Abnormal Psychology

Lecture #1 - January 13 2011

Psychological Disorder: 3 factors/criteria- Psychological Dysfunction- Which leads to distress or impairment- Can include atypical response

- People with anxiety disorder are aware that their thought are irrational but they cannot stop it

- Ex. Chip in brain

- Behavior is inconsistent in some sense to be described as psychological disorder. The greater the deviation of the curve, the more likely we can describe as psychological disorder

- How rare does behaviour have to be in order to be atypical/considered a disorder

- Someone who has depression for 14 days it would be coded as a depressive episode

- Someone who has 2 panic attack that comes out of no where within four weeks - then we can code it panic disorder

- DSM: committee within university which sets boundaries/coding, how to diagnose

- Behaviour can be coded as abnormal if it violates/breaks some sort of social norm: abnormality can be defined by certain cultural norms

- ex. family members (positive voices), O.C.D.- There are no universally assumed psychological disorders/no single universal definition of abnormality (relative to person's culture)

The mental Health Professions- Work as a scientist-practitioner in diff. ways

1. Consumers of science for their patient; keeping up with latest scientific developments in their field; up to date treatments

2. Active in evaluating there own procedures; patient complete measures before and after treatment so psychologist knows their treatment is effective

3. Conducting research that leads to new procedures useful in practice

- Clinical Psychologist (Ph.D, Psy.D)- In Canada Psychologists cannot prescribe.

- Psychiatrist (M.D., F.R.C.P. (C)- Psychoanalyst (M.D., Ph.D.)

- comes from freudian theory in practice- you have to be an M.D. first- visits 3-4 times a week for about 4.5 years- covered by OHIP- Social Worker (M.S.W.)

- work with couples/entire family/organizations- Counseling Psychologist (Ph.D)

- help people with life adjustment problems**All accept social workers, can diagnose a condition as abnormal**

Study clinical disorders- Clinical description

- Change, how many people have the disorder (prevalence), incidence (how many new cases in 12 month period), onset patterns (when and how does disorder start), gender ratios,

- Causation- prognosis- biological, social

- Treatment and outcome- studying new treatments- university departments

History of Psychopathology: Demonology- Good and Bad Manasfestations of power where regarded as supernatural- An evil being, such as the devil may dwell within a person and control the body :

Demonology- Found in early records of many civilizations (ex china, egypt, greece)- Predominate perspective of 11th-15th Century

- Church interpreted these "threats" as demonic forces- 13-16C, people were obsessed with the devil.

- many people where put to death because of these thinkings ("witches, witchcraft", etc.)

- some people believed themselves to be witches/ could've been suffering from mental disorders- people used cultural belief to explain their thoughts and behaviours- detailed examination of notes taken during this era, shows that not all people who where "witches" had psychological disorders

- Forced confessions - more symptoms of mental illness in stressful circumstances

- Non-forced confessions in England as well

History of Psychopathology: The Somatogenic Perpective-Hippocrates (460-377BC) - Father of Modern Medicine

- Regarded the brain as the organ of wisdom- Deviant thinking indication of brain pathology- Provided an early classification system

- His model:Substance Place of Origin Mental HealthBlood Heart Labile MoodBlack Bile Spleen MelancholyYellow Bile Liver Irritability/ AnxiousnessPhlegm Brain Sluggish/Dull

- He outlined the treatment for these condition

a. a fine trip to the country side, b. blood leading (leeches), c. nutrition -> half boiled head of cabbage a day

- has not survived scientific scrutiny- Balance within chemicals needed for normal day to day functioning.- In 19th century

- Discovery of the cause of syphalis- people would hear voices and develop delusions- a # of mental patients would develop a steady deteriorations of

mental and cognitive functioning- In 1825 this deteriorations was designated as general perisious - many of the patients with this had earlier had syphallis - Therefore, it reactivated the belief that the cause of certain destruction of certain areas of the brain after certain infections, etc.

