- Beck gives his patients activity assignments to provide them with successful experiences and
allow them to think well of themselves. But the overall emphasis is on cognitive restructuring,
on persuading the person to think differently. Behavioural change by itself is not expected to
Mindfulness-Based Cognitive Therapy:
- MBCT: been developed specifically to prevent relapse among clinically depressed people.
- combines relaxation and related techniques designed to increase awareness of changes in the
body and the mind with standard cognitive intervention techniques.
- The key component is developing meta-cognitive awareness (i.e a sense of how cognitive sets
are related to emotional feelings and vice versa.)
- MBCT reduces the overgenerality of autobiographic memory.
- The NIMH Treatment of Depression Collaborative Research Program: a large three site study of
Beck’s CT, comparing it with IPT and pharmacotherapy, called the Treatment of Depression
Collaborative Research program.
- The pharmacological therapy imiparmine (tofranil) a well tested tricyclic drug widely regarded at
the time as a standard therapy for depression, was used as a reference treatment against which
to evaluate the two psychotherapies, the second and third treatments.
- Some of the complex findings are summarised here: (** GO TO PAGE 305, read dotted points**)
Social Skills Training:
- Evidence supports the effectiveness of a focus on enhancing overt social behaviour by such
techniques as assertion and social skills training.
Psychological Treatment of Bipolar Disorder:
- One problem in getting bipolar patients to take their medication regularly is that they lack
insight into the self-destructive nature of their behaviour. Studies show that careful education
about the disorder and its treatment can improve adherence to medication which is helpful in
reducing the mood swings, bringing more stability.
- Patients relapse more quickly if they return from hospital to family settings characterized by
high levels of hostility and over-involvement (called ‘expressed emotion’) than if they returned
to a less-charged emotional climate.
- This points to the need for interventions aimed at the family and no merely at the patient.
- A problem-solving approach called interpersonal and social rhythm therapy is designed to help
the patient deal better with life events that trigger stress and manic episodes.
- Lam outlined the common features in psych treatments for relapse prevention in BD:
Promotion of medication adherence
Promotion of regular daily routines and sleep
Monitoring of mood
Detection of early warnings and relapse prevention strategies
General coping strategies and problem-solving techniques
ECT is being used with increased frequency in Canada and elsewhere. One reason is that when it
works, it is faster than antidepressants and psychotherapy. ECT entails the deliberate induction of a seizure and momentary unconsciousness by passing a
current between 70 and 130 volts through the patient’s brain.
Electrodes were formerly placed on each side of the forehead, allowing the current to pass
through both hemispheres, a method known as bilateral ECT.
Today, unilateral ECT, in which the current passes through the non-dominant (right) cerebral
hemisphere only is more commonly used.
The mechanism through which ECT works is unknown. It reduces metabolic activity and blood
circulation to the brain