Mood Disorder in Mental Health

Discuss about the Mood Disorder in Mental Health.

Introduction

According to Shea et al, (1992), depression is a serious mood disorder that affects the mental health. Adverse situations such as financial troubles, emotional heartbreaks including death of a person, loss of the loved one, and loss of any other belongings are some of the reasons because of which a person fall victim of depression. As discussed by Friedman et al, (2004), there can be no specific concrete reason for depression. Sudden changes in the day-to-day lifestyle can also make a person depressed. As discussed by Perlis et al, (2002), a minor depression, sometimes, can lead to a major downfall of psychological health that may take a lot of time to recover. Therefore, the researcher and psychologists have been applying various approaches of treatment to identify the symptoms of depression and cure a depressed mind. This essay will analyze if Cognitive behavioral therapy is useful for the treatment of depression or not.

As opined by Nathan & Gorman, (2015), Cognitive behavioral therapy is considered as a practical and modern approach of treatment. It is based on the evidences and it tries to develop in the patient personal coping strategies. CBT is a psychological intervention guided by the empirical research. CBT includes the Thinking that every human being has a particular pattern of thought, which can be controlled. Hence, before one understands how CBT can help curing depression, one should recognize the positive thought patterns and the negative thought patterns. The main treatment that CBT does is to convert these negative patterns into positive ones by using practical method that ensures recovery from depression. ("DSM Home", 2016)

CBT and Depression:

Cognitive Behavioral Therapy is an alternative procedure of Medication for combating depression. According to EdwardCraighead et al, (2007), however, the question is how much this therapy is advantageous to a patient of severe depression. In this essay, the discussion will focus on the advantages and disadvantages of Cognitive Behavioral Therapy for the patients suffering from acute and minute depression.

The analysis will be based on three scholarly articles. Two articles that have thrown light on the advantages of CBT are as follows:

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.

Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Conti, S., & Grandi, S. (2014). Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. American Journal of Psychiatry.

One article that underlines the disadvantages of CBT is the following:

Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior therapy, 44(2), 180-198.

Hofmann et al, (2012), has opined in their article that CBT is applied to cure various problems related to depression. Their research work is based on 269 studies of meta-analytics and review of 106 representative samples that examine depression of various kinds. To distinguish CBT with other treatments they have done eleven studies, which they have ended up finding out that CBT has an edge over other methods of treatment. CBT has a very strong evidence base.

According to Lynch et al, (2010), CBT tries to affect the thinking pattern of a depressed mind. It believes that our thoughts, physical sensations, and feelings are interconnected. Therefore, the negative thought patterns can damage both our mental and psychological well-being. According to Berking et al, (2013), CBT helps a person overcome the negative thinking by breaking the thoughts into smaller parts. The major difference with CBT and other treatments are that CBT deals with the current problems and do not look into the past issues. It is a practical method for the improvement of the mental condition on a daily basis. The focus of CBT in their research is the following:

Understanding negative thinking: hopelessness, guilt feeling, powerlessness, and worthlessness are some of the negative thinking that make a person depressed. CBT can be applied here to remove all such negativity from mind. For example, to engage a depressed mind in reading through sending a message that if he were helpless he would not have been able read.

Understanding the negative emotions and emotive solution: Negative thinking leads to a melancholic mood. CBT tries to break the pattern and makes the patient to believe that such a melancholic mood is painful yet temporary. Acceptance of sudden mood swings prevents it from becoming a long lasting problem.

Understanding negative behavioral habits and behavioral solutions: CBT aims at changing the regular behavioral habits that might be the reason for depression. Activity scheduling and changes in the regular habits has been seen as a useful technique.

The study conducted by Fava et al, (2014) on forty people found out that application of CBT prevents recurrence of depression. The research highlighted the difference between CBT and medication. These forty people had been under antidepressant drugs for quite a long time and showed positive results. However, depression was a recurrent problem for them. Then CBT, which includes modification of lifestyle and well-being therapy, was applied. It was a six-year follow- up with minor usage of antidepressant drugs for any critical situation. The treatment showed 40% rate of relapse, which is a significant change. Previously, the relapse rate was 90%. Such a result proved that sequential application of Cognitive Behavioral Therapy cures the recurrence of depression. Even, some patients were able to withdraw themselves from medication successfully. Their psychological well-being lasted for six years with a course of psychotherapy only.

