Treating Depression E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
A practical and conceptual guide to treating depression using both Beckian CBT and the latest, cutting-edge third wave CBT approaches, including mindfulness and metacognitive therapy. It provides an understanding of depression and its treatment and a clear practical guidance on how to use each treatment approach.
- Covers CBT, metacognitive therapy, and third-wave behavioural approaches within one volume
- Presents the theoretical background and evidence for each approach, and describes application in a clear case study approach which clearly outlines the contrasting features of the treatments
- Includes separate chapter commentaries on the theory and clinical material covered
- Internationally renowned contributors include Arthur Nezu, David A. Clark, Robert Zettle, Keith Dobson, Ruth Baer, Adrian Wells and Robert Leahy
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Veröffentlichungsjahr: 2015
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Treating Depression
MCT, CBT, and Third-Wave Therapies
Edited by
Adrian Wells, PhD and Peter L. Fisher, PhD
This edition first published 2016 © 2016 John Wiley & Sons, Ltd
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The right of Adrian Wells and Peter L. Fisher to be identified as the authors of the editorial material in this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
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Library of Congress Cataloging-in-Publication Data
Treating depression : MCT, CBT, and third wave therapies / edited by Adrian Wells and Peter L. Fisher. pages cm Includes bibliographical references and index. ISBN 978-0-470-75905-9 (cloth) – ISBN 978-0-470-75904-2 (pbk.) 1. Depression, Mental–Treatment. 2. Metacognitive therapy. 3. Cognitive therapy. I. Wells, Adrian. II. Fisher, Peter L.
RC537.T735 2016 616.85′27–dc23 2015017696
A catalogue record for this book is available from the British Library.
Cover image: Human Brain Engraving © CraigNeilMcCausland / iStockphoto
Contents
List of Contributors
Preface
Section 1: Assessment, Prevalence, and Treatment Outcomes
Chapter 1: The Nature of Depression
Introduction
Diagnosing Major Depressive Disorder
Diagnostic Criteria for Major Depressive Disorder
The Epidemiology of Major Depression
Course
Conclusion
References
Further Reading
Chapter 2: The Assessment of Depression
Introduction
Clinician Ratings
Self-Report Measures
Case Example
Future Directions
References
Further Reading
Chapter 3: The Efficacy of Cognitive Behavioural Therapy for Depression
How Much does Acute-Phase CBT Reduce Depressive Symptoms?
How Many Patients Are Well at Exit from Acute-Phase CBT?
How Many Responders to Acute-Phase CBT Relapse or Experience Recurrence?
How Do Relapse and Recurrence Rates after Acute-Phase CBT Compare to Those of Alternative Treatments?
Does C-CT Reduce Relapse and Recurrence among Responders to Acute-Phase Treatments?
How Clinically Significant Is the Change after Exposure to CBT?
Research to Do or Watch: Collaboration with Neuroscience and Basic Psychology to Develop the Paradigm
How Generalizable Are the Findings from Randomized Trials on CBT for Depression?
Where Are the Mechanisms of Effect and What Do We Teach and Disseminate?
What Do We Measure? A Key to Advancing Understanding
Summary
Acknowledgements
References
Chapter 4: Psychobiological Processes and Therapies in Depression
Introduction
Monoamine Hypotheses
Intracellular Effects
Serotonin Systems
Noradrenergic Systems
Dopaminergic Systems
Other Neurotransmitter Systems
Disturbances of Sleep and Its Regulation
Neuroplasticity and Neurogenesis
Neuroimaging Studies in Depression
Neural Network Models of Depression
Treatment
Conclusions
References
Further Reading
Section 2: Psychological Models of Depression
Chapter 5: Schema Theory in Depression
Introduction
Beck's Schema Theory of Depression
Young's Schema-Focused Therapy
Schema Theory and Cognitive Science
The Future of Schema Theory in Depression
References
Chapter 6: Metacognitive Therapy: Theoretical Background and Model of Depression
Theoretical Background
The Metacognitive Model of Depression
MCT
Empirical Status of the Metacognitive Model
Metacognitive Control Strategies
Metacognitive Beliefs
The Effectiveness of MCT and Techniques in Depression
Conclusions
References
Further Reading
Chapter 7: Acceptance and Commitment Theory of Depression
Overview of Functional Contextualism
Overview of Relational Frame Theory
An Acceptance and Commitment Model of Depression
Conclusion
References
Chapter 8: The Theory Underlying Mindfulness-Based Cognitive Therapy as a Relapse Prevention Approach to Depression
Historical Background
Mindfulness-Based Cognitive Vulnerability Model of Depressive Relapse
How Cognitive Therapy Prevents Depressive Relapse
MBCT
Empirical Support
Conclusion
References
Chapter 9: Behavioural Activation Theory
Behavioural Theory of Depression: Early Models and Core Concepts
The Empirical Status of the Theory
Early Behavioural Treatments for Depression: Key Elements
Early Behavioural Treatments for Depression: Evidence Base
Integration with and Ascendance of Cognitive Therapy
Is Behavioural Activation Necessary and Sufficient?
