cognitive-behavioral therapy for depression psyc 4500: introduction to clinical psychology brett deacon, ph.d. novembe

2. Announcements No class this Thursday (Thanksgiving) Remaining response papers due: Tuesday, November 30th (topic: EMDR) Thursday, December 2nd (topic: prescription privileges for psychologists) Exam #3: Tuesday, December 7th at 10:15

3. Questions for Herbert et al. (2000) response paper, due Tuesday 11/30 1. Why do think EMDR has become so popular among therapists? 2. What can be concluded about EMDR from the observation that component studies generally find that imagery without eye movements is as effective as standard EMDR? 3. Which one of the FiLCHeRS (essential features of science) do you find most troublesome about EMDR?

4. Questions for Fox et al. (2000) response paper, due Thursday 12/2 1. Do you think that organized medicine�s historical (and current) opposition to prescription privileges for non-physicians like nurse practitioners, optometrists, and psychologists reflects (a) concerns about a public health hazard, (b) concerns about other professions encroaching on their turf, or (c) both? 2. The American Psychological Association (APA) requires practicing clinical psychologists to pay an extra $137 per year in membership fees, which it calls a �Practice Assessment.� According to APA�s website, �this fee supports APA�s companion organization, the APA Practice Organization which is exclusively devoted to advancing the goals of the practitioner community.� A major goal of the APA Practice Organization is to advocate prescription privileges for psychologists, and much of the revenue raised by the $137 Practice Assessment supports this effort. What do you think of APA�s policy of charging all practicing clinical psychologists this extra $137 fee? 3. To what extent will the ability of clinical psychologists to prescribe medication, provided that they have completed an approved training course, result in �expanded patient access to expert mental health services� (p. 267)?

5. From Last Class� Cognitive and behavioral processes in anxiety disorders Cognitive and behavioral treatment strategies Exposure therapy

6. CBT for Depression Assess cognitive and behavioral factors that are contributing to the problem Develop cognitive and behavioral strategies to address them

7. Nature of Depression Basic psychological processes that contribute to depression Behavioral processes Cognitive processes

8. Cognition in Depression Cognitive triad Negative view of self, world, future Depressed persons engage in cognitive errors - tendency to interpret life events negatively Examples: Overgeneralization All-or-nothing thinking Mind reading

9. CBT for Depression Basic clinical strategies in CBT for depression Education Behavior modification techniques: behavioral activation Cognitive modification techniques Integrating these: behavioral experiments

10. Education A ? B ? C Activating Belief Consequence Event (Emotion)

11. Cognitive Restructuring http://www.youtube.com/watch?v=45U1F7cDH5k Disputing inaccurate thoughts 1. Identify the specific, inaccurate thought 2. Examine the evidence for alternative possibilities 3. Replace it with a more realistic thought Goal is to eventually modify core beliefs

12. Flashback to October 21:Construct Validity of Cognitive Therapy Dismantling cognitive therapy for depression: Jacobson et al. (1996) Cognitive therapy consists of: (a) behavioral activation, (b) modification of automatic thoughts, (c) modifying core schema 150 patients randomly assigned to receive (a) only, (a) + (b), or the full treatment (a + b + c) Findings and implications

13. Behavioral Activation Basic components Self-monitoring of daily activities Identifying hierarchy of meaningful, healthy activities Gradually scheduling activities into routine

14. Behavioral Activation �Behavioral activation. The BA treatment condition utilized in the study was an expanded version of the approach used in the component analysis study, which was based exclusively on the behavioral interventions recommended by A. T. Beck, Rush, Shaw, and Emery (1979). The expanded BA model is based on a conceptualization of depression that emphasizes the relationship between activity and mood and the role of contextual changes associated with decreased access to reinforcers that may serve an antidepressant function. The model highlights the centrality of patterns of avoidance and withdrawal (e.g., of interpersonal situations, occupational or daily-life routine demands, distressing thoughts or feelings, and so forth). Because contacting potential antidepressant reinforcers is often initially punishing, avoidance of contact minimizes distress in the short term but is associated with greater long-term difficulty, both by reducing opportunities to contact potentially antidepressant environmental reinforcers and by creating or exacerbating new problems secondary to the decreased activity. Increased activation is presented as a strategy to break this cycle. In general, BA seeks to identify and promote engagement with activities and contexts that are reinforcing and consistent with an individual�s long-term goals. Specific behaviorally focused activation strategies include self-monitoring, structuring and scheduling daily activities, rating the degree of pleasure and accomplishment experienced during engagement in specific daily activities, exploring alternative behaviors related to achieving participant goals, and using role-playing to address specific behavioral deficits. In addition, the expanded BA model includes an increased focus on the assessment and treatment of avoidance behaviors, the establishment or maintenance of regularized routines, and behavioral strategies for targeting rumination, including an emphasis on the function of ruminative thinking and on moving attention away from the content of ruminative thoughts toward direct, immediate experience.�

15. Emerging Research on CBT for Depression: Short-Term Outcomes of Cognitive Therapy vs. Antidepressants

16. Emerging Research on CBT for Depression: Long-Term Outcomes of Cognitive Therapy vs. Antidepressants

17. CT vs. BT vs. Antidepressants: Short-Term

18. CT vs. BT vs. Antidepressants: Long-Term Maintenance of Gains

19. CT vs. BT vs. Antidepressants: Long-Term Cost-Effectiveness

20. Aaron Beck Therapy Session Begin at 17:40 Cognitive therapy for a woman with depression Look for use of education and cognitive restructuring What it�s like to be a therapist using this approach? What it�s like to be a patient in this therapy? Similarities and differences with Albert Ellis�s REBT