- A reactivations of the thinking that disorders go along with wither destruction or chemical changes in the brain

History of Psycholopathology: Asylums- Confinement began in 15th & 16th century C-Asylums were designed to hold beggars who were seen as psychologically ill- St. Mary of Bethelem became a place for confinement of those designated as insane- "Bedlam": a place of wild uproar, chioas and confusion- "Lunatics tower": patients rooms were in glass cases- Philipe Pannel: introduced moral treatment : main figure of moral treatment in asylum

- "removed the chains"- he was the first to argue that they were sick human beings and not beasts taken by the devil- thought people would get better by removing restrictions so patients could interact- moral treatment in asylum was a small treatment, mostly for the upper classes- one center who introduced this treatment was called: York Asylum, which becomes the model for other Asylum

- Patients were treated in York Asylum- cannabis, opium and alcohol- outcomes where not favourable

- We see the emergence of Asylums in Canadian cities in 1850s-60s-at the end of 19th century all provinces have at least one Asylum, first one was in quebec in 1845- conditions of asylums in canada modelled after earlier european ones

- chronic over crowding- sees pool discovered under building (toronto asylum)

Last Movement: Psychogenisis- 19th - 20th C-Mesmer: Austrian physician

- In Western Europe many people were suffering from historical disorders- Mesmer believed that these disorders were being cause my some kind of magnetic fluid- put people in hot tub with iron bars- Mesmer considered early performer of hypnosis

- Sharco 1825-1893- studying historical states- physical aspects of hysteria

- Breuer 1842-1925- vianese physician- treatment: "Anna O."; hypnosis, succeeded in getting her to talk more freely about past events

- release of some kind of pent up emotion- method becomes known as cathartic method

- relieves trapped emotional energy- 1895 - Studies in hystaria

- colaborator - freud

Lecture #2 - January 20 2012

Lecture 2(missed the first 10 minutes)Clinical assessment, different reliabilities (missed)Concepts that determine the value of clinical assessmentReliability: the degree to which a measurement is consistentValidity: the degree to which a technique measures what it is designed to

measureStandardization: application of certain standards to ensure consistency

across different measuresTypes of validityFace validity: appears to measure what it should measureIf the measure doesn’t make sense to the person completing it, they

probably won’t answer it correctlyContent validity: assesses all important aspects of the phenomenonConcurrent validity: test yields the same results as other similar measuresPredictive validity: test predicts behaviour it is supposed to measureConstruct validity: test measures what it is supposed to measureClinical interviewFirst the clinician does is focuses on the presenting problem. Then tries to understand if there were certain stressors going on at the time

of the development of the problem (detail life events and relationships as a source of stress and support).

Tries to document the correlation between stress and problemTry to document the range of physical illnesses that might be presentA lot of stress arise from interpersonal relationships

Document the range of social supports a person hasSome attention in the first meeting to the family background; how does the

family function; what the person’s role is within the familyConsider if there are any cultural factors involved in this person’s problem. Different problems have different prevalence rates in different cultures. Different disorders get expressed differently in different cultures. Certain disorders are only observed in specific culturesSometimes the first interview is enough to diagnose the problem but there

might be other types of information that the clinician wants to collect, depending on the context

Components of the mental status examMore formal interview where the clinician in a short amount of time (15-20

min) is asked to make a score on 5 or 6 dimensionsThe type of interview most people will receive if they go to an emergency

room1. Appearance and behaviourOver behaviour; attire; appearance, posture, expressionsActually appearance may give us clues as to what the clinical problem may

beDifferent disorders tend to be associated with certain presentations2. Thought processesRate of speech, continuity of speech, content of speechProcess of how someone communicates themselves and the content of what

is expressed3. Mood and affectMood: Predominant feeling state of the individual that they tend to

experience over time; predominant almost trait based patternAffect: feeling state accompanying what the individual says (at a given point

in time)Assessing quality of mood and affect – is it appropriate? Lack of expression = blunted affect4. Intellectual functioningType of vocabulary (number one predictor of intellectual functioning is use of

vocabulary)Use of abstractions and metaphors5. SensoriumAwareness of surroundings in terms of person (self and clinician), time and

place – “oriented times three” if they have all three aspects correct

General assessment that allows the physician to make a preliminary assessment of which areas of the person’s behaviour should be further examined

Starts to hypothesize what disorder the person may haveThe ABCs of observationBehavioural assessment: Going to see the person in their naturalistic lifeDirect observation to assess a person’s thoughts, feelings and behaviours in

a situationTrying to assess people’s difficulties in certain circumstancesObservational assessment focuses on:Antecedents: where does the problem tend to show up and with whom?

