Depression and Its Social Impact
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Questions and Answers

What percentage of adults experience depression at any one point in time?

  • 4%
  • 2%
  • 10%
  • 5% (correct)
  • Which statement best describes the relationship between depression and socio-cultural factors?

  • Depression is purely a biological disorder.
  • Socio-cultural context is irrelevant to understanding depression.
  • Only emotional symptoms influence the perception of depression.
  • Depression should be seen as a socio-cultural construct. (correct)
  • What is the lifetime prevalence range of depression according to the information provided?

  • 2% - 21% (correct)
  • 1% - 5%
  • 10% - 30%
  • 15% - 25%
  • What caution should be taken regarding diagnostic systems for psychological disorders?

    <p>They may hinder understanding due to over-medicalization. (A)</p> Signup and view all the answers

    According to the information, what percentage of individuals with one major depressive episode may experience recurrence?

    <p>50% (A)</p> Signup and view all the answers

    Which physiological symptom is associated with depression?

    <p>Marked loss of libido (D)</p> Signup and view all the answers

    What cognitive aspect is commonly associated with a negative cognitive triad?

    <p>Sense of worthlessness (B)</p> Signup and view all the answers

    Which emotion is NOT typically associated with depressive disorders?

    <p>Joy (A)</p> Signup and view all the answers

    What behavioral symptom might a person showing signs of depression exhibit?

    <p>Lowered activity levels (C)</p> Signup and view all the answers

    Which of the following is considered a social-interpersonal symptom of depression?

    <p>Disengagement from friends (C)</p> Signup and view all the answers

    What type of therapy focuses primarily on changing negative thought patterns?

    <p>Cognitive Behavioral Therapy (CBT) (A)</p> Signup and view all the answers

    Which treatment approach utilizes direct electrical stimulation to affect brain activity?

    <p>Electroconvulsive Therapy (ECT) (A)</p> Signup and view all the answers

    Which of the following symptoms signifies a cognitive-motivational issue in depressive disorders?

    <p>Negative rumination (B)</p> Signup and view all the answers

    What impact does inadequate care in childhood have on self-perception?

    <p>It builds a model of self as inadequate and unlovable. (A)</p> Signup and view all the answers

    How do negative internal working models from childhood affect adults during stressful times?

    <p>They may generalize to a negative life outlook. (C)</p> Signup and view all the answers

    According to the theory of causal attribution, depression is more likely if the attribution is perceived as which of the following?

    <p>Internal, stable, and global. (A)</p> Signup and view all the answers

    What is the primary focus of the cognitive-behavioral approach to emotional difficulties?

    <p>Addressing thinking and behavior issues. (A)</p> Signup and view all the answers

    Which of the following is NOT listed as a method for clinical assessment?

    <p>Patient self-reporting only. (C)</p> Signup and view all the answers

    What classifications are considered when assessing depression?

    <p>Onset, severity, features, duration, and course. (C)</p> Signup and view all the answers

    Which assessment tool is specifically designed to evaluate symptoms of depression?

    <p>Patient Health Questionnaire (PHQ-9). (A)</p> Signup and view all the answers

    What additional factor is recognized in the evolved formulation of the cognitive-behavioral approach?

    <p>Social context in understanding difficulties. (B)</p> Signup and view all the answers

    What is the primary focus of Interpersonal Therapy (IPT)?

    <p>Improving current interpersonal relationships (A)</p> Signup and view all the answers

    Which of the following aspects is NOT a key feature of Cognitive Behavioral Therapy (CBT)?

    <p>Analysis of childhood traumas (D)</p> Signup and view all the answers

    Who originally developed Interpersonal Therapy?

    <p>Gerald Klerman (D)</p> Signup and view all the answers

    What does 'collaborative empiricism' in CBT involve?

    <p>Shared exploration of thought patterns (A)</p> Signup and view all the answers

    According to the theoretical background of IPT, which factor is linked to psychiatric problems?

    <p>Insecure attachment to caregivers (C)</p> Signup and view all the answers

    What is a common misconception about the aims of IPT?

    <p>Focusing solely on current interpersonal problems is sufficient (A)</p> Signup and view all the answers

    What critical element is emphasized in the therapeutic relationship of CBT?

    <p>The dynamics of the relationship (C)</p> Signup and view all the answers

    Which principle is emphasized during the intervention phase in CBT?

    <p>Engagement in both talking and doing (A)</p> Signup and view all the answers

    What is NOT one of the interpersonal problems that IPT addresses?

