened yesterday that support your statement.”
Cognitive Behavioral Therapy
• Cognitive behavior therapy utilizes many
different techniques. Below are some
tools used:
• Behavioral experiments – A technique that
aims to counteract harmful behaviors.
Example: A therapist working with a client
who feels anxiety from speaking in class
will ask the client to try different behaviors.
Such as having the client sit in front of class
and ask a few questions. Another day the
client may sit in the back of class and
remain quit. Then the therapist and client
process the feelings and observations
between the two scenarios.
Cognitive Behavioral Therapy
• Cognitive behavior therapy utilizes many different techniques. Below are some
tools used:
• Thought records – This technique also aims to change dysfunctional and irrational
automatic thinking. The therapist and client identify a belief that needs to be addressed
and the client keeps systematic records of thoughts and situations relevant to the belief.
Example: A student (client) believes her teachers do not respect her. The therapist asks
her to keep a detailed record of interactions with her teachers. The client then looks
through the systematic evidence and realizes she has ignored contradictory evidence.
Cognitive Behavioral Therapy
• Cognitive behavior therapy utilizes many different techniques. Below are some
tools used:
• Situation Exposure Hierarchies – This technique requires the client to develop a list of
stressful situations or behaviors. The client then orders the behaviors in order from least
(such as playing a video game) stressful to most stressful (taking an exam). After the list
is finalized the client is encouraged to try out the least stressful situations until the tasks
become less stressful and client can move up the list.
Cognitive Behavioral Therapy
• Cognitive behavior therapy utilizes
many different techniques. Below are
some tools used:
• Pleasant Activity Scheduling – This
form of therapy has the client agree to
do something pleasant every day. This
pleasant task is often something the
client does not normally do but
something that brings positive
emotions, sense of competence or
mastery to the client. Example: reading
a book, going for short walk, playing an
instrument or cooking a meal.
• You don’t need to see a therapist to feel the
benefits of cognitive behavioral therapy
techniques. Reflect on your own behaviors and
thinking patterns then choose a behavior or
belief about yourself that causes you some
ATL Skills: concern.
• Next prepare a notebook and set a positive goal
Self- for yourself with a clear deadline. Use some of
the cognitive behavioral therapy techniques to
Management see if you can modify your own behavior to
reach your goal.
• Remember this is an amateur exercise and
there are no guarantee of results. Therapist
have extensive education and training to apply
the techniques professionally.
Response and
Remission of CBT
• Mental health professionals go Emotions
through years of training and advanced
education in order to correctly and
safely apply CBT therapy techniques.
• Most sessions last close to an hour and CBT
include numerous steps such as
checking patient’s mood, creating an
Behavior Thoughts
agenda, evaluating assignments and
discussion.
• CBT treatment can last multiple weeks
and requires clients to be personally
invested.
• Before moving on and learning about
Mini- response and remission rates in key
studies take some time and conduct some
exercise: Self research on YouTube concerning CBT.
• An introduction to Cognitive Behavioural

Guided
Therapy - Aaron Beck - YouTube

Research • Then explain your thoughts and opinions


of this approach to treatment. Do you
think CBT is an effective form of therapy?
Explain your answer with supporting
details.
Response and Remission of CBT
• The research into the effectiveness of CBT appears to show that CBT
can be as effective as medication. The DeRubeis et al (2005) study
randomly assigned 240 patients with moderate to server major
depressive disorder.
• The participants were placed into one of three conditions:
1.) Medication for 16 weeks
2.) Individual CBT treatment for 16 weeks
3.) Placebo for 8 weeks
Response and Remission of CBT
• The study used the Hamilton Depression Rating Scale (HDRS)
in order to measure the dependent variable.
• On the HDRS, a score of 0-7 is considered to be within
normal range (or remission) while a score of 20 or more is
considered entry into a clinical trial.
• In the study researchers used response criteria of a score of
12. Meaning if a participant scored a 12 or less, they were
considered as “responding” to the therapy.
Response and Remission of CBT
• The table below summarizes the results of the study:
8 Weeks 16 Weeks
Response rate Response Rate Remission Rate