When does it show up? What are the contexts?Behaviour: what is the person’s actual behaviour following the antecedent? Consequences: emotional consequences for the personProblems: most people cannot actually go into people’s natural contextsSo, have them monitor their own ABCs at home/work/etcOnly psychologists can measure specific testsPsychological AssessmentProjecetive testing: rorshack inkblot test, thematic apperception test (TAT)Both based on the assumption that most people are not aware of their

thoughts and feelings (psychoanalytic concepts)Trying to measure thoughts and feelings that are unconscious to the personInclude variety of measure where ambiguous stimuli are presented to people

and they are asked to say what they see. The idea is that they will project out their own personality and unconscious conflicts onto ambiguous objects and people without even knowing it

Rorshack inkblot test:10 cards, 45 min to administer, 2 hours to score itResponses are coded according to an elaborate manualCategories that are being coded onContent being perceived: sexual content? Human figures?Location: whole blot as one picture or one particular area of the blot?Determinants being observed: colour? Movement? Shading?Widely used by scientific status remains highly controversialProblems: Reliability: two different clinicians might come up with two different interpretations, might be primed to activate things (low test-retest reliability), Validity: predictive validity? doesn’t give treatment directionsStandardization: most clinicians do not follow the same format in the way it

is administeredTends to classify normal individuals as pathologicalThe higher a person’s IQ, the worse their scores tend to beTAT: look at picture and tell a storyLow reliability, no objective way to code, low validity, no direction for

treatmentPersonality inventoriesDesire to come up with a personality inventory for clinician to assess

personality, maybe even in groupsMMPI-I (minnesota multiphasic personality inventory) and MMPI-II = most

widely used personality measureBased on the empirical approach; not based on theory so more objectiveMultiple choice questions (567), 18 or over, grade 8 reading level or more

Validity scales used to tell you if you are measuring what you want to measure

L scale (Lie scale): whether or not someone is apt to lying. Indication of whether the person is being truthful or not

F scale (infrequency scale): looking at whether someone is trying to look abnormal when they are normal

K scale (correction): trying to present self in favourable light even if they have a range of problems

MMPI-I: poor sample selection (upper, white middle class – non-representative), sexist wording, culturally insensitive

MMPI-II was developed and it used a more representative sampling basis (US sensus), changed the language and created a number of new scales

Excellent reliability and validityNeuropsychological testsAssess: receptive and expressive language, attention, concentration,

memory, motor skills, perceptual abilities, learning and abstraction3 test batteries that are widely administered1) Bender visual-motor gestalt test2) Luria-nebraska3) Halstead-reitanIf administer (2) and (3) together can accurately identify likelihood of brain

damage to 80% accuracyGood as a screening device but still hampered as problems of false-positives

and false-negativesNeuroimagingComputerize tomography (CT)Narrow x-ray beams are passed through the person’s head and amount of

radiation that is absorbed can be measured. Results in 3D structures of the brain

CT scan can reveal brain imagery, tumors, and other structural abnormalitiesProblems: being exposed to radiationPositron emission tomography (PET)Provides a picture of the activity of the brainDifferences between activity levels of specific areas of the brain between

people with and without psychological disorders (see which parts of the brain are active when they are experiencing their abnormalities)

Magnetic resonance imaging (MRI)Creates a magnetic field around the brain resulting in really detailed imagingUse MRO to study functionality and structural brain abnormalitiesLowest amount of radiationDSMWhen we’re diagnosing psych disorders there are two different strategies1) idiographic strategy: tries to understand a person’s problem by trying

to understand what is unique about that person (personality, cultural

background or circumstances)Most idiographic measure: ABC2) nomothetic strategy: information is gathered to determine a general

class of problems to which that problem belongs; seeing that person’s difficulties within a broader class

Ex. MMPIOur current diagnostic system is nomothetic (DSM). Most widely used

diagnostic framework in the worldDSM uses a prototypical approach. Identifies certain characteristics of the

disorder that have to be present for the diagnosis to be made. It allows for certain non-essential variations to exist that don’t change the classification.

First edition published in 1952Vague descriptions of problems couched in psychoanalytic termsBased on the identification of unconscious conflictsDSM-II in 1968: not much different than DSM-IReliability of first two were extremely lowDSM-III in 1980: changed the nature of diagnosisBecomes a-theoretical approach with no psychoanalytic principlesClear descriptions of all disorders based on symptom presentation (vs.