    <p>Personality disorders (B)</p> Signup and view all the answers

    What is the primary goal of the first phase of IPT?

    <p>Exploring difficulties and setting goals (B)</p> Signup and view all the answers

    During which phase of IPT are solutions to problems actively worked on?

    <p>Phase 2 (C)</p> Signup and view all the answers

    What does Behavioral Activation aim to reduce?

    <p>Avoidance and unhelpful behaviors (B)</p> Signup and view all the answers

    What role does functional analysis play in Behavioral Activation?

    <p>It evaluates behaviors before, during, and after activities. (D)</p> Signup and view all the answers

    Which of the following describes an outcome of successful Behavioral Activation?

    <p>Enhanced engagement in enjoyable activities (C)</p> Signup and view all the answers

    Which aspect of depression does Behavioral Activation specifically address?

    <p>Reducing rewarding behaviors and activities (C)</p> Signup and view all the answers

    Which classification system is produced by the American Psychiatric Association?

    <p>Diagnostic &amp; Statistical Manual of Mental Disorders (DSM) (A)</p> Signup and view all the answers

    What is a common depressive disorder listed in the DSM-5-TR?

    <p>Premenstrual Dysphoric Disorder (D)</p> Signup and view all the answers

    Which of the following is NOT listed as a mood disorder in the ICD-11?

    <p>Disruptive Mood Dysregulation Disorder (D)</p> Signup and view all the answers

    Which factor is NOT considered a broad determinant of depression?

    <p>Economic Status (D)</p> Signup and view all the answers

    Which model relates closely to the understanding of interpersonal relationships in depression?

    <p>Interpersonal Model (D)</p> Signup and view all the answers

    What neurotransmitter is primarily associated with depression according to biological theories?

    <p>Serotonin (A)</p> Signup and view all the answers

    Seasonal Affective Disorder (SAD) is categorized as which type of disorder?

    <p>Other Syndromes with Depression (C)</p> Signup and view all the answers

    Which of the following is considered a potential cause of depression?

    <p>Drug or alcohol use (B)</p> Signup and view all the answers

    What type of disorder is characterized by depressive symptoms occurring after childbirth?

    <p>Post-natal Depression (B)</p> Signup and view all the answers

    Which DSM-5-TR disorder is specifically designated for individuals experiencing significant mood instability?

    <p>Bipolar Type I Disorder (A)</p> Signup and view all the answers

    Flashcards

    Multifaceted nature of depression

    Depression involves multiple aspects like physical changes, emotional distress, thoughts and motivation, behaviour, and social interactions.

    Importance of context in depression

    It's important to understand the context of a person's feelings to validate their experience of depression.

    Depression as a socio-cultural construct

    Depression is influenced by societal norms, cultural beliefs, and economic conditions. It's not just an individual problem.

    Limitations of diagnostic systems

    Diagnostic systems can be helpful, but they can also oversimplify or overlook the complexity of mental health.

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    Power, Threat, Meaning Framework (PTMF)

    The Power, Threat, Meaning Framework (PTMF) offers a different perspective on psychological disorders, considering factors like power dynamics and personal meaning.

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    What is the ICD system?

    A system used to classify mental disorders, created by the World Health Organization (WHO). It includes chapters for various mental health conditions.

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    What is ICD-11?

    The current version of the WHO's classification system for mental health disorders, published in 2019. It focuses on understanding the full range of a person's mental and social experiences.

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    What is the DSM system?

    A system used to classify mental disorders, created by the American Psychiatric Association (APA). It provides specific criteria for diagnosis and helps in understanding various mental health conditions.

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    What is DSM-5-TR?

    The most recent version of the American Psychiatric Association's (APA) classification system for mental disorders, published in 2022. It includes updates and changes based on new research findings.

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    What is Major Depressive Disorder?

    A type of mood disorder characterized by persistent sadness, loss of interest, and other related symptoms.

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    What is SAD?

    A type of depression that occurs mainly during certain times of the year, often linked to changes in sunlight exposure.

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    What is Psychotic Depression?

    A mental health condition that involves experiencing depression alongside thoughts or behaviors that are not connected to reality.

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    What is Post-natal Depression?

    A mental health condition that occurs after childbirth, characterized by sadness, anxiety, and feelings of inadequacy.

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    What is Adjustment Disorder?

    A type of depression triggered by a stressful life event, like a breakup or job loss. It can have a significant impact on a person's ability to cope with everyday life.

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    What is PTSD?

    A mental health condition that develops after a traumatic event. It can manifest in various ways, including depression, anxiety, and flashbacks.

