but never receive the shock treatment. There is a placebo effect with ECT (as you would expect with any form of treatment for depression) however, placebo ECT falls well short of genuine ECT in its effectiveness. This provides evidence for the validity of ECT as a form of treatment.
De Vreed et al (2005) found that the following groups respond best to ECT:
Side effects and other evaluation points
The most widely reported is memory loss. This has been reduced since ECT was administered to only one hemisphere of the brain. In fact the treatment is most effective when given bilaterally (across both sides) but the memory loss that followed was considered too great a risk. Memory loss is reported by a bout a third of patients.
Nearly a third of patients report long lasting fear and anxiety following the procedure.
Cognitive processes also slow for a number of weeks or even months, following the procedure. Although most psychiatrists seem to think these risks are worth taking, others, most notably Peter Breggin, believe that the treatment is not as effective as widely stated and that the side effects are more severe than most practitioners admit. Breggin (1997) has found little evidence to show that the beneficial effects last longer than four weeks.
The WHO guidelines (2005) clearly state ‘"ECT should be administered only after obtaining informed consent." In the USA doctors should make the patient aware of the risks and the number of treatments that are likely to be needed. Patients are also told of their right to withdraw from the treatment at any point during the course of shocks. In the UK the situation seems to be ‘less formal.’ The British Journal of Psychology (2005) found that only half of patients felt they had received sufficient information in advance.
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Beck's Theory also includes the fact that these negative cognitions are fueled by distortions of rationale, such as all-or-none reasoning, selective abstraction, and overgeneralization. Beck's Cognitive Model of Depression shows how early experiences can lead to the formation of dysfunctional beliefs, which in turn lead to negative self views, which in turn lead to depression.
T1 - Cognitive-stress-diathesis Models of Suicidal Behaviour
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Bifulco et al (1992) found that children who lose their mother are more likely to develop depression in adult life. However, they themselves conclude that this is more likely due to a drop in parental care than it is down to the loss itself.
Loss is a factor in relatively few cases of depression (probably as little as 10%). So what causes depression on the other 90%?
Generally speaking, psychoanalysis has not been successful at treating depression, suggesting the theory behind the treatment lacks validity. However, as we shall see, Psychodynamic Interpersonal Theory (PIT) is an exception to this, particularly when the depression results from dysfunctional relationships with others.
Freud also offered an explanation of bipolar disorder. The depressed phase is due to the Superego gaining overall control of personality and creating an overwhelming feeling of guilt and unworthiness. Eventually the Ego strikes back (part three of the trilogy obviously J) and is able to regain control of personality, but in so doing swings the balance too far the other way producing the manic backlash. This then leads to a further counter attack by the Superego producing alternating mood swings.
Cognitive explanations of depression can broadly be split into two:
We’ll look at the first category for starters:
It should come as no surprise that these are combined; i.
Paulo Knapp I; Aaron T Beck II, III
This coincides strongly with Beck's Model of Depression and the large problem of female depression in western society. Another interesting study compared Beck's Cognitive Theory against the hopelessness theory of depression in predicting depression in adolescents, done by Lewinsohn et al (2001).
Overview of Beck's Cognitive Theory of Depression
"Contrary to the widespread understanding of perfectionistic attitudes as a clear-cut representation of the self-related features of perfectionism, socially prescribed perfectionism--not self-oriented perfectionism--was most strongly related to perfectionistic attitudes." (Hewitt et al., 2003, p.383) In this case Beck's theory has been expanded with another theory in the field of cognitive psychology.