Unconscious problems)Can be used from clinicians in different theoretical approaches; isn’t based

on the causes of symptoms just simply the symptoms themselves

Multiaxial assessment: introduced by DSM-IIIAxis 1 – clinical disordersAcute?Axis 2 – personality disordersOr chronic?Axis 3 – general medical conditionsAxis 4 – psychosocial and environmental problemsConsider person’s life context Axis 5 – global assessment of functioningHow severe and impairing the functioning of the person are1994: DSM-IVHighlighted importance of social and cultural factorsStill a problem of overlap between disordersPerhaps still gender biases; certain genders are more likely to receive certain

diagnosis 2013: DSM-V (coming out next year)OCD will no longer be seen as an anxiety disorder but it’s own disorderPSD will no longer be coded as an anxiety disorder but a stress disorderHoarding will no longer be part of OCD but it’s own clinical problem

Lecture #3 - January 27 2012

Problems Associated with Researching Abnormal Psychology- bb

Components of a Research StudyHypothesis

- Null Hypothesis - no relationship between variables we are studying. ex. no relationship between stress and depression

- contingent on doing statistical testing- a result is considered significant if it will occur more than 5 times out of 100

Independent and Dependent Variables - Dependent will change, Independent we will manipulate to see if it can produce the change

Reliability - can it be replicated in different laboratories

Internal Validity - are you really measuring what you think your measuring/degree to which effects you have observed are really due to the independent variable your testing

- Confound - makes results difficult to understand and cannot be sure that result happened because of their independent variable- The Control Group - neutral group- Randomization - pick people randomly- Analogue Models - trying to make lab as realistic to the outside world as we can

External Validity - do the results of the study apply outside of the immediate study, can the results be applied generally

Effecticy Studies - is treatment going to look the same in different labs- by making a study more controlled, you lessen the generality of the study

Research Methods- The Case Study - measuring one person at a time and recording detailed info about that person- collecting historical and biographical information of one person

- symptoms, medical history, education/employment history, treatment history- describe a person in detail to solve clinical problems, used to test new

treatment or treatment method- 4 main reasons for publishing case histories

- description of rare or unusual phenomenon (ex. the many faces of eve)- provide novel methods of diagnosis and treatment- Disconfirm aspects of theory- Generation of hypotheses

- Epidemiological Research - study of frequency and distribution of a disorder in a population

- tells us the- prevalence rate: # of people with disorder at any given time- Incidence: the percentage of development of the disorder- Risk Factors: risk of developing a disorder

- Not theoretical, just documenting things at a very general level

-Correlational Method- Are variable X and variable Y associate in some way so that they vary together- Variables are studied as they exist naturally - no manipulation/contrast to experimental research where we do manipulate situations -

Steps:- Collect pairs of observations- Compute the Correlation Coefficient (r- -1.00 to 1.00): tells us both magnitude (how big), and direction (positively or negatively

associated)- Determine statistical significance

- Positive Correlation : / , Negative Correlation: \, Scatter: no association - When you have a perfect Correlation, it is in a straight line. As a scatter is formed; the two variables are not related- Correlation does not imply Causation

Experiments- Generally considered to be the best way to find causal relationships between two variables- Will be randomization of subjects

- Repeated Measurements - Measure the dependent variable once, introduce independent variable, then measure the dependent again

- problem with doing one assessment before and one after; the reseacher may miss some natural variability (before and after treatment)

- we should get multiple before and after to avoid to much variability- Another problem is TREND: if we had taken measurements before hand you can sometimes find there is already a trend (ex. participant already doing well in improving on her own without the treatment)

- Withdrawal Design - Asks a researcher to carefully measure the patient

situation before the treatment (baseline); treatment is introduced - multiple measures taken during treatment; treatment removed again, treatment is applied again and measured

- if change occurs in the treatment faze, reduces in reduction period, and occurs again in treatment -> treatment works! If it doesn't work the second time then we know something else was causing the effect

- Multiple Baselines - researchers start treatment at different times across different settings/situations

- problems occur until intervention is introduced; staggered. Easier to see that natural baseline continues until treatment/intervention is introduced. - we can contrast what happens in one situation to another until the

intervention is introduced.