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    Inadequate Self Model

    A negative internal model of oneself as inadequate and unlovable, often stemming from inadequate care in childhood.

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    Unavailable Other Model

    A negative internal model of others as unavailable or hostile, often formed due to inadequate care during childhood.

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    Theory of Causal Attribution

    A cognitive model focusing on how people explain the cause of events, especially in relation to depression. It suggests depression is more likely if someone attributes events to internal, stable, and global factors.

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    Cognitive-Behavioral Approach (Depression)

    A cognitive-behavioral approach that explains depression as a result of negative thoughts and behaviors. It emphasizes the role of socio-cultural context in shaping these patterns.

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    Comprehensive Assessment for Depression

    A process of gathering information to assess the nature and severity of depression. Includes using clinical interviews, observation, and validated questionnaires.

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    Classification of Depression

    A classification system used to describe depression based on factors such as onset, severity, duration, and course.

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    Major Depressive Disorder

    A type of depression characterized by severe symptoms, such as loss of interest in activities, feelings of worthlessness, and changes in sleep and appetite.

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    Persistent Depressive Disorder

    A milder form of depression characterized by persistent feelings of sadness, hopelessness, and loss of interest, but not as severe as Major Depressive Disorder.

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    Physiological symptoms of depression

    These are the physical symptoms that may occur in depression, like appetite changes, sleep disturbances, fatigue and pain.

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    Emotional symptoms of depression

    These are the emotional experiences that can occur in depression, such as feeling low, empty, anxious, or guilty.

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    Cognitive-motivational aspects of depression

    These involve thinking patterns and motivations, including negative thoughts about oneself, the world, and the future. It can also include difficulty concentrating and a lack of motivation.

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    Behavioral symptoms of depression

    These are behavioral changes that may occur in depression, such as reduced activity levels, withdrawal from hobbies, and self-destructive behaviors.

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    Social-interpersonal aspects of depression

    These relate to social interactions and how depression influences relationships. It can lead to social withdrawal, isolation, and difficulties with communication.

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    Cognitive Behavioral Therapy (CBT)

    This therapy focuses on identifying and changing negative thought patterns and behaviors.

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    Interpersonal Therapy (IPT)

    This therapy explores interpersonal relationships and how these impact mental health, especially in the context of depression.

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    Behavioral Activation (BA)

    This therapy aims to increase engagement in activities that bring pleasure or meaning to life, and focuses on how this can improve mood and reduce depressive symptoms.

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    Interpersonal Psychotherapy (IPT)

    A therapy approach that tackles depression by helping people improve their skills in managing difficult interpersonal relationships and reducing negative interactions.

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    Phase 1 of IPT

    IPT's first phase involves assessing the client's needs, establishing a diagnosis, setting goals, and explaining the therapy.

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    Phase 2 of IPT

    This phase is where the client actively works on solutions and strategies to improve their interpersonal challenges.

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    Phase 3 of IPT

    The final phase of IPT focuses on preparing the client for the end of therapy and developing plans for maintaining their progress.

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    Functional Analysis in BA

    BA focuses on exploring the connection between actions, feelings, and outcomes. It helps understand what happens before, during, and after activities.

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    Re-engagement in BA

    BA helps clients gradually re-engage in activities they find rewarding, even if they don't feel like it at first.

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    Reducing Unhelpful Behaviors in BA

    BA targets behaviors that fuel depression, such as withdrawal and avoidance, by helping clients realize they don't always need to feel good to do things.

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    What is the core concept underlying CBT?

    CBT focuses on how thoughts, feelings, and behaviors interact and influence each other.

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    What is the primary goal of CBT?

    CBT aims to help individuals change their thinking patterns and behaviors to manage symptoms and improve overall well-being.

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    How does CBT involve the individual?

    Active participation is encouraged in CBT, where individuals take ownership of their treatment and work collaboratively with therapists.

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    What is the central idea of IPT?

    IPT views depression primarily as a response to difficulties in personal relationships and life events.

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    What theoretical framework does IPT build upon?

    IPT emphasizes the impact of interpersonal relationships on mental health, drawing on the work of Harry Stack Sullivan and John Bowlby.

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    What is the main focus of IPT therapy?

    While recognizing other factors, IPT focuses on the current interpersonal challenges individuals are facing.

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    What are the primary aims of IPT?

    IPT aims to help individuals understand and manage their depression by addressing their interpersonal difficulties in a structured and time-limited manner.

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    What is the key characteristic of IPT therapy?