Summary
References
Further Reading
Chapter 10: A Critique of Theoretical Models of Depression: Commonalties and Distinctive Features
Challenging Beliefs in Depression: Locus, Distraction, or Harm?
Proximate or Distal Causation of Pathology?
Notes
References
Further Reading
Section 3: Treatments for Depression
Introduction to Section 3: Case Study
Case Presentation
Complaints and History
References
Chapter 11: Cognitive Behaviour Therapy for Depression
Cognitive Behavioural Theory and Therapy
Summary
References
Chapter 12: Metacognitive Therapy for Depression
Introduction
Brief Overview of MCT for Depression
Assessment
Treatment
Conclusions
References
Chapter 13: Acceptance and Commitment Therapy: Application to the Treatment of Clinical Depression
Case Conceptualization
Clinical Application
Assessing the Costs of Avoidance
Control Is the Problem, Not the Solution
Treatment Flow: What Is Being Avoided?
Identifying Barriers
Restless Mind, Calm Mind
Values as the Fuel
Value-Based Committed Action
Relapse Prevention: Building an ACT Lifestyle
Summary
References
Further Reading
Chapter 14: Treating Acute Depression with Mindfulness-Based Cognitive Therapy
Overview of MBCT
Distinctive features of MBCT
Questions for Future Research
Conclusions
Acknowledgements
References
Chapter 15: Behavioural Activation Treatment for Depression
Overview
Distinctive Elements of Behavioural Activation
Conclusion
Appendix
References
Further Reading
Chapter 16: A Critique of Therapeutic Approaches to Depression: Commonalties and Distinctive Features
Distinctive Features
Strengths and Weaknesses
Future Developments
General Conclusions
References
Further Reading
Epilogue
Index
EULA
List of Tables
Chapter 1
Table 1.1
Chapter 3
Table 3.1
Table 3.2
Chapter 5
Table 5.1
Chapter 11
Table 11.1
Chapter 12
Table 12.1
Table 12.2
Chapter 13
Table 13.1
Chapter 15
Table 5.1
List of Illustrations
Chapter 3
Figure 3.1 Proportion of acute-phase CBT patients with symptom scores nominally (
U
3
) and reliably (
U
3
R
) better than the average patient in waitlist/placebo. Copyright ©: J. R. Vittengl, Truman State University, and R. B. Jarrett, the University of Texas Southwestern Medical Center at Dallas. Reprinted with permission from the authors.
Chapter 5
Figure 5.1 Beck's cognitive model of depression.
Chapter 6
Figure 6.1 The metacognitive model of depression.
Figure 6.2 Example of a depression case formulation.
Chapter 11
Figure 11.1 The cognitive model of depression (Dobson, 2008).
Figure 11.2 The cognitive model of depression as applied to Gail.
Chapter 12
Figure 12.1 Gail's MDD-S self-report form at pre-treatment.
Figure 12.2 Idiosyncratic case formulation.
Chapter 13
Figure 13.1 Gail's Bull's Eye Values Clarification Results.
Chapter 15
Figure 15.1 Cycle of depression.