The techniques of treatment

As opined by Gearing et al, (2013), the techniques are the following:

CBT develops in an individual the skills to identify the thoughts and emotions and behaviors that affect emotions. The process through which the skill is acquired is collaborative. This method discriminates CBT from “talk therapies”. The psychologists use session times to inject the skill into the depressed mind and it is something more than offering advice and discussing issues with the patients. The methods used by the therapists in CBT are the following:

Cognitive restructuring and behavioral activation: CBT is grounded upon two particular tasks. These are Cognitive restructuring and behavioral activation. In the first case, both the therapist and the patient try to change their thinking patterns; and in the second case, the patient learns to participate in various enjoyable activities after the removal of psychological barriers.

As discussed by Stikkelbroek et al, (2013), Cognitive restructuring is the skill to identify the negative thought pattern. As discussed by Kupfer et al, (2012), for example, a college student is depressed as he failed in Math quiz. He may start thinking that he is stupid and not intelligent. He may blame himself for his failure. In this situation, the therapist would ask him if this is all the test means or not. The aim is to let the student identify his inaccurate thinking. Then he may ask the student’s overall grade in Math. If he answers that “it’s B”, it can be pointed out that a stupid person cannot acquire B-Grade. It is only after this identification that they both help each other and reframe the reality behind the failure in the quiz show. However, the feeling of stupidity in the student is an automatic thought. As opined by Kennard et al, (2008), depression is the result of these automatic or spontaneous thoughts that ooze out of certain situations. Negative thoughts do not include any deliberate or logical thinking. The main reason of it lies in the negative perception of the patient about the situation or the world.

According to Henwood et al, (2015), Behavioral activation aims at removing the psychological inertia found in most of the patients. It is the loss of interest in things that the patients used to enjoy previously. As opined by Gearing et al, (2013), in CBT, the patients are made to schedule their enjoyable experiences, and often it includes the other people who can reinforce the experience once again. The therapists try to find out the barriers that hold them back from enjoying and remove it by breaking the process into smaller components. According to Davidson (2010), during the process, patients keep their records of experiences, which include how the patient felt in what situation. The answers may not turn satisfactory and in that case, the patients are asked to note down what and why the change is necessary and how it can occur. This goal-oriented treatment removes the depression caused by inertia by activating them.

The method of CBT is goal oriented. Patients are asked by the therapists to set the goals for each session and for a long time. The long-term goals take several months and some goals are tried to be completed after the end of a session.

CBT has an educational approach. It employs structured learning experiences to teach the patients how to monitor and note down all their negative thoughts or mental images. The way those negative thoughts leave a bad influence on their moods and behavior is judged by this method. Another important aspect is that the therapists give lessons of how to cope with a bad situation. This is done through problem solving and scheduling of pleasurable experiences. 

The therapists try to involve the patients into the learning activities in between the sessions or in the sessions. At each session, they give them homework assignments. Some patients are graded at the very beginning and even the assignment tasks are appraised with the starting of the next session.

The various strategies that CBT includes are- Socratic questioning, imagery, role-playing, behavioral experiments. CBT is a time-limited treatment that generally lasts for 14 to 16 weeks.

The article by Hofmann et al, (2012) included one major case study. Robyn was suffering from depression due to the loss of job and separation from her husband and her son. She felt as if her life had turned upside down. She was diagnosed with depression and was under low dose of medication. However, she decided to go for CBT. At the very beginning of the first session, the therapists asked her what she might be thinking as the reason behind the depression. The aim was to know the exact feeling of Robyn. The extra time was spent on explaining the collaborative work that they would do. The therapists made a plan to draw a pictorial representation of how Robyn’s thought pattern is working. Then, they identified the negative thought patterns and asked Robyn to undergo eight sessions. Robyn did so and after each session, the therapists reviewed her progress. The pictorial formulation is mentioned below:

The diagram clearly shows the interconnection between each part of the systems. They were the reasons behind the depression. However, it was difficult to change the behaviors and thought patterns overnight. The therapists gave homework to Robyn in each week which involved the tracking the negative feelings too. Robyn also became interested at finding the negative thoughts as the treatment progressed. Throughout the session, her activities and behavior changes were monitored by the therapists. Thus, the eight sessions, ended and after sometimes she joined a course in an Open University which she enjoyed very much. This was a success story of CBT.

As discussed by Hayes et al, (2013), 65 patients with having depression were under CBT treatment. However, after the end of 16 weeks of sessions, 64 patients were recovered and went back to normal. There was a one patient aged 35 showed a different situation. His name was Jack. Jack remained happy as long as the activities took place. After it ended, he seemed to go back into his cocoon.  The CBT therapists ultimately failed to cure him completely. The reasons behind this failure were as follows:

Jack was molested at a very early age. His past was lying asleep at the very core of his subconscious mind. The CBT therapists, however, focused on the current mood swings and anger found in Jack.

