PY6301 Clinical Psychology: Major Depressive Disorder
You are then required to write a literature review critically examining the utility / effectiveness of the psychological interventions / therapies (minimum of two) to address the needs of your client group.
a) Describe the focus of the review - e.g. that you will be critically reviewing (at least) two different interventions / therapies relevant to your client (e.g. BPT & Family Therapy).
Answer:
Major depressive disorder
Major depressive disorder simply known as depression is a type of mental disorder distinguished by low mood from past two weeks it is generally associated with low self-esteem, low energy, and loss of interest in day to day activities. Depression is the main cause of suicide and it affects 6% of adults each year. Its symptoms slowly increases and the effects are penetrating not only to the individuals but also to their families and society. The NICE guideline is a resource which enables healthcare doctors and other professionals to review and allow effective treatments for this mental health condition which can gradually become a chronic illness if not treated properly (Snyder, 2013).
Psychological needs of person with depression
A range of psychosocial and psychological needs for depression is being shown to the patients to give them relief from the symptoms. Also there are evidences that psychological therapies can cure a patient from long term depression. However all the patients suffering from depression does not responds to the same treatment so the healthcare professionals offers various types of interventions for further improvement of the treatment. Over the past year the researchers have became interested in examining the psychological needs of the people with depression. Many psychological researchers started to apply attachment theory to understand the differences between the individuals through the counselling process. Studies of depression are most important for the psychologists who are counselling because if the causes of psychological needs are found then the psychologist can target these mediators with the medications to help the individuals to get relief from the depression (National Collaborating Centre for Mental Health, UK 2013).
It has also been stated that various indices of psychological distress such as shame, anger, anxiety, distress and depression. Moreover, depression and avoidance have shown strong relation to interpersonal difficulties, loneliness feelings and lack of sympathy toward others.
Most of these studies have adopted a pathology-based strategy by investigating maladaptive procedure as mediators between depression and needs. This makes sense since one explanation behind looking for advising is to figure out how to adapt with dysfunction in day to day life. On the other hand, changing useless tendencies does not ensure that individuals will work well, as some strategies may have versatile capabilities. For instance, perfection may serve to ensure people whose attachments don't sufficiently react to their needs. People may come to trust that, in the event that they are flawless, others will respect them, see them as capable, and like them. This suggests the utilization of maladaptive systems comes from an inability to meet fundamental mental needs (Beesley et al., 2015).
The significant findings in the present study are that basic psychological needs satisfaction partially mediated the relationships between attachment anxiety and shame, depression, and loneliness and fully mediated the relationships between attachment avoidance and shame, depression, and loneliness. The results also suggest that both attachment anxiety and attachment avoidance are negatively associated with basic psychological needs satisfaction (Wei et al., 2015).
- Critically examine the utility/effectiveness of the psychological interventions of Major Depressive Disorder
Journal article 1 - “Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study”
Literature review
The aim of this project was to directly look at elective methodologies in the tailoring procedure and simultaneously evaluate the adequacy of tailored interventions. Elderly patients with depression have an expanded danger of an endless course, and the anticipation is more awful as contrasted. Proof demonstrates that social insurance experts utilize longer time to analyze discouragement and start satisfactory treatment in elderly patients (Aakhus et al., 2015).
Plan/Intervention
This project conducted a survey of 13 clinical practice rules for managing depression. With the assistance of a reference group, it was organized six proposals that are implemented. Depression in the elders are frequent, influencing 10–16 % of individuals more than 65 years, and complex, activated by social, mental, and natural elements. Recognizing this unpredictability, the proposals tended to the requirement for an organized mix of intercessions, including pharmacotherapy, psychotherapy, self improvement techniques, social systems, and coordination of care. Because of the organizing procedure in the previous part of this project, treatment issues were only picked. In spite of the fact that the proof for the adequacy of antidepressants in depression has been addressed, there are methodical reviews that show that antidepressants are valuable in blend with psychotherapy in elderly patients with serious depression (Jäger et al., 2017).
Intervention 2 – “Advancing psychotherapy and evidence based psychological interventions”
Plan / Intervention
Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas (Goschke, 2014)1. Psychological models of mental issue have progressed toward becoming progressively transdiagnostic, concentrating on centre intellectual endophenotypes of psychopathology from an integrative subjective brain research point of view instead of offering clarifications for unitary mental issue.
2. Psychotherapy research still does not have a reasonable structure that unites the wide assortment of ?ndings, models and points of view.