Medication 50% 58% 46%

CBT 43% 58% 40%

Placebo 25% - -

• Researchers did find one site where medication was more effective,
but it was attributed to the skill of the therapist.
Response and Remission of CBT
• Conclusion: The researcher concluded that CBT can be as effective as
medication when treating severe depression. However, the degree of
effectiveness depends on the therapist and their experience, as seen
in the results.
Response and Remission of CBT
• Some mental health clinicians speculated that the success of CBT
could be explained by the symptoms being targeted. Meaning that
CBT is more effective at treating some symptoms while medication is
better at targeting other symptoms.
• Therefore, the Fournier et al
(2013) study investigated the
effectiveness of medication
and cognitive therapy on
specific depressive symptoms
instead of depression as a
whole.
Response and Remission of CBT
• The study comprised of 231 depressed outpatient participants who
were randomly assigned to cognitive therapy, medication or placebo
groups.
• The study looked at several depressive symptoms as dependent
variables, specifically mood, cognitive/suicide, anxiety and vegetative
symptoms.
Response and Remission of CBT
• The results showed that medication was the most effective
in reducing cognitive/suicide symptoms at the four-week
mark compared to CBT and placebo.
• However, by week eight CBT was performing nearly as well as
medication in reducing symptoms.
• CBT was found to be the most effective at reducing
vegetative symptoms (insomnia).
• Conclusion: Researchers were able to conclude that
medication and CBT targeted slightly different symptoms
Duration of CBT
Treatment
• Another indicator of the effectiveness
of CBT treatment would be in the
length of time CBT treatment is
effective.
• Research has shown that CBT is
effective in the short term, but what
about long term?
• The Hollon et al (2005) study
investigated this idea and found that
antidepressants prevent the return of
symptoms only when coupled with
treatment.
Duration of CBT Treatment
• The study aimed to understand if cognitive therapy has a long last
effect. Researchers conducted a randomized control trial with three
groups in which moderate-to-severe depressed patients were
assigned. The three groups were:
• 1.) Patients that responded positively and were withdrawn from cognitive
therapy for 12 months.
• 2.) Patients that responded to and continued to take medication.
• 3.) Patients that responded to medication and continued to take placebo.
Duration of CBT Treatment
• The results showed patients who were withdrawn from cognitive
treatment were less likely to relapse into depression at a rate of 31%.
While patients who were withdrawn from medication were more
likely to relapse into depression at a rate of 76%. However, patients
that continued medication relapsed back into depression at a rate of
47%.
• Conclusion: Two implications from this study note that CBT has a
long-lasting effect, and the benefits can extend past ending of
treatment. Secondly, medication appears to be good at reducing
symptoms but are unable to target the cause of the disorder.
Changes in the Brain
Caused by CBT
• Goldapple et al (2004) investigated
brain changes using PET scans of
individuals who received CBT treatment
compared to antidepressant
treatments.
• The study had 17 individuals who were
unmedicated and depressed with a with
an average HAM-D score of 20. These
individuals were scanned before and
after the course of their CBT treatment.
• After treatment, the participants
average HAM-D score was 6.7.
Changes in the Brain Caused by CBT
• The group of 17 were compared to a second group of 13 patients who
were treated and responded to antidepressant treatment. This
antidepressant group had similar HAM-D scores at the beginning of
therapy and similar reduction of score at end of therapy.
Changes in the Brain Caused by CBT
• Results: researchers found that CBT caused significant metabolic
changes in the brain. Additionally, the brain patterns were distinctly
different for CBT treatment patients compared to antidepressant
treatment patients.
• Moreover, patients who received CBT treatment saw most changes in
the cortex region of the brain and antidepressant treatment patients
saw changes in the limbic and subcortical regions.
Individual vs Group
CBT
• Cognitive behavioral therapy does not always
have to be a one-on-one session between two
people but can take place in a group settings.
• Some advantages to group setting therapy
