PSYC 403 Lecture Notes - Lecture 14: Hamilton Rating Scale For Depression, Beck Depression Inventory, Behavioral Activation
13 May 2018
School
Department
Course
Professor
CBT- Depression Continued
• Behavioral activation: evidence
o Dimidjian et al. 2006
▪ Critical article
• Challenged the thinking about CBT being the best therapy for
depression
▪ 241 participants with major depression
• Large for an RCT
▪ Randomized to behavioral activation, cognitive therapy, antidepressant
medication, and placebo
▪ Note: CT therapists allowed to use some BA techniques but BA therapists
did not use CT techniques
▪ Outcomes: Beck depression inventory (self-report) and Hamilton
Depression Rating Scale (clinician-rated)
▪ Results:
• Higher attrition in ADM condition
o Common because medication has so many side-effects
• Low severity group: no differences between 3 active treatments
• High severity group: BA and ADM improved more over time than
CT
▪ On the Beck Depression Scale-> ADM and CT are similar, big difference
between ADM and BA, and between CT and BA
▪ On the Hamilton rating scale- Statistically significant difference between
the medication condition and the behavioral activation treatment
▪ Among severely depressed patients, BA is superior to CT and equivalent
to ADM
• Challenges notion that severely depressed patients require
medication
• Raises questions about necessity of targeting negative thinking to
achieve treatment response
o Updates:
▪ Ekers et al. 2014
• Meta-analysis of 26 RCTS
• BA superior to control conditions and ADM
▪ Richards et al. 2016
• BA delieed juio etal health okes as’t ifeio to
CBT delivered by psychological therapists
• This points to cost utility
• Can use junior mental health workers
• Behaioal atiatio is’t supe had to tai i people
CBT for Eating Disorders
• CBT- Enhanced (CBT-E)
find more resources at oneclass.com
find more resources at oneclass.com
o Developed later and wanted to distinguish from CBT
• Transdiagnostic approach:
o Many ED features present across diagnoses (e.g. weight/ shape concerns, binge
eating, purging)
o Most patients migrate across diagnoses over time
▪ Change in symptoms or weight-> change in diagnosis
o Over-evaluation of shape/ weight is central maintenance factor
• Precise form of applied treatment depends on presentation
o Additioal ehaed odules a e used to addess sptos eteal to
core ED
▪ Perfectionism, low self-esteem, major interpersonal problems
▪ Pefetiois is’t alas estited to the od-> sometimes across
other domains
▪ “oeties do’t hae lo self-esteem
o Level of intensity specific to weight status
▪ BMI > 17.5, 20 sessions over 20 weeks
▪ BMI < 17.5, 40 sessions over 40 weeks
• Starting well
o Engage the patient in treatment and change, increase motivation/ commitment
to treatment
▪ The’e saed to gai eight
o Collaboratively create a personalized formulation
o Psychoeducation about treatment and eating disorder
o Establish:
▪ Self-monitoring
▪ Weekly weighing
▪ Regular eating
• Transdiagostic formulation
o Philosophy: ED is a vicious cycle maintained by interaction among thoughts,
behaviors, and beliefs
o Goal is to understand what factors and symptoms are relevant to the patient
o Explain to patient how symptoms are a vicious cycle
▪ Overemphasis on body weight and shape
▪ If thee’s too uh ephasis o od fo self-esteem then ou’e likel
to try and change it
o For the specific person, what is most important in maintaining the disorder
• Self-monitoring
o Better understand processes maintaining the eating disorder
o Auate eod of patiet’s food itake
o Highlight key behaviors, feelings, thoughts, and the contexts in which they occur
▪ Specific examples to address in session
▪ Therapeutic work between sessions
▪ Increases patient self-awareness
o Encourage self-oitoig i eal tie
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Cbt- depression continued: behavioral activation: evidence, dimidjian et al. Depression rating scale (clinician-rated: results, higher attrition in adm condition, common because medication has so many side-effects, low severity group: no differences between 3 active treatments, high severity group: ba and adm improved more over time than. 2014: meta-analysis of 26 rcts, ba superior to control conditions and adm, richards et al. 2016: ba deli(cid:448)e(cid:396)ed (cid:271)(cid:455) ju(cid:374)io(cid:396) (cid:373)e(cid:374)tal health (cid:449)o(cid:396)ke(cid:396)s (cid:449)as(cid:374)"t i(cid:374)fe(cid:396)io(cid:396) to. Cbt delivered by psychological therapists: this points to cost utility, can use junior mental health workers, beha(cid:448)io(cid:396)al a(cid:272)ti(cid:448)atio(cid:374) is(cid:374)"t supe(cid:396) ha(cid:396)d to t(cid:396)ai(cid:374) i(cid:374) people. If weight is up or the same: diet harder. Initial emphasis on when, later examine what: urges to eat between, problem solve, use incompatible behaviors, surf the urge. Ineffective at preventing calorie absorption: throw away supplies or plan a schedule of withdrawal (consult with, over-evaluation of shape and weight physician, address the over-evaluation using 2 techniques, develop the over-evaluation using 2 techniques.
