Faculty/Presenter Disclosure In compliance with the Conflict of - - PowerPoint PPT Presentation
INSTITUTE FOR INTERPERSONAL PSYCHOTHERAPY Intensive 2 -Day Training Institute Dr. Ron Frey C. Psych. Consulting Clinical and Organizational Psychologist Cindy Goodman Stulberg, Dip.C.S.,C.Psych. Psychologist Info@ipt-institute.com
INSTITUTE FOR INTERPERSONAL PSYCHOTHERAPY
Intensive 2-Day Training Institute
Psychologist
Cindy Goodman Stulberg, Dip.C.S.,C.Psych.
Psychologist
Info@ipt-institute.com
www.interpersonalpsychotherapy.com
developed IPT in the 1960’s. Research into efficacy of SSRI’s for depression prompted them to ask about the efficacy of psychotherapy. The concept of researching therapy was unheard of at that time. They sought to articulate what was being commonly delivered by clinicians as supportive psychotherapy for depression. From that point they also incorporated interpersonal theory of Adolf Meyer and Harry Stack Sullivan and research that demonstrated life events significantly impacting the development and sustaining impact on depression (eg. death of a loved one, loss of job, divorce, etc.) In the United States, third party insurers paying for therapy were limiting the number
It was these factors that impacted the development of manualized therapy that could be taught, researched and discussed amongst clinicians. Video: the Harlow Experiments
Harry Stack Sullivan, Concepts of Modern Psychiatry
Before the understanding of how the external world affected mental health, the emphasis was on intrapsychic functioning. Common thinking was there must be something wrong with you, inside your head, a more biologic, personal failing, illness, problem. There was a big shift from assuming one was “crazy” to understanding the impact of trauma, abuse, systemic factors, cultural norms, racism, patriarchy, poverty, financial factors, etc., etc. Factors that we take for granted now a days as impacting mental health functioning.
Klerman & Weissman, 1993
the most treatable
major depression in the course of their lives
criteria for a mood disorder at some point during their lifetime, including 11.3% for depression and 2.6% for bipolar disorder
(Government of Canada, 2020)
Depression is a common illness worldwide, with more than 264 million people affected. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Close to 800 000 people die due to suicide every
Although there are known, effective treatments for mental disorders, between 76% and 85% of people in low- and middle-income countries receive no treatment for their
care providers and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants. Depression results from a complex interaction of social, psychological and biological
bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself. There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa. Source, World Health Organization, 2020
DIAGNOSIS OF DEPRESSION DSM-V Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.
sad, empty, hopeless) or observation made by others (e.g., appears tearful)
nearly every day (as indicated by subjective account or observation)
body weight in a month), or decrease or increase in appetite nearly every day
subjective feelings of restlessness or being slowed down)
nearly every day (not merely self-reproach or guilt about being sick).
subjective account or as observed by others)
specific plan, or a suicide attempt or a specific plan for committing suicide (cont’d)
Symptoms of Depression (continued) \ The symptoms cause clinically significant distress or impairment in social,
The episode is not attributable to the physiological effects of a substance or to another medical condition. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.
DSM-V Criteria Changes DSM-V removed what was known as the bereavement exclusion for major depressive episodes. Rather a footnote assists clinicians to distinguish between normal grief and a major depressive episode. DSM-V added premenstrual dysphoric disorder (PMDD), a severe form of PMS which is characterized by strong emotional symptoms such as depression, anxiety, moodiness and irritability.