include:
• Lower cost
• Direct observation of client’s behavior in a group.
• Witnessing improvement in other could be
motivating.
• Opportunity to practice new behaviors with other
people.
• Some of the disadvantages to group setting
therapy include:
• Client may feel uncomfortable speaking in a group.
• Group therapy could be harmful in that group
members give harsh feedback to clients.
Individual vs Group CBT
• Some studies have supported the idea that group therapy is as
effective as individual therapy. The Toseland and Siporin (1986) study
reviewed clinical and research literature.
• They found that group treatment was more effective in about 25% of
the cases and equally effective 75% o the time.
• However, critics pointed out that
the studies used investigated
either individual or group
treatment but not both. This can
lead to confounding variables
since patients were not
randomly allocated to one of the
two conditions.
Individual vs Group CBT
• The McRoberts, Burlingame and Hoag (1998) study attempted to
look into this criticism. They analyzed 23 primary studies which
compared individual and group therapy within one study.
• Results: They found that the average effectiveness of individual and
group therapy was close to zero indicating no real advantage for
either of the treatment methods.
• However, when the treatments methods were compared for specific
diagnosis, differences were found. Specifically, in that individual
therapy did tend to favor treating individuals with depression
disorders.
Cultural Factors
Influence on Treatment
• As seen in the sociocultural chapter and
earlier in this chapter, behaviors that are
acceptable in one culture may be viewed
or considered unusual in others.
• Not surprisingly symptoms of mental
disorders can be expressed, perceived or
even presented differently from culture to
culture.
• Therefore, the question arises of whether
an individual's culture can influence how
they respond to treatment.
Cultural Factors Influence on Treatment
• In the Kinzie et al (1987) study, researchers studied 41 Southeast
Asian patients who had undergone long-term treated with tricyclic
antidepressants (TCA) for depression. The patients all underwent
treatment in US clinics.
• The patient's blood was then
drawn and tested for levels of
tricyclic antidepressants. It was
found that 61% of the patients
did not have detectable levels
of antidepressants in their
bloodstream. Only 15% (six
patients) had therapeutic levels
of mediation in their blood
stream.
Cultural Factors Influence on Treatment
• What was the explanation for the results?
It turned out that there was a high
incidence of non-compliance with the
treatment. Meaning the patients were not
taking the medication prescribed to them.
• Results: Researcher found that patients
were not conscientious enough to follow
the regimented medication prescribed to
them.
• Interestingly, intergroup differences did
occur, such as Cambodians were more
compliant than Vietnamese patients.
Cultural Factors Influence on Treatment
• Conclusion: researchers speculated that the results could be
explained by patient's reluctance to take medication, particularly if
the side-effects could be noticeable and patients may suffer from
social stigma.
• However, once clinicians explained the benefits of taking
antidepressants regularly, compliance increased in all ethnic groups.
TED Talk: Treatment of Mental Health
• Watch Sebastian Junger’s TED Talk “Our lonely society makes it hard to
come home from war”: https://www.youtube.com/watch?
v=o9DNWK6WfQw
Internal Model of
Illness
• As seen from previous research a
person’s perception about
treatment are influenced by the
individual’s beliefs about the
disorder, the internal
representation of the illness.
• This is referred to as the patient’s
internal model of illness. In
essence it is the culturally
determined schematic
representation of a mental disorder.
Internal Model of Illness
• In the Naeem et al (2012) study
researchers aimed to create a
culturally sensitive CBT program and
then determine its effectiveness in
the developing world, in this case
Pakistan.
• The study utilized extensive
interviews with depressed patients.
Questions about the patient's
thoughts of the illness, causes,
treatments and opinions of
psychotherapy were asked.
Internal Model of Illness
• Researchers chose to conduct a qualitative research method because
very little information was known about the studied population and
qualitative research is a good method for obtaining new information.