    IPT is a short-term, solution-focused therapy that helps individuals manage depression by addressing their interpersonal problems.

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    Study Notes

    Course Information

    • Course: Year 3: PS3112 Clinical Psychology
    • Date: 1 October 2024
    • Speaker: Dr Aftab Laher
    • Topic: Psychological Understanding and Treatment of Depression

    Additional Information

    • Dr Aftab Laher is a Consultant Clinical Psychologist.
    • He is an Accredited Cognitive Behavioural Psychotherapist.
    • He is an Honorary Lecturer in Clinical Psychology.
    • He is in the School of Psychology at the University of Leicester.

    Looking After Yourself (and Others)

    • The presentation advises students to step out or do what feels safe if they are experiencing distress.
    • Students can speak with the presenter or contact the Student Wellbeing Service at 0116 223 1780 or [email protected]

    Aims

    • Explore the nature of "depression".
    • Provide an overview of classification and clinical diagnosis.
    • Examine the causes and theories of depression.
    • Consider the clinical assessment of depression.
    • Summarize the psychological treatment approaches to depression.
    • Focus on CBT for adults.
    • Critically examine how depression has been conceptualized, categorized, and treated.

    Nature of Depression

    • Quotations are provided from various sources describing depression.
    • J.K. Rowling describes depression as the absence of hope and a deadened feeling, different from sadness.
    • Dorothy Rowe describes depression as a prison.
    • An anonymous source describes depression as walking down a dark hallway, not knowing when the light will turn on.

    Depression as a Clinical Syndrome

    • Depression is a clinical syndrome distinct from sadness, characterized by a non-transient depressed mood.
    • Key themes include pervasive feelings of loss, emptiness, entrapment, worthlessness, and hopelessness.
    • Impairment in daily functioning.
    • Clinical presentation can be "masked" or vary.
    • Symptoms include physiological, emotional, cognitive-motivational, behavioral, and social/interpersonal components.
    • Recognizing depression as a societal construct is important.

    Epidemiology of Depression

    • 280 million people worldwide experience depression (WHO, 2023).
    • The lifetime prevalence is estimated at 2%-21%. (Gutiérrez-Rojas et al., 2020).
    • Prevalence in community samples reached 32% during the COVID-19 pandemic (Dettman et al., 2022).
    • A significant portion of primary care patients experience recovery from depression (35-60%) with some experiencing chronic illness. (Steinert et al., 2014).
    • The risk of recurrence is over 50% with one major episode.

    Overview of Classification & Diagnosis

    • The WHO's International Classification of Diseases and the DSM system produced by the APA are two major systems for classifying and diagnosing psychological disorders.
    • Specific ICD and DSM subtypes of depressive and bipolar disorders are listed.

    Caution Regarding Diagnostic Systems

    • Diagnostic systems can be helpful but also hinder the understanding of psychological disorders.
    • There's debate on how diagnostic categories are developed and applied.
    • Systems may promote "over-pathologizing" or "over-medicalizing" psychological disorders,
    • Socio-cultural context is frequently disregarded.

    ICD-11 and DSM-5-TR

    • Specific depressive and bipolar disorders from ICD-11 and DSM-5-TR are presented in lists.

    Major Depressive Disorder

    • Diagnostic criteria are outlined in a table from the DSM-5, including symptoms (e.g., depressed mood or loss of interest, nearly daily for 2 weeks, etc.).
    • Diagnostic criteria for recurrent MDD are also listed in the table

    Other Syndromes with Depression

    • Other conditions associated with depression listed include; Seasonal affective disorder (SAD), psychotic depression, post-natal depression, and adjustment disorders (reactive depression).

    Causes & Theories of Depression

    • The presentation outlines various factors contributing to depression, including:
      • Lifestyle.
      • Life history.
      • Personality.
      • Other illnesses.
      • Socio-cultural context.
      • Genetics/ biomedical factors.
      • Life events/ stress/ big changes.
      • Conditioning/ learning.
      • Cognitive style/ outlook/ meaning-making.
      • Drugs/ alcohol

    Depression Often Associated With

    • A list of factors often correlated with depression is presented, encompassing bereavement, relationship difficulties, work problems, family problems, isolation, and role change/ loss of personal identity.

    Theoretical Approaches

    • Biological, behavioural, personality, psychodynamic, attachment, cognitive, and interpersonal models are discussed as potential explanations for depression.

    Biological Factors

    • Moderate heritability is seen through twin and family.
    • Neurotransmitter imbalances/ dysregulation (serotonin, norepinephrine, cortisol, and dopamine) are potential contributing factors.
    • Other brain and neuropsychological abnormalities can also play a role.