3. In order to provide more powerful psychological interventions to children and adolescents, there is a need to grow new or potentially enhanced psychotherapeutic mediations on the premise of formative psychopathology explore considering information of middle people and arbitrators.
4. Psychotherapy research requires expanding as far as reception of huge scale general wellbeing techniques and medications that can be connected to more patients in a basic and practical way. Expanded research on adequacy and arbitrators of Internet-based medicines and e-emotional wellness instruments may be one promising route forward (Seligman & Csikszentmihalyi, 2014).
- Search strategies used for findings this article
Different types of database search tools such as CINHAL, MEDLINE and PUBMED are used the following keywords: Primary health care – depression – elderly patients – determinants of practice – tailored implementation
- Organization of the literature review
In the research paper 1, there is an effectiveness of the tailored interventions that we have developed in a randomized trial. It has been identified the most important determinants and selected appropriate interventions to address those in a process evaluation.
There is a scarcity of research comparing different methods of identifying determinants of practice and tailoring implementation interventions and there is a need of further research for improving the methods used for the interventions and to understand how best to do this. This includes evaluation of strategies to prioritize suggested interventions, given the abundance of suggestions that is possible, as illustrated by this study (Jager et al., 2014).
The research paper 2, contains a full understanding of mental disorders and thus require approaching triggers and enabling conditions, knowledge of their substrate and mechanisms, identification of their function, i.e. the factors that maintain disorders, and a theoretical model of the various processes that are involved in disordered behavior (Emmelkamp et al., 2014).
- Critical evaluation
Article 1- Emotion-focused therapy of depression
A review of emotion-focused therapy (EFT) of depression including a proof is given. EFT aims at an affectively adjusted empathic relationship to contact and change frequent maladaptive passionate schematic that are viewed as the cause of the depression. Through the restorative procedure, versatile feelings are gotten to change maladaptive feelings and to sort out the individual for versatile reactions. This procedure of changing feeling with feeling is supported by the utilization of particular therapeutic techniques that assistance stimulates excitement of feelings (Greenberg, 2017).
Article 2- Depression: Loss of Reinforcers or Loss of Reinforcer Effectiveness – Republished Article
Various psychologists have suggested that depression comes about when a discriminative stimulus or support for conduct is expelled. It is proposed that the depressed individual's general loss of interest in his day to day life recommends that there is loss of support. The loss of some close thing in daily life events including the removal of the support, may lead to depression (Costello, 2016).
Article 3-The Genetics of Major Depression
Major depression is the most widely recognized psychiatric issue and the U.S. has the biggest effect of all biomedical diseases on inability. Here is the proof of the hereditary contribution to infection susceptibility and the present condition of molecular approaches. It is considered as prove for the hereditary heterogeneity of the disorder and the probability the subtypes exist that represent to hereditarily homogenous conditions (Flint and Kendler, 2014).
Article 4-Depression: major problem for public health
The aim of this article is to talk about depression as an imperative issue for general wellbeing. The writing with respect to the study of disease transmission, outcomes, and counteractive action of depression is investigated. Depression is a typical issue with long term effects, especially in women, and those encountering social difficulty. It is a noteworthy reason for disability and leads to death both by suicide and because of raised rates of physical issue. Many cases are undiscovered and treatment is regularly lacking (Paykel, 2016).
Article 5- Natural Course of Adolescent Major Depressive Disorder: Continuity into Young Adulthood
In this article the major depressive disorder of the teenagers are measured by comparing the rate of mood between 19 – 24 years of age, those who are having past history of MDD with those who are suffering from depressed mood. These participants have been interviewed twice during the project for assessing the psychopathology and personality disorders (Lewinsohn et al., 2013).
- Synthesize of the research articles
In the intervention 1; an interview was conducted with several stakeholder groups for informing the decisions of how to implement the interventions to improve adherence of clinical practice. A draft plan consisting of 55 inventions for the six recommendations: for the six recommendations. From the above articles that have been given, it can be concluded that MDD is the most widely recognized psychiatric issue and in the U.S. has the biggest impact of all other mental diseases.
In the intervention 2, in order to provide an evaluation of the research in different domains like, promising methods, identifying major advances, pointing out gaps and problems are to be addressed in the research to be done in future. A comparable basic evaluation with somewhat comparative conclusions is simultaneously given somewhere else (Schumann et al., 2013) by the ROAMER workgroup "Biomedical research". Specialists in both work bunches have been chosen for their scholarly magnificence and for their skill in the distinctive units of investigation expected to thoroughly portray specific indication areas
Depression is a common problem with long term effects, especially in women, and those encountering social difficulty. It is a biggest reason of death both by suicide and increased rates of physical issue. Various psychologists have suggested that depression occurs about when a spur or support for conduct is removed. It is proposed here that the loss of interest of an individual in depression is caused as that there is loss of support (Wittchen, Knappe & Schumann, 2014).
