Examine biomedical, individual and group approaches to treatment,
Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder



Explanation: The biomedical approach to treating anorexia nervosa and major depression is to stabilize brain chemistry of the patient; psychiatrists in this field believe that the brain chemistry is the cause to many mental disorders.

Anorexia Nervosa
  • Hospitalization to prevent death, suicide, and medical crisis.
  • Weight restoration to improve health, mood, and cognitive functioning. Note: An anorexic's fear of weight gain, especially forced weight gain in hospital, is a huge obstacle to treatment and recovery. Nevertheless, it is clear that the closer to normal weight is at the end of treatment, the better the chances of complete recovery. In study after study, low body weight is strongly correlated with treatment failure and relapse
  • Medication to relieve depression and anxiety
  • Dental work to repair damage and minimize future problems
  • Nutrition counseling to debunk food myths and design healthy meals
Major Depression
Electroconvulsive Therapy
Electroconvulsive therapy is a therapy which inputs electric currents into the patient’s brain. The electric currents then induce seizure towards the patients, which makes neurons fire rapidly, increasing metabolism within the brain. This process may be painful, but modern day doctors use anesthetics and sedatives so patients won’t feel any pain.
Doctors do not actually know how this process works, but patients with severe depression who do not respond to other therapies usually experience some recovery through this process.
-Side effects that may occur to some patients are loss of memory prior to the ECT and headaches but usually recovers a couple of hours after the therapy.
-Describe and evaluate two studies on the effectiveness of the biomedical approach to treatment of either major depression or anorexia nervosa

For Major Depression
Name and year of study
Kirsch et al (2002)
Aim
To find out whether new generation anti-depressants Selective Seratonine Reuptake Inhibitors (SSRI) is effective in treating depression or not.
Research method
Experimental
Procedure
Using the Hamilton Scale for Depression on patients of different severity of depression taking the SSRI and placebo to see if the SSRI is effective or not.
Findings
The effects on the SSRI did not seem effective on patients with mild and moderate symptoms of depression; only severe depression patients experience some positive effects.
Conclusion
Methodological strength
- Make people more aware of the real effects of the new generation drugs.
- Ecological validity is high as drugs are being tested for their real effects.
Methodological weakness
- Employed too many participants of the milder depression with fewer participants with severe depression. Creates a bias. (Low generalizability.
- Some drugs experimented were still in the experimental phase, and not yet approved by the FDA.
Ethical considerations
- Requires human testing on drugs, but consent was given.
For Anorexia Nervosa
Name and year of study
Kaye Et Al (UCSD)
Aim
The aim of this study is to find out whether Anorexia Nervosa is caused by abnormal brain functioning.
Research method
Study
Procedure
13 women with anorexia in remission and 13 women with no eating disorder were instructed to play a computer quiz with quizzes that activate different parts of the brain. The functioning of the brain is observed with fMRI.
Findings
- A region in the brain called the anterior ventral striatum becomes more active in healthy women when they winning a game, whereas in anorexic women, the differences of the activity of the AVS was quite low.
- Another region in the brain called the caudate became more active in women with anorexia in remission when quizzes appeared. They were more anxious with their decision making and tried to find rules when the quizzes themselves had none. This symptom, if more severe, may become OCD.
Conclusion
Anorexia nervosa is considered abnormal brain activity, therefore considered a mental illness. This means it is not only contributed by only cognitive processes of the brain, but more of the biological processes.
Methodological strength
- Paves a new aspect of biomedical study in the anorexic field
- Use of a controlled, scientific method: biological processes in the brain using advanced technology.
Methodological weakness
- Sample size only consisted of women in remission or was healthy, but does not contain women who were still having anorexia, therefore low on generalizability.

-Explain individual approach to treatment of anorexia nervosa and major depression, using two therapies (e.g. cognitive therapy, client-centered therapy)
Rational Emotive Behavior Therapy (REBT)
- Pioneered by Albert Ellis, REBT focuses on the belief that all disorders are based on an irrational belief on an event and that they should be cured with a rational argument which will relive the individual of the consequences of irrationality.
- The ABCDE Model
- A - activating event that causes the problem
- B - beliefs that are irrational
- C - consequences of such beliefs
- D - disputing the belief with a more rational and healthy belief
- E - effort of disputing the belief, putting things into action

Major Depression
- Tackle the source of the problem by pointing out the flaws in the thought process (the irrational belief), and suggest a more rational, logical belief to replace the irrational one. The disputing belief, however, have to be tailor-made for different client because the activating event for varies from patient to patient.

