Learning Objectives This is an intermediate level course. After completing this course, mental health professionals will be able to:
A brief description of treatments listed as efficacious and specific or efficacious is presented below. Behavioral activation BA BA is based on early functional descriptions of depression by Lewinsohn [ 36 ] and Ferster [ 37 ] that emphasized the role of positive and negative reinforcement in depression, [ ] suggesting that individuals with depression have deficient response-contingent positive reinforcement and engage in problematic avoidance behaviors.
Modern BA treatments developed in response to a component analysis by Jacobson et al. While several different versions of BA exist, all emphasize the role of activity monitoring and activity scheduling in order to increase engagement in activities suggested to improve mood see Kanter et al.
While early variants of BA emphasized activity scheduling that focused on increasing engagement in pleasant events e.
Patients are typically given activity assignments to complete between sessions, with increasing difficulty over time. At times, activity assignments may be arranged along an activity hierarchy e. Mindfulness strategies may be incorporated to address rumination.
A placebo controlled trial compared BA, cognitive therapy CTand paroxetine and found that there were no differences between conditions for patients with lower depression severity, but for those with more severe depression, BA and paroxetine performed equivalently and each of those treatments led to greater improvement than the CT condition.
In addition, there is some initial support for the use of BA with older adults in nursing home  and community settings. CBT for depression typically includes behavioral strategies i.
There is evidence supporting the use of CBT with individuals of all ages. For adults, CBT is considered to be efficacious and specific for the treatment of acute depression and prior CBT is considered to be efficacious and specific for the prevention of relapse.
In fact, in most pediatric clinical samples, CBT was found to be superior to other manualized treatments, including relaxation training and family and supportive therapy. While more structured than dynamic treatments, IPT has less structure than cognitive and behavioral approaches.
IPT draws from attachment theory and emphasizes the role of interpersonal relationships, [ ] focusing on current interpersonal difficulties. Specific areas of emphasis include grief, interpersonal disputes, role transitions, and interpersonal deficits.
During the middle phase of treatment sessionsspecific interventions are used to address the area of focus. Thisincludesproviding validation and support, improving communication skills, and working to solve interpersonal problems.
The final phase of treatment sessions focuses on termination of therapy. This includes reviewing progress, developing relapse prevention strategies, and addressing emotions that come with ending the therapy relationship. In addition, a fifth area of focus on single-parent families has been added to IPT for adolescents IPT-A to address difficulties arising from a separation or divorce.
The primary treatment component is mindfulness training as developed by Jon Kabat-Zinn and his colleagues at the University of Massachusetts Medical Center.
MBCT is a structured program that includes eight weekly, 2-hour group sessions. Patients are assigned homework on a daily basis.
Patients are encouraged to incorporate mindfulness into their daily activities as well as to practice specific mindfulness exercises. Research indicated that MBCT reduced risk of relapse or recurrence among patients who completed treatment with medications for depression.
This includes the ability to identify and select a variety of coping responses to address the features of a specific stressful situation. Problem orientation can either be positive i.
Problem-solving style refers to the activities someone engages in while trying to cope with a problem. An adaptive problem-solving style is referred to as rationalproblem-solving,whichincludes systematically applying skills to effectively solve a problem.
Maladaptive coping styles include the impulsivity-carelessness style and avoidance. Electroconvulsive Therapy Electroconvulsive therapy ECT is a highly effective treatment for depression.
Onset of action may be more rapid than that of drug treatments, with benefit often seen within 1 week of commencing treatment. A course of ECT usually up to 12 sessions is the treatment of choice for patients who do not respond to drug therapy, are psychotic, or are suicidal or dangerous to themselves.
Thus, the indications for the use of ECT include the following: Need for a rapid antidepressant response Failure of drug therapies History of good response to ECT Patient preference High risk of suicide High risk of medical morbidity and mortality Although advances in brief anesthesia and neuromuscular paralysis have improved the safety and tolerability of ECT, this modality poses numerous risks, including those associated with general anesthesia, postictal confusion, and, more rarely, short-term memory difficulties.
Especially in elderly patients, a preprocedure workup should be undertaken and should examine cardiac and vascular risk, because the procedure places a high cardiovascular demand on the patient. Bright-Light Therapy Bright-light therapy BLT for seasonal affective disorder is used at an intensity of 10, lux for minutes daily, usually within 1 hour of arising in the morning.
Like any effective antidepressant, BLT has the potential to precipitate a hypomanic or manic episode in susceptible individuals.
Other common adverse effects include eye irritation, restlessness, and transient headaches. These lamps are not a significant source of ultraviolet UV light. Conventional antidepressants, with or without BLT, also can be used to treat seasonal affective disorder.Learning Objectives.
This is an intermediate level course. After completing this course, mental health professionals will be able to: Briefly discuss the history and prevalence of ADHD in adults.
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