Conclusion
Therefore from both the interventions it can be concluded that the extent to which there are similar determinants of practice in other settings and the extent to which similar interventions would be appropriate in other settings is uncertain. Here the approach that has been used to develop a package of tailored implementation interventions was both feasible and efficient. On the other hand in the second intervention it has been described that psychological treatments developed in recent decades, but they are not up to the point which may help to reduce the mental disorders efficiently. Therefore in order to do a better contribution for reduction of mental disorders, psychotherapy research has to increase its area from clinical focus on individuals to more public health strategies and treatments that can be applied more simply and more cost-effectively. Four broad areas of research can be distinguished in this field:
- How to apply the internet based knowledge in routine mental health care.
- Development of the internet based therapy
- Use of modern technology and avatars
- Past history of medication to reduce treatment failures
All this will lead to more information about the effects of psychological treatments and also about the type of therapy for different patients.
References
Aakhus, E., Granlund, I., Oxman, A. D., & Flottorp, S. A. (2015). Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study. International journal of mental health systems, 9(1), 36.
Beesley, V. L., Smithers, B. M., Khosrotehrani, K., Khatun, M., O'rourke, P., Hughes, M. C. B., & Brown, L. J. (2015). Supportive care needs, anxiety, depression and quality of life amongst newly diagnosed patients with localised invasive cutaneous melanoma in Queensland, Australia. Psycho?Oncology, 24(7), 763-770.
Costello, C. G. (2016). Depression: Loss of Reinforcers or Loss of Reinforcer Effectiveness?–Republished Article. Behavior Therapy, 47(5), 595-599.
Emmelkamp, P. M., David, D., Beckers, T., Muris, P., Cuijpers, P., Lutz, W., ... & Berking, M. (2014). Advancing psychotherapy and evidence?based psychological interventions. International Journal of Methods in Psychiatric Research, 23(S1), 58-91.
Flint, J., & Kendler, K. S. (2014). The genetics of major depression. Neuron, 81(3), 484-503.
Goschke T. (2014) Dysfunctions of decision-making and cognitive control as transdia-gnostic mechanisms of mental disorders:advances, gaps, and needs in current research.International Journal of Methods in PsychiatricResearch, 23(Suppl. 1), 41–57.
Greenberg, L. S. (2017). Emotion-focused therapy of depression. Person-Centered & Experiential Psychotherapies, 1-12.
Jager C, Freund T, Steinhauser J, Aakhus E, Flottorp S, Godycki-Cwirko M, et al. Tailored implementation for chronic diseases (TICD): a protocol for process evaluation in cluster randomized controlled trials in five European countries. Trials. 2014;. doi:10.1186/1745-6215-15-87.
Jäger, C., Steinhäuser, J., Freund, T., Kuse, S., Szecsenyi, J., & Wensing, M. (2017). A tailored programme to implement recommendations for multimorbid patients with polypharmacy in primary care practices—process evaluation of a cluster randomized trial. Implementation Science, 12(1), 31.
Lewinsohn, P. M., Rohde, P., Klein, D. N., & Seeley, J. R. (2013). Natural course of adolescent major depressive disorder: I. Continuity into young adulthood. Journal of the American Academy of Child & Adolescent Psychiatry, 38(1), 56-63.
National Collaborating Centre for Mental Health UK (2013). Depression: the treatment and management of depression in adults (updated edition). British Psychological Society.
Paykel, E. S. (2016). Depression: major problem for public health. Epidemiology and Psychiatric Sciences, 15(1), 4-10.
Seligman, M. E., & Csikszentmihalyi, M. (2014). Positive psychology: An introduction. In Flow and the foundations of positive psychology (pp. 279-298). Springer Netherlands.
Snyder, H. R. (2013). Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: A meta-analysis and review.
Wei, M., Shaffer, P. A., Young, S. K., & Zakalik, R. A. (2015). Adult attachment, shame, depression, and loneliness: The mediation role of basic psychological needs satisfaction. Journal of Counseling Psychology, 52(4), 591.
Wittchen, H. U., Knappe, S., & Schumann, G. (2014). The psychological perspective on mental health and mental disorder research: introduction to the ROAMER work package 5 consensus document. International journal of methods in psychiatric research, 23(S1), 15-27.
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