    Behavioural Factors

    • Learned Helplessness (classical conditioning).
    • Reduction in positive reinforcement/ increase in negative reinforcement (operant conditioning).
    • Social learning.
    • Formation of "vicious cycles" of depression-sustaining behaviours.

    Psychodynamic Approach

    • Freud's concepts of mourning and melancholia are compared, differentiating them.
    • Both conditions involve pain.
    • Loss is a key element.

    Later Developments (Neo-Freudian)

    • Object Relations Theory, an updated psychodynamic approach is shown
    • Depressive vulnerability originates from caregiver interactions.
    • Depression often arises from losing close relationships.

    Attachment Theory

    • John Bowlby and Mary Ainsworth's influence on attachment theory is noted.
    • An attachment theory model of self and other is presented.
    • Children with inadequate care may develop negative self-images and negative views of others.

    Cognitive Models

    • The theory of causal attribution (re-formulated learned helplessness).
    • Attribution of depression to internal, stable, global factors is highlighted – factors like these.
    • Beck's cognitive-behavioral approach, emphasizing thinking and behavior.
    • Evolved formulation- acknowledging socio-cultural context.

    Assessment

    • Comprehensive clinical assessments are vital.
    • Clinical interviews, observations, and psychometric questionnaires (e.g. PHQ-9, BDI-II, HADS) are highlighted as valuable tools
    • Information from other sources is important when obtained with patient consent.

    Classification of Depression

    • Onset (sudden/ gradual).
    • Severity (mild/moderate/severe).
    • Features (melancholic, catatonic, etc.).
    • Duration.
    • Course/ recurrence (longitudinal, seasonal, rapid cycling, etc.).
    • Aspects to consider when classifying depression.

    Core Dimensions

    • Physiological, emotional, cognitive-motivational, behavioral, and social/interpersonal domains are core aspects to consider when analyzing depression.
    • Listing of specific examples of these dimensions and descriptions is presented.

    Treatment

    • Talking therapies, including CBT, IPT, and others are presented as ways to approach treatment
    • Brain stimulation approaches are also mentioned.

    CBT

    • CBT is an evidence-based therapy aimed at identifying unhelpful thoughts and behaviors.
    • The therapy method employs techniques like cognitive restructuring, behavioural activation, and others.
    • Brief CBT models, online approaches, and approaches for cognitive impairment are listed.

    Aims of CBT

    • To change unhelpful thoughts, beliefs, behaviours, and patterns of interacting with the environment while addressing adverse systemic and environmental variables.
    • Involves cognitive reframing (using 'talking' and 'writing' to challenge negative thinking).
    • Behaviour changes, activity planning, and 'experiments' are incorporated
    • Social and environmental context modifications are encouraged.

    CBT Model Core Aspects

    • Reciprocal interactions between biological/psychological, and social/environmental systems are key aspects in the model
    • Prominence in cognition, especially subjective meaning/appraisal, is vital within the CBT approach.

    IPT

    • A short-term therapy focusing on current interpersonal relationships and needs.
    • The onset and fluctuations of depression are understood through the lens of interpersonal issues.
    • Methods to deal with interpersonal problems effectively.

    IPT – Core Aspects

    • Difficulties in interpersonal roles, transitions, loss, and deficits are central areas of interest for IPT.

    IPT– How it Works

    • Three phases are involved:
      • Phase 1 (2-4 sessions): Understanding the issues, agreeing on diagnosis, and collaboratively planning goals.
      • Phase 2 (4-8 sessions): Actionable steps are used to solve problems and achieve goals.
      • Phase 3 (2-3 sessions): Preparing for the end of therapy and maintaining gains.

    Behavioural Activation

    • A therapy method used to reduce depression rooted in behavioral therapy.
    • Focuses on increasing engaging and rewarding behaviours to confront the cycle of inactivity and disengagement, improving motivation and energy.

    Summary

    • Depression is more complex than sadness. It is a pervasive condition requiring several factors.
    • Multiple factors influence individuals and depression is often multi-factorial.
    • Several types of therapy can be effective, including CBT and IPT.
    • Medication and biological interventions may be necessary for severe or persistent cases.

    Additional Points

    • A website for the speaker's contact information is included.

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    Description

    This quiz explores key concepts related to depression, including its prevalence among adults and the influence of socio-cultural factors. You will also learn about the implications of diagnostic systems and the rates of recurrence in individuals with major depressive episodes.

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