Studying Behaviour Over TimeTwo different studies with time notion

- Cross Sectional Design - researchers take a cross-section of the population at a particular point in time

- ex. take three different age groups- ex. Anxiety Sensitivity Index ; Factor Analysis

- Longitudinal Design - study when young; then follow same persons throughout there life

ex. 7 up seriesex. Stanford students followed for 25 years; answering health/wellness, happiness etc. (certain types of smiles in follows = predict time of death)ex. studies during pregnancy predicting OCD and post pardum depression (12000 women across pregnancies across 40 hospitals) - Problems: expensive, time consuming, people dropping out of study/death leaving you with bias sample

Lecture #4 - February 3 2012

DSM-IV2 mood disorders: bipolar and unipolar

To be diagnosed as depressed you must be feeling down for 2 weeks straight: symptoms (major depressive/unipolar):

Diminished internal or pleasure in almost all activitiesDepressed mood for most or all of the daysignificant weight lose or weight gain (+/- 5 pounds)sleep difficulties:initial insomnia - problems falling asleepnot being able to sleep/wake up during the night - mid insomniagetting up at 5 in the morning and can't fall back asleep - terminal insomnia - related to

depressionminds are sluggishloss of energy - have to napall of a sudden feel like a failure/worthless -> stuck on one decision they feel guilty

about sometimes from years beforesuicidal thoughts/gesturesmost depressive episodes last for 4-5 monthsmust have 5 of these symptoms for 2 weeks to be diagnosed as depressedMajor depressive Disordermost commonly diagnosedtwice as common in womenreaccurent nature 80%Chronic condition >2 yrs in 15% of patientsMedian lifetime number of episodes = 4Average duration = 5 monthsSingle episode or recurrent (more then one separated by at least 2 months not being

depressed)Dyslymic DisorderPerson describes being depressed for most of the day (half the time)Mild mood disorderOver a two year period reporting, problems eating, sleeping, low energy, struggling with

feeling good about themselves as individuals

feelings of hopelessness not major depressive disorder but there is a stable low mood for 2 years, there cannot

be 2 months when they are feeling better or they cannot get the diagnosis of dyslexic disorder

Major depressive disorder in partial remission: major depressive episode with a low mood carryon for 2 years. Never fully recovered

Double depression: dyslexia comes first then followed by a major depressive episodeAcross the world, depression seems to be onset at earlier and earlier ages9, 10, 11 years oldwe know more and more about depression, so are we just identifying depression more

effectivelydepression tends to be underdiagnoseswho has the highest likelihood? : between ages of 15-24 = highest rates; lowest rates:

45-54

Video: Barbara's symptoms:suicidal thoughts/"end it all"recurrent major depressive episode (unipolar without psychosis): happening on

and off for yearssleeping for 2 days straightirritability / hopelessnessphysically lethargic, not wanting to get out of bed or showerstays in bed for days on and off / feeling heavy and slow and lazyshe hates herself (physically, emotionally, guilty) / guilty about things that she did in the

past six months in Duration; this episodethinking about how she wants to kill herself, afraid she wouldn't die and just be hurtfight of the impulse to kill herself. cries all the time insomnia: terminal # of times you've felt depressed in your life? she said "15-20 times" for "year and year

and a half at a time" she has had very productive times in her life/and felt good about it

Depressive Personality Disorder: people just generally have a depressive personality

Bipolar DisorderAlternate between depressive and manic episodes (emotional roller coaster)

Bipolar I: involves episodes of mania or mixed episodes that include symptoms of both mania and depression

diagnosis: prince of very irritable mood plus 3 other symptoms⁃ for a full 1 week period must have a very elevated/irritable moodGrandiose: extraordinarily special, powers, self importance is not justifiedDecreased need to sleep (around 2 hrs, or do not sleep at all, people can go 3-4 days

with no sleep)talk very quickly (pressing to speak)raising mind, thoughts are all over the place, can't keep up with own thoughtsDistractable RestlessConducting dangerous/impulsive behavioursOccurs more evenly between men and womenOnset in early teenage hood; more acuteBipolar II: depressive episodes alternate with hypomania episodesLess severe then bipolar IOnset in early 20s, early adulthood25-60% of people with bipolar disorder will attempt suicidePeople who are manic tend to crash into depressive episode

VIDEO:(Mary) bipolar disorderDepressedkill devilfeeling on top of the worldspecial relationship with jesus: shut downpsychotic depressionin depressed state firstNow in manic phaserestrictions because of her bipolar/ beat up husband"Incognito for the large"so happy/ on top of the world/ can i just talk!!Talking about death of her mother and starts laughingFeels good/ except when she can't sleepmesses around on her husbandshe hears voices (psychotic manic episode)morphadite: male and female mixed, both organsflight of ideas; jumps from one idea to anotherHer disorder is different from schizophrenia as in this disorder, hallucinations and

delusions occur without any abnormality in mood. Bipolar disorder does not discriminate; anyone can get this disorder