“The Famous Five in ’29” - does a “Person” include a woman? 15
Children don’t typically have the vocabulary to express deep feelings of sadness and, instead, express their troubled mood through behaviours. The signs of possible depression in children and teens involve a noticeable change; a usually sunny child or teen becomes sad and withdrawn, school performance drops, hygiene suffers, friends are avoided and appetite is off. They may have angry outbursts and begin to abuse drugs and alcohol. The age with the highest rate of depression symptoms is those under 20. Teens with depression, especially, are at a high risk of suicide. Suicide accounts for 24% of all deaths among Canadian teens and young adults aged 15 – 24. Mid 70’s began identifying depression as a clinical entity in children and adolescents Children and adolescents reliable informants of their mental states Early intervention results in reduction in long term psychosocial morbidity Epidemiological studies unclear due to lack of clarity in definition of depression Great variability in prevalence rates 8.6% to 55.6% Most accepted rates are .4% to 5.7% -depressive disorders, 8.3% lifetime rate of major depression (Journal
DSM-V adds disruptive mood dysregulation disorder for 6-18 year olds who show persistent irritability and frequent episodes of extremely out-ofcontrol behaviour
Minor variations at different developmental stages Children more vegetative signs, adolescents more inner psychological experiences More suicide attempts than adults Adolescents resemble adults in depth of despair, hopelessness, propensity for suicide, accompanying anxiety and agitation Chronic and/or recurrent symptoms Significant psychosocial impairment particularly in interpersonal relationships Need for family involvement
Cont’d
Postpartum Depression
Postpartum depression is classified DSM-5 as Depression with Peripartum Onset. A person suffering from postpartum depression has to meet these symptoms of a major depressive episode: Depressed mood most of the day, nearly every day Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day Significant weight loss when not dieting or weight gain Insomnia or hypersomnia Psychomotor agitation or retardation nearly every day Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt nearly every day Diminished ability to think or concentrate, or indecisiveness, nearly every day Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt
Postpartum depression is diagnosed when the depressive episode occurs before or after the birth
Show Video Clip: https://www.maternalmentalhealthnow.org/index.php/stories?slg=nicoles-story
https://www.postpartum.net/resources/discussion-tool/
Postpartum depression, the symptoms are more severe/intense i.e. duration and frequency Withdrawing from partner and/or having difficulty bonding with baby Anxiety feels out of control and preventing sleep, even when baby is asleep Feelings of guilt or worthlessness overwhelming or begin to develop thoughts preoccupied with death/not being in this world DSM5 suggests postpartum depression be diagnosed in first 4 postpartum weeks, most clinicians and researchers use the six month or one year postpartum as the cutoff time for diagnosis Usually someone experiencing PD has risk factors including personal or family history of mood disorder; stressors such as marital dysfunction and demographic variables such as young age, minimal education, increased number of children and a history of child abuse
Majority of women experience at least some symptoms of the baby blues immediately after childbirth i.e. sudden change in hormones, combined with stress, isolation, sleep deprivation and fatigue
Either auditory or visual hallucinations Delusions Suicidal thoughts Thoughts of harming body Confusion and disorientation Sleep disturbances, paranoia Excessive energy and agitation
Postpartum psychosis is extremely rare, but incredibly serious. It involves delusional thinking that can include the new mother having thoughts of harming herself and/or her baby. Medical attention must be sought
Self report clinical measures of depression can be utilized at the assessment, termination phase or throughout the counselling process. They are helpful to both the clinician and client as added information to assess the severity of clinical disorder and functioning, to assist in treatment direction and planning and to monitor changes in symptoms
Depression scales
Beck Depression Inventory (BDI) The Beck Depression Inventory (BDI) is widely used to screen for depression and to measure behavioral manifestations and severity of depression. The BDI can be used for ages 13 to 80. The inventory contains 21 self-report items which individuals complete using multiple choice response formats. The BDI takes approximately 10 minutes to complete. Validity and reliability of the BDI has been tested across populations, worldwide. Center for Epidemiologic Studies Depression Scale (CES-D) The Center for Epidemiologic Studies Depression Scale (CES-D) was designed for use in the general population and is now used as a screener for depression in primary care settings. It includes 20 self-report items, scored on a 4-point scale, which measure major dimensions of depression experienced in the past week. The CES-D can be used for children as young as 6 and through
scale takes about 20 minutes to administer, including scoring. Hamilton Depression Rating Scale (HAM-D) The Hamilton Rating Scale for Depression, abbreviated HDRS, HRSD or HAM-D, measures depression in individuals before, during and after treatment. The scale is administered by a health care professionals and contains 21 items, but is scored based
Children’s Depression Inventory (CDI) The Children’s Depression Inventory is a modification of the Beck Depression Inventory for adults. The CDI is now on its second
and functional problems. Three separate rater forms are available: one for parents (17 items), one for teachers (12 items) and a self-report (28 items). Administration time is between five and 15 minutes. Children’s Depression Rating Scale (CDRS) The Children’s Depression Rating Scale (CDRS) was originally designed to measure changes in depressive symptoms in children ages 6 to 12, but its validity and reliability have also been demonstrated in the adolescent population (up to 18 years
structured interview with the child/adolescent. It takes 10 to 15 minutes to administer and score.