• Moreover, the research focused on subjective interpretations and
meaning in a social context and qualitative methods are not suited for
this focus.
Internal Model of Illness
• All patients attended a psychiatric outpatient clinic in Pakistan and all
interviews were conducted in Urdu language and video taped. Nine
patients participated in the interviews.
• After the data was transcribed and analyzed, researchers identified
four main themes:
• 1.) Patient’s perception of depression. Patients were more likely to described
their symptoms as physical ailments. Descriptions of headaches were the
most common complain. Sadness was mentioned but not emphasized. When
prompted by researcher to describe what illness they had, patients did not
give any specific labels but used expressions such as “weakness of brain”,
“physical illness”, “illness of poor sleep” and “tension”
• Moreover, when asked if they knew what depression was, none recognized
depression. Yet, when given a forced choice most patients recognized their
illness was mental.
Internal Model of Illness
• After the data was transcribed and analyzed, researchers identified
four main themes:
• 2.) Patient’s model of causes of depression. When asked about the causes of
mental illnesses patients generally attributed the illness to “tension and
trauma”, “problems in the environment”, “thinking too much” and “worries”.
No names of a specific illness were ever mentioned. Interestingly, all but one
patient had never heard of depression.
Internal Model of Illness
• After the data was transcribed and analyzed, researchers identified
four main themes:
• 3.) Models of referral for help. Most patients were referred to the clinics by a
relative only a few patients referred themselves.
• 4.) Patient’s knowledge and experience concerning treatment of depression.
Most patients believed that good quality medication would be able to cure
them. When prompted about non-medical healers (religion or magic) only
one individual admitted to it and other patients became guarded when
talking about non-medical treatments.
Creating Culturally
Sensitive Treatments
• When clinicians are developing
treatments regiments that are sensitive
to different cultural communities'
numerous factors must be considered.
• Adapting treatments to a different
cultural context can be done
superficially, such as changing the
language or hiring bicultural staff. Or it
can be changed on a deeper level, such
as changing treatment focus or
relationship between patient and
clinician.
Creating Culturally Sensitive Treatments
• When clinicians make superficial changes to a treatment it is know as top-down
adaptations. This form of change keeps the existing treatment as the focal point
and make minor changes keeping the approach and structure the same. This
include things such as language, customs, art, architecture and dress.
Creating Culturally Sensitive Treatments
• However, changes that are relatively deep are known as bottom-up
adaptations because this approach takes into culture as the starting
points. In depth interviews and focus groups are often used to
generate a theory about a culture then the treatment is built based
on this treatment. The Naeem et al (2012) is an example.
Creating Culturally Sensitive Treatments
• The Ecological Validity Framework has been used when designing
culturally sensitive treatments. This method outlines eight areas to be
adapted:
1.) language – translation/jargon
2.) persons – ethnic similarities
3.) metaphors – cultural expressions
4.) content – cultural knowledge
5.) concepts – belief about treatment
6.) goals – using cultural beliefs to set treatment
goals
7.) method – culturally appropriate methods
8.) context – accounting for acculturation/social
support
• In pairs, pick any country in which treatment
of mental illnesses is not common. Then
choose a mental disorder.
• Conduct extensive research and outline
Project specific aspects of your chosen culture and
mental disorder. You can highlight areas such
Based as culture values, rank in the Hoefstede’s
Learning: dimensions, primary symptoms of disorder
and effective treatments for disorder.
Treatment • Next, choose one treatment you would use for
the disorder and explain why this will be
and Culture effective. Explain your reasoning.
• Finally, use the Ecological Validity Framework
to outline how you will adapt your study to
best suite the culture you have chosen.
• Be ready to defend your project!

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