IPT for Major Depression
Overview● Major Depression
○ Symptoms○ Subtypes○ Prevalence○ Risk Factors○ Comorbidities○ Maintenance
IPT○ What is it○ How does it work ○ Course of therapy○ Strengths and weaknesses ○ Directions for research
Symptoms for Major Depression
● Depressed mood ● Diminished interest or pleasure of activities● Loss of appetite or significant weight loss● Insomnia or hypersomnia ● Psychomotor changes● Fatigue● Feelings of worthlessness or excessive guilt
daily● Recurrent thought of death or suicide● Diminished ability to think or concentrate
Major Depression subtypes● Related disorders: dysthymia ● Subtype:
○ Seasonal Affective Disorder ○ Atypical Depression ○ Melancholia○ Organic Mood Disorder○ Post Partum Depression ○ Melanchoilic Depression
Major Depression● 12 month prevalence in
United States is 7%● 3 times more likely in 18-
29 year old compared to those 60+ years old
● Females 1.5-3 times more likely than men
Risk Factors for Major Depression ● Being female (Edward&William, 1995) ● Stressful life events (Ian H. &Constance L. , 2002)
Interpersonal Risk Factors for depression (Ian H. &Constance L. , 2002)● Interpersonal vulnerability to depression falls into three
categories: ● impaired social skills as a risk factor● excessive interpersonal inhibition ● excessive interpersonal dependency
Comorbidities 0n Major Depression● The great majority 95 % of patients with Major Depression Disorder suffered one or more comorbid disorders.● mental disorder● anxiety disorder● substance abuse● conduct disorder ● somatic disorders
Factors that maintain Major Depression
● Even after successful treatment as judged by symptomatic recovery, formerly depressed outpatients may continue to have occupational and sexual difficulties.
● Personal experiences : evidence of impairment and incompetence, and negative responses from family members represent personal experiences.
● Persistent fear of its return and a hypervigilance about the fresh emergence of symptoms or an incipient breakdown functioning.
● Depressed persons avoid again in the position of being unable to meet demands of work, school, and close relationships
Theory of the disorder● general model of mental disorders of IPT (see
graphic)● diathesis+stress+social context!● depression associated with social dysfunction
Depression Model of IPT (Klerman at al. 1984)
● attachment theory (Bowlby, 1969)
● stress related to depressive symptoms (Pearlin and Lieberman, 1977)
● impaired relationships mental disorder(Briscoe & Smith, 1973)
“Interpersonal vicious cycle”
Components of a depressive episode
1)Symptom formation→ coming from psychobiological mechanisms
2)Social and interpersonal relations→ based on childhood learning, social reinforcement, disrupted by life events
3)Personality problems→ predisposition to depression, inhibited emotional expression, problematic communication and self-esteem
Strengths and limitations+ dynamic theory/interactive theory+ explains maintenance of depression
- hard to pinpoint the exact cause of MDD
- hard to falsify
Overview of intervention● Interpersonal Therapy (IPT)● developed by Gerald Klerman in the
1970’s as a short-term treatment for depression (Klerman et al. , 1984)
● Designed for weekly sessions● typically 12-16 sessions
Course of therapy (Klerman et al. , 1984) Phase 1 (Session 1 - 3): ● review of symptoms, onset of depression● assessment of interpersonal functioning
→ connecting symptoms to specific problem area
● grief● role disputes● role transitions● interpersonal deficits
Assessment of problem areas (Klerman et al. 1984)
Course of TherapyPhase 2 (Session 4 - 11):● address specific problem area● develop skills and strategies
→ intervention according to specific interpersonal problem area!
Intervention at specific problem area● grief:
facilitate mourning, establish new relationships, offer temporary attachment, reconstruction relationships to dead person
● interpersonal role disputes:help identify the dispute, developing
alternatives, changing maladaptive communication,
monitoring interactions (also in therapy!)
Intervention at specific problem area● role transitions:
help to regard new role as positive, explore previous role, encourage mastery, help to initiate new relationships
● interpersonal deficitsidentify past positive relationships, guiding to
new relationships→ often requires long-term treatment!
Course of Therapy Phase 3 (Session 12-16)● recognizing and consolidating
therapeutic gains● supporting the patient with his
interpersonal relationships● pointing out painful and good aspects
of therapy ending
IPT Visual Dialogue ● Ruth 62 years of age● husband has passed ● lived a very isolated lifestyle, focusing mostly on husband● relationships with children were rocky, had a hard time letting
them grow and venture off*Ruth’s anticipation of rejection and her feeling that she wouldn’t enjoy other people’s company differed with what actually happened when others asked her to join them in their social events
Dialogue-Techniques● exploratory techniques
● encouragement of affect
● clarification naming the client’s feelings
● behavior change techniques
Strengths and limitations of the intervention+ relationships are important+ treatment manuals+ straightforward/easy to understand+ short-term treatment possible
- what about partners/reactions?- ???
Meta-analysis I: Medication vs. IPT● 9 studies● 947 patients● 488 randomly assigned to solely IPT● 459 randomly assigned to solely medicationREMISSION:Medication-51 %IPT-43.8%
Efficacy
EfficacyMeta-analysis II: IPT & Meds vs. Meds alone
REMISSION:● IPT plus medication-76.8%● Medication alone-67.7%
EfficacyMeta-analysis III: IPT vs. Placebo● 9 studies● 653 patients● 337 randomly assigned to IPT● 316 randomly assigned to PlaceboREMISSION:IPT-68.1%Placebo-48.7%
EfficacyMeta-analysis IV: IPT vs. CBT● 3 studies ● 204 patients● 102 randomly assigned to IPT● 102 randomly assigned to CBTREMISSION:IPT-56.1%CBT-47.1%
Effect SizeIPT & Control Group● 38 studies ● 4,356 patients● overall effect size 0.63 (95%CI= 0.36
to 0.90)
Effect Size IPT vs. other Psychological Treatments● 10 studies comparing IPT and other
treatments● effect size 0.04 ( 95%CI= -0.14 to
0.21)
Future of IPT● determine if there are more ways to make IPT
even more effective than the data already proves● test generalizability of IPT to other populations
and extend research to other disorders● Parental involvement in therapy with
adolescents “parent-child conflict” ● shortening the numbers of sessions
References Abela, J. R. Z, & Hankin, B. L (Eds.), (2008). Handbook of Depression in Children and Adolescents. New York, NY. The Gilford Press
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