Guide
Cover
Table of Contents
Preface
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List of Contributors
Ruth A. Baer
University of Kentucky, USA
David A. Clark
University of New Brunswick, Canada
Martin Connor
University of Liverpool, UK
Pilar Cristancho
Washington University in St Louis, USA
Robert J. DeRubeis
University of Pennsylvania, USA
Sona Dimidjian
University of Colorado, USA
Keith S. Dobson
University of Calgary, USA
Peter L. Fisher
University of Liverpool, UK
Brendan D. Guyitt
University of New Brunswick, Canada
Samuel Hubley
University of Colorado, USA
Robin B. Jarrett
University of Texas Southwestern Medical Center, USA
Roselinde H. Kaiser
University of Colorado, USA
John R. Keefe
University of Pennsylvania, USA
Mark A. Lau
Vancouver CBT Centre and University of British Columbia, Canada
Robert L. Leahy
American Institute of Cognitive Therapy
Kelly S. McClure
LaSalle University, USA
Arthur M. Nezu
Drexel University, USA
Christine M. Nezu
Drexel University, USA
Patricia J. Robinson
Mountainview Consulting Group, Washington, USA
Kirk D. Strosahl
University of Washington, USA
Yvonne Tieu
University of Calgary, USA
Michael E. Thase
University of Pennsylvania, USA
Jeffrey R. Vittengl
Truman State University, USA
Erin Walsh
University of Kentucky, USA
Adrian Wells
University of Manchester, UK
Robert D. Zettle
Wichita State University, USA
Preface
Depression is a very common psychological disorder, which affects over 120 million people worldwide. Approximately 10–15% of the population will be affected by depression during their lifetime. The personal, social, and economic burden of depression is profound, and depression is estimated to be the leading cause of disability worldwide. Fortunately there are effective psychological therapies for depression. One of the most studied interventions is cognitive behavioural therapy (CBT), which consists of cognitive and behavioural strategies. These two components of CBT, namely cognitive therapy (CT) and behavioural activation (BA), are equally effective. The high volume of empirical support for these approaches has led to their recommendation in healthcare guidelines as a first-line psychological treatment for depression. The pursuance of newer and alternative treatments has emerged in the last twenty years as a result of an increasing recognition of the limitations of CBT. Approximately half of the patients treated with CBT and behavioural methods recover from depression; this leaves the other half – a significant number of patients – with a partial response or with none at all. Furthermore, amongst those that do recover, there is a substantial rate of relapse that cannot be ignored. Only one third of the patients remain depression-free one year after the completion of psychological interventions.
It is evident that we need to add to the armoury of treatment approaches, with a view to providing a larger choice for both clinicians and patients. Moreover, we must find treatments that are more effective in the immediate term, and especially in the longer term. Fortunately the area has moved forward thanks to an influx of ideas and new techniques from a range of backgrounds. This progress has led to the development of metacognitive therapy (MCT), mindfulness-based cognitive therapy (MBCT), and acceptance and commitment therapy (ACT). These approaches are based on different theoretical models of the causes and maintenance of depression. But we do not yet know whether these newer additions can be more effective than CBT or BA, and we are in danger of not being able to find out, because there is ambiguity concerning the distinctive features of these approaches.
Unfortunately the boundaries and integrity of these newer approaches are not always maintained. In clinical settings, we find that therapists have a tendency to draw on techniques and principles from any combination of CBT and these other approaches, often violating some of the basic principles of any one of the models. Why should this be of concern? Two reasons predominate: first, techniques drawn from different approaches are not always compatible and, when used together, may cancel each other out, annul the desired effects on causal mechanisms, and lead to reduced rather than improved efficacy. Second, when techniques are combined, we move away from the well-controlled evaluation of established, bona fide approaches that can be found in treatment manuals, which prevents the assessment of the absolute and relative efficacy of the newer therapies.
If psychological treatments for depression are to be delivered competently and with a high level of treatment fidelity, it is necessary for practitioners to recognize and understand the fundamental differences between, and distinctive features of, each approach. However, the difficulty of acquiring this level of knowledge is often underestimated, as some of the constructs contained in the therapeutic approaches sound similar but vary in the degree of conceptual refinement and specificity.
The present volume was conceived with the aim of addressing these above issues. First, we wanted to bring together in one place evidence-based, effective, and emerging approaches to treating depression. This would serve as a reference treatment manual for therapists and researchers. Second, we aimed to provide a vehicle for showcasing the important conceptual and practical differences that exist between these treatments. Third, we devised a format for the contributions that would allow scrutiny of the goodness of fit between psychological theory and the implementation of the different approaches.
Consequently the volume is divided into three sections. Section 1 comprises four chapters, which provide an overview of the nature of major depressive disorder, the clinical assessment of depression, a review of the effectiveness of CBT, and an account of the psychobiological processes and therapies of depression. Section 2 presents the theoretical foundations of the five psychological interventions and concludes with a critique of the five theories that highlights the similarities and differences between the models on which treatment is based. For Section 3, we have provided the proponents of each approach with a hypothetical case study (which constitutes the Introduction to this section). In response, they have produced a brief treatment manual to illustrate each stage of treatment – assessment, case formulation, and treatment methods – with reference to this same case study. The section concludes with a critique of the distinctive components of each treatment.
Treating Depression has been made possible by its distinguished participants, and we express our gratitude to them for sharing their knowledge and skills. Without their significant contributions we would not be standing on the edge of the next chapter, heralding our quest to resolve this state of significant human suffering.
Adrian Wells, PhD
Peter L. Fisher, PhD