Anorexia Nervosa
- Dispute the irrational perception of the client's body image by offering a more rational one by methods such as showing the patients a photograph of an actual model and compare the model to the patient in order to change their beliefs that they are "too fat" when they are actually too skinny in reality.

Cognitive therapy
- Treatment of thoughts and thought process
- CT believes that people with depression have negative thoughts of the self, world environment, and the future.
- CT helps people get rid of self-defeating thoughts and to solve problems.
- Process: analyzing the patient then trying to change thinking that is unfounded or negative because they may lead to depression, phobias, obsessions or other disorders.
o Such as…meditation/mindfulness, thought stopping, self distancing.
- How CT is used to treat patients with depression
Cognitive restructuring – replacing faulty thinking with more accurate beneficial ones: involves the patient to gain awareness of bad thoughts/habits, learn to challenge the bad thoughts/habits, and change their life style to one that enhances thoughts and believes.
- How CT is used to treat anorexia nervosa
The therapist must develop accepting and warm relationship with the patient since most anorexic patients do not want treatment. The therapist will have to accept the patients’ belief about their body image. They can question the patients and giving suggestions on how to deal with problems in life and let them experiment with them.

In the 2004 Goldapple Study, PET scans of 14 cognitive therapy patients before and after then therapy were taken over the course of 7 weeks, 15-20 therapies were involved. PET scans of participants taking antidepressants were used as a control group. Goldapple concluded that cognitive therapy yields a similar result to that of the antidepressants where activities in the prefrontal-hippocampal pathways increased.

Goldapple’s study is quite systematic, but the patients might develop some uncontrolled level of stress when they are being scanned with the PET machine which might have distorted the findings slightly.
Similarly, the 1991 Lyon and Woods study compared the effectiveness of 70 cognitive therapy reults with other types of psycho therapies. The study showed the cognitive therapy showed the greatest improvement of the patient’s conditions, however, the effectiveness also depends largely on the therapists’ experience as well as the duration of the therapy.
The study has a few flaws that should be addressed, such as possible researcher bias, since the results are based mainly on observations. Secondly, the study is quite reductionistic; it focuses on only one factor, the cognitive factor.

Cognitive-behavioral therapy (CBT) : treatment for adult/children with depression
- Focuses on current issue/symptoms
- 12-20 weekly session, daily practice (to help client use new skills on a day-to-day basis)
- CBT is based on cognitive therapy + behavioral modification

-
Riggs et al (2007)
- Aim: Study of effectiveness of CBT in combination with placebo or an SSRI
- Sample: Randomized double blind study with 126 adolescents (13-19) who suffered from depression/ substance use disorder
- Participants recruited from juvenile justice systems/ social service
- Problem: could not follow 6, 12 could not complete (got into jail), 2 withdrew
- Procedure: cognitive-behavioral therapy with placebo was given to a group of participants while CBT and SSRI (a type of medicine) was given to the other group of participants
- Findings: CBT + placebo = 67% “very much improved”, “much improved”
- CBT + SSRI = 76% “very much improved”, “Much improved”
- Self report of participants showed that their depression has increased and their other behavioral problems too
- Conclusion: CBT + drugs is effective, CBT is almost as effective
- CBT techniques helped them manage negative thoughts and feelings that can trigger substance use
- Treatment could start with CBT alone, if the participants does not response a drug use from the SSRI group should be added
Strenght: Cost-effective – does not involve a long treatment

- found that they CBT + drug most effective for chronic depression (caused by childhood experiences)
Weaknesses:
- Focus on symptoms rather than causes
- Provide clients with strategy for self help : less manipulative than other treatment
- Therapist could make judgment about which thoughts are acceptable
- Personal information of client could be leaked

Group treatment of major depression and anorexia nervosa

-group participants with the same experience
-meet every week
-share experiences
-support and motivate each other to comply with treatment

Depends on the type of the group, they can be classified into 4 types:

Classification of group methods


Highly specific therapeutic goals
Non-specific therapeutic goals
High level of leader activity
-structured group programs in centers for drink and drug dependence
-activity groups, including occupational therapy
= activity groups
-problem-solving and psycho-educational groups for homogeneous populations
= problem-solving and psycho-educational groups
Low level of leader activity
-psychodrama, drama and music therapies
-short-term dynamic groups
-systems-centered groups
= psychodynamic groups
-support groups, art therapy groups
-psychotherapy groups, interpersonal therapy, Tavistock groups, group analytical therapy
= support groups

Activity groups (opposite of support group)
-engaging patients in a form of focused activity or work
*help to develop social skills and address hidden anxieties and also create a sense of togetherness

Problem-solving and psycho-educational groups
-group made up of individuals with similar problems working towards clearly defined aims
*the emphasis is on shared learning; with some modeling of the group leader; unconscious dynamics are not explored and the group itself is not viewed as a therapeutic force for change

Support groups (opposite of activity group)
-provide a psychosocial network and offer opportunities for problem-sharing
-patients with chronic mental and physical illness for whom a more exploratory dynamic form of therapy would not be indicated
-aim is to maintain homoeostasis: change is not expected and any that occur is gradual

Psychodynamic groups
-aim to create a lasting personality change brought about through non-directive free association (the therapist will not ‘lead’ the group in an obvious way – the stance of the therapist allows unconscious dynamics between group members to be examined and personality change to be achieved in the working through of new understandings within the transference (redirection of feelings) and counter-transference material

Two studies on the effectiveness of the group approach to treatment of either major depression or anorexia nervosa

Name and year of study
Can group therapy help treat depression among HIV/AIDS patients? (By counselors from World Vision, and researchers from Johns Hopkins University, Columbia University - 2004)
Aim
Can group therapy help treat depression among HIV/AIDS patients?
Research method
Comparative study
Procedure
-classified patients with HIV/AIDS into 15 groups with 12 people each group (total of 144)
- patient with extreme suicidal thoughts were not
-created another control group of patients (do not participate in the group therapy)
allowed in the study
-group therapy which last 90 minutes once per week for 4 months


Finding
-6.5% of the group therapy still had major depression
-54.7% that did not participate in the group therapy still had major depression
Methodological strength
-supports how group therapy is effective
-no ethical issue, participants participate on their willing nesses
Methodological weakness
-the degree of depression in each group was different (could cause the data to be inaccurate)
-participant might lie or else they would feel bad that they ruined the doctor’s therapy
-difficult to replicate and time consuming
-might be other factors during the 9 months that changed the patients’ thinking
-group therapy relies on the patients to confront to their problems, support each patients in the group, and develop themselves
-required experienced psychologist to perform a well structured group therapy
Ethical considerations
-friendly environment, participants can talk openly

Name and year of study
Wilson, G.T., Fairburn C.G. & Agras W.S. (1997)
Aim
Compare the effectiveness of group therapy versus individual therapies for anorexia patients
Research method
Comparative study
Procedure
-3 types of individual therapies were used; cognitive therapy, psychodynamic therapy and behavioral therapy on patients with anorexia for 5 years
-group therapy was used on patients with anorexia for 5 years
Finding
-group therapy had a higher success than the 3 individual therapies
-18 months, 68% of patients stopped binge eating and purging
-Compare to other therapies
Behavioral therapy = fast effect but short-lived
Cognitive therapy = slow effect but improvements did not deteriorate
- 48% of patients in behavioral therapy dropped out due to lack of improvement after 1 year
After 5 years, percentage of self denial to binge eating and purging were:
Cognitive Therapy: 44%

Psychodynamic Therapy: 52%
Behavioral Therapy: 18%
Methodological strength
-supports how group therapy is effective
-no ethical issue, participants participate on their willing nesses
Methodological weakness
-the degree of depression in each group was different (could cause the data to be inaccurate)
-participant might lie or else they would feel bad that they ruined the doctor’s therapy
-difficult to replicate and time consuming
-might be other factors that changed the patients’ thinking during the period of the experiment
-group therapy relies on the patients to confront to their problems, support each patients in the group, and develop themselves
-required experienced psychologist to perform a well structured group therapy
Ethical considerations
-friendly environment, can talk openly