Depression Scales (continued)
Geriatric Depression Scale (GDS) The Geriatric Depression Scale (GDS) is specifically designed to screen and measure depression in
with cognitive dysfunction. Questions relate to how an individual has felt in a specified time frame. It takes five to seven minutes to complete the questionnaire. Depression, Anxiety, Stress Scales (DASS) The DASS is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. The DASS was constructed not merely as another set of scales to measure conventionally defined emotional states, but to further the process of defining, understanding, and measuring the ubiquitous and clinically significant emotional states usually described as depression, anxiety and stress. The DASS should thus meet the requirements of both researchers and scientist-professional clinicians. Edinburgh Postnatal Depression Scale (EDPS) The EDPS was developed for screening postpartum women in outpatient, home visiting settings, or at the 6-8 week postpartum examination. It has been utilized among numerous populations including U.S. women and Spanish speaking women in other countries. The EPDS consists of 10 questions and takes less than 5 minutes to complete.
IPT compared to other therapies
IPT is time-limited (12-16 weeks), not long-term. IPT is focused (on specific interpersonal related goals), not open-ended IPT concentrates on the here and now, not past interpersonal relationships (though the past is explored in the beginning phases of IPT therapy, particularly when constructing the Interpersonal Inventory) IPT is interpersonal, not intrapsychic, cognitive or behavioural (e.g., it does not turn inwards and focus on automatic or irrational thoughts). IPT recognizes personality traits, but does not focus on it. Personality disorders are better treated with longer-term models. IPT does not rely on formal homework assignments
Increased scientific evidence of the benefits of psychotherapy for depressed patients treated with IPT compared to controls associated with brain and psychological changes In one study, IPT was found to be effective in the acute treatment of depression and may be effective in the prevention of new depressive disorders and in preventing relapse In a group model for the treatment of postpartum depression, the study found that depression scores decreased significantly from pre-to-post treatment up to 6 months In a controlled 12-week clinical trial for adolescence, patients who received IPT-A treatment reported a significantly greater decrease in depressive symptoms and a significantly greater improvement in social functioning overall and with friends and dating relationships, a primary focus of adolescent life. Patients/MD. want to avoid medications during pregnancy and lactation if possible Potential adverse effects of untreated illness on mother, baby attachment et al. 10-20% incidence of postpartum depression (PPD) 50% of PPD starts during antepartum Increased risk of symptoms antepartum following loss
(Spinelli, 2002 and Mufson et al., 2007)
IPT believes that depression is comprised of three processes (Weissman et al., 2000):
neurovegetative symptoms are presumed to have psychological and biological
based on learned behaviours, social reinforcement, and competency.
individual’s predisposition to depression. These traits include inhibited expression
IPT addresses 1 and 2 not 3.
Interpersonal Psychotherapy connects interpersonal dysfunction with depression. By optimizing interpersonal functioning (e.g,. Recognizing, managing or changing your interpersonal style or learning the value of interpersonal relationships) will (as a secondary effect) improve your mood. In other words, Interpersonal Psychotherapy does not treat depression directly. It treats interpersonal dysfunction that indirectly improves mood (significantly).
Is active not passive Does not manifest a therapeutic relationship of transference Elicits affect, including negative affects like anxiety and anger Helps the patient to explore options (rather than offering direct advice, this is often best accomplished by asking questions that allow patients to describe their own options) Provides psychoeducation and corrects misinformation about depression Helps the patient develop resources outside the office
(Weissman et al., 2000)
Role of the IPT therapist (continued)
One key role of the IPT therapist is to develop a patient awareness that there is a connection between how they relate to others and their mood. That the quality of interpersonal relationships has a significant impact on their mood. The role of the IPT therapist also includes: Empathetic listening, which provides support and a safe outlet for the patient's feelings. Encouragement of affect, which is a process that will let you experience unpleasant or unwanted feelings and emotions surrounding your interpersonal issues in a safe therapeutic environment. When you do, it becomes easier to accept those feelings and emotions as part of your experience. Clarification, which is a technique for helping the patient examine his or her own misconceptions about interpersonal issues (e.g., unresolved grief, disputes, life transitions or a history of interpersonal isolation) Role playing Communication analysis
symptoms and make a diagnosis
need for physical examination.
(Interpersonal Inventory)
interpersonal focus
Websites
www.feelingbetterthebook.com www.interpersonalpsychotherapy.com
Administrative Office 33 Collinson Blvd. Toronto, Ontario M3H 3C1 Email: cindystulberg@gmail.com Phone: 416-736-6809