Molestation made him shy and introvert. Therefore, the sudden emotional explorations during the CBT made him conscious and uncomfortable

Another case study mentioned by Hayes et al, (2013), in their article pointed out how an adolescent girl Maria aged 16 faced learning difficulties. She was suffering from depression due to the separation between her parents yet she failed to understand that her thought pattern is negative; therefore, she could not cooperate with the therapists. It clearly shows the limitation of CBT.

The effectiveness of CBT: overview

According to Papageorgiou & Wells, (2015), CBT plays an important role in curing mild depression in both the adults and the adolescents because high doses of antidepressant can be harmful for the latter. However, for the treatment of major depression a combination of CBT and antidepressant will be beneficiary. According to DiMauro et al, (2013), there are many cases where a patient is cured by medication alone and it may happen that medication is working out improperly. It is leaving am partial effect. In that case, CBT can be a useful method for the complete removal of the symptoms of depression. The researchers have also find out that patients respond more effectively in CBT than medication. The types of people who are benefitted by CBT are as follows:

A person who is motivated

Someone who recognizes the ability in him to control the events surrounding him

Someone with an ability to introspect

This is, however, a limitation of CBT. Patients without the above-mentioned characteristics may either take longer time or do not respond at all. It happens in a case of major depression. The risk of relapse is another factor. As discussed by Honyashiki et al., (2014), Patients that take more than 14 to 16 weeks need “Booster” sessions. It reduces the possibility of relapse and reinforces “refreshers” session that uses the very basics of CBT skills. However, the advantages of CBT are s follows:

Necessary treatment where medication alone cannot cure

Takes relatively short period of time than the “talking formats”

The structured method of CBT makes it useful for different formats such as groups, computer programs and self-help reading

The practical strategies used in CBT is useful for everyday life too

Conclusion:

The prevalent and recurrent problem of depression cannot be avoided. Medication and counseling are traditional approaches of combating depression. However, with the increase of complex situations one can find complex mental conditions too. Sometimes, the therapists do not understand the reason behind such complexities. Therefore, a high chance of wrong treatment can worsen the situation. For this reason, they have started emphasizing on unlocking the hidden secrets of the mind. It is seen that people the thought patterns that rule the minds are the reasons behind depression. The task they have undertaken is to identify the negative thought pattern that damages the mental well-being. The responsibility to untie the complexities is given to the patients so that they realize their wrong perceptions about the world or any situation. The CBT highlights on the fact that a patient is both the subject and the object. They should understand their situation and take active part in getting out of it. This is a very practical and modern approach of treatment. In this essay, the two articles that justify the advantages of CBT and one article that compares CBT with other treatment methods to find out that CBT is not the best solution are discussed in detail to reach to the desired objective.

Reference

Berking, M., Ebert, D., Cuijpers, P., & Hofmann, S. G. (2013). Emotion regulation skills training enhances the efficacy of inpatient cognitive behavioral therapy for major depressive disorder: a randomized controlled trial. Psychotherapy and Psychosomatics, 82(4), 234-245.

Davidson, J. R. (2010). Major depressive disorder treatment guidelines in America and Europe. The Journal of clinical psychiatry, 71(suppl E1), 4-4.

DiMauro, J., Domingues, J., Fernandez, G., & Tolin, D. F. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study. Behaviour research and therapy, 51(2), 82-86.

DSM Home. (2016). Psychiatry.org. Retrieved 3 September 2016, from https://www.psychiatry.org/psychiatrists/practice/dsm

EdwardCraighead, W., Sheets, E., Brosse, A. L., & Ilardi, S. S. (2007). Psychosocial treatments for major depressive disorder. A guide to treatments that work, 289.

Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Conti, S., & Grandi, S. (2014). Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. American Journal of Psychiatry.

Friedman, M. A., Detweiler?Bedell, J. B., Leventhal, H. E., Home, R., Keitner, G. I., & Miller, I. W. (2004). Combined psychotherapy and pharmacotherapy for the treatment of major depressive disorder. Clinical Psychology: Science and Practice, 11(1), 47-68.

Gearing, R. E., Schwalbe, C. S., Lee, R., & Hoagwood, K. E. (2013). The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders. Depression and anxiety, 30(9), 800-808.

Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior therapy, 44(2), 180-198.

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Stikkelbroek, Y., Bodden, D. H., Dekovi?, M., & van Baar, A. L. (2013). Effectiveness and cost effectiveness of cognitive behavioral therapy (CBT) in clinically depressed adolescents: individual CBT versus treatment as usual (TAU). BMC psychiatry, 13(1), 1.

 

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