- Is the person presenting by atypical symptomsoversleeping, over eating, gaining lots of weightmelincolic (only related to being depressed) - tends to have a lot of physical symptomsloss of sex drive, weight loss, inability to experience pleasureoften seen in elderlymore biological oriented depressionchronic mood condition - 2 years or moreabsence of movement - catatonia5-15% of all mood disorders will present with psychotic featuresprognosis tends to be much pooreris this mood condition related to having a baby??postpartum symptoms show up really early - 2nd or 3rd day after birth10% of all birth result in post pardum depressive episodeif mother has had PPD with one baby 50% chance of having it again with another baby

Theories of DepressionDepression and mania tend to be episodic just like physical illnesses (biological causes)Both depression and mania represent disruptions in vital bodily functionsdepression and mania run in familiesdepression and mania respond to biological treamentsdrugs can remove depression and manic symptoms, suggesting biological causesGenetic abnormalities and disfunction in neurological systemsGenetic Etiology of DepressionFamily studieslook at prevalence of given disorder by looking at first degree relative - pro band - is

there increased rate of having disorder2-3 times higher with person in family with mood disorderproblem: can't look at environment of family/way family interacts that may be the reason

instead of geneticswhether or not the biological relatives of someone with a mood disorder is likely to have

a disorder even if they are raised by non-biological parentsAdoption StudiesTwin Studiesbest evidence for genetic related depressionmonozygotic and dizygotic twinsif genetic theories are correct we should see higher concordance rates when twins are

from the same egg then two different onesmore severe depression is more biologically loadedthere is an 80% chance that the identical twins will both have it (3x the likelihood of a

dizygotic twin)

Neurotransmitter Theories of Mood DisordersNorephinephrine: Seretonin:Dopamine these three neurotransmitter found in high concentrations in the limbic systemdepression/mania = changes in the amount of the neurotransmittersmore recent findings concentrate on how the sensitivity of the receptor sites effect moodtreatments are trying to change the sensitivity of the neurone (before it starts to be

helpful 1-2weeks)we don't know if the neurotransmitter is the cause or consequence of having these

mood conditionsNeuro-Endocrine Systemhormones effecting sleep, appetite, sexual drive, and ability to experience pleasurewhen stressed hypothalamus is activated an releases hormones such as cortosolgetting readypeople with chronic depression have shown that hyper activation of the hypothalamus,

even when stressure is removed it takes a long time for these people to bring their hypothalamus to a resting state

this leads to a deregulation of endocrine system

Sleep and Cercadian Rhythmswe can measure changes of sleep in depressed individualsnot getting slow wave sleeppeople who are depressed sleep at a much shallower levelMania: major factors that can trigger a manic state is lack of sleep

If we look at different antidepressants we can see that half of all patients will respondto an antidepressant

Psychodynamic Theory Unconscious conflict associated with griefFreud (1917) Mourning and Melancholiapotential for depression is created in childhood

fixation at early oral stage leads to excessive dependence on others to maintain self-esteem

anger turned into ones self - was proved wrongnot too much support

Behavioural TheoriesNegative Life eventsFollowed by the loss of positive reinforcersEmerging literature that people could go through a lot and not get depressedCognitive Therapy For Depressionpeople that go through terrible life events they are at higher risk of getting depressed,

but how they handle it is what determines whether they develop depression or not (at the cognitive level)

Negative appraisals can drive the low mood into a downward spiral of depression (BECK)

More he talked to depressed patients the more he noticed a cognitive patternCognitive Triad of Depression; people getting locked into a negative pattern of

thinkingled to a very testable hypothesis (activation of negative thinking pattern)90-95% of studies supports this theoryBeck: treatment should be developed to treat this pattern of thinking (CBT)BECK came up with manual on how to treat (therapy) the patient

Components of Cognitive Therapy for DepressionManual-based 15-20 session protocolEarly emphasis o non-specific factorsDeveloping collaborative relationshipCognitive strategies - Eliciting, testing and changing negative automatic thoughtsBehavioural activation- activity schedules etc.Cognitive strategies for schema changeFocusing on relapse preventionWe now have over 1000 studies in CBT to treat depression

Much greater degree of benefit continuing CBT after stoping medication - much less likely to relapse

Long term Effects of Cognitive Therapy, Medications, and Placebo

Patient responders that terminated CT were significantly less likely to relapse than responders that terminated medication

The CT group was no more likely to relapse than the patients conforming