PSYCHOSOCIAL INTERVENTION FOR CHILDREN AND ADOLESCENTS WITH

DEPRESSION

Mr. Praful Prabhuappa Kapse

OUTLINE

Introduction - Psychosocial intervention Depression– common features Case vignette Assessment Intervention

WHAT IS MEANT BY PSYCHOSOCIAL INTERVENTION?

Most basic level - psychosocial

Psycho – psychological aspect of our experience. Refers to our feelings, thoughts, desires, belief, values and how we perceive ourselves and others.

Social – refers to the our wider social experience i.e. our relationships, traditions and culture.

Both aspects are closely intertwined and influence each other.

PSYCHOSOCIAL INTERVENTION

Psychosocial intervention is an approach aimed at improving people’s well-being. Acknowledges:

Psychological well-being of the individual

Knowledge and skills of the individualSocial support Culture and values that influence individual’s experience

DEPRESSION – COMMON FEATURES

Depressed or irritable mood most of the day, nearly every day

Markedly diminished interest or pleasure in all activities

Significant weight loss Trouble sleeping Restlessness Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive guilt Recurrent thoughts of death, suicidal thoughts or

suicide attempts

CASE VIGNETTE

Mr. A, 12 year old boy, from low-socioeconomic background, presented to NIMHANS, with the complaints persistent sad mood, death wishes, irritability, diminished daily activities, etc.

ASSESSMENT

Temperament history Family environment Social environment Emotional environment Traumatic events Faulty adaptation

PSYCHOSOCIAL INTERVENTION

1. Psycho education2. Cognitive & behavioral strategies 3. Social skill training4. Sleep hygiene 5. Interpersonal Psycho therapy 6. Group therapy 7. Rehabilitation

PSYCHO EDUCATION

Education about mental illness For their social support network To help them to understand and deal MI To prevent or plan relapse

COGNITIVE BEHAVIORAL STRATEGIES

Cognitive strategies 1. Distraction Technique2. Counting ThoughtsBehavioral Strategies3. Monitoring Activities4. Scheduling Activities5. Graded Assignment

COGNITIVE BEHAVIORAL STRATEGIES

Identifying Negative Automatic thoughtsThe self (I am useless)Current experience (nothing I do turn out

right)The future (I will never get better)

Testing Negative Automatic thoughtsVerbal Challenging Behavioral Experiment

Draw Conclusion

EVIDENCE BASED PRACTICE IN CBT

Early studies with sub clinical populations by Show 1977; Taylor and Marchall 1977 and single case series by Rush, Khatami, and Beck in 1975 show the following results of cognitive behavioral therapy for depression

Immediate effect of CBT Preliminary evidences show that interventions designed

to reduce the frequency or intensity of depressing thoughts can have an immediate beneficial effect on mood. These include distraction and challenging (Teasdale and Reizin 1978; Deviws 1982 Fennel and Teasdale 1984; Blackburn and Bonham 1980)

Post treatment effect of CBT Studies assessing post treatment outcome reliably show

cognitive behavioral therapy to be as effective in reducing depression (Rush, Beck, Kovacas, and Hallon 1977, Blackburn et al.1981 Hallon, Evans and DeRubbeis 1983)

Long term effect CBT may be more effective in preventing relapse than

anti-depressant drugs. (Kovacas et al. 1981; Hollon et al; Simons, Murphy, Levine and Wetzel, 1986)

SOCIAL SKILLS TRAINING

To help persons in relating to people Especially when they have difficulty in that Verbal skills Nonverbal skills Expression ability Understanding cues and contents

COMPONENTS OF SOCIAL SKILLS

Nonverbal behaviors: eye contact, facial expression, posture,

use of gesture, body orientation, interpersonal distance.

Paralinguistic skill: loudness, tone, pitch, affect, rate of

speech, clarity of speech, duration of utterance.

Verbal content: verbal massage, choice of words,

appropriateness of self disclosure.

Interactive balance: smoothness of turn-taking, use of social

reinforces (e.g. reflective listening skill), balance of time

taking.

TECHNIQUES OF SOCIAL SKILLS

Instruction Role playing Feedback Reinforcement Back chaining

INTERPERSONAL THERAPY

Developed by Gerald Klerman, This therapy is based on two assumptions.

1. current interpersonal problems are likely to have their roots in early dysfunctional relationships

2. current interpersonal problems are likely to be involved in precipitating or perpetuating the current depressive symptoms

EVIDENCE

Study of interpersonal psychotherapy versus supportive psychotherapy for dysthymic patients

Subjects with primary DSM-IV dysthymic disorder were randomly assigned 16 weeks of IPT. Patients in both treatments reported improved depressive symptoms

Department of Psychiatry, Weill Medical College of Cornell University, New York, New York 10032, USA.

GROUP THERAPY

Group psychotherapy is a treatment in which carefully selected persons who are emotionally ill meet in a group guided by a trained therapist and help one another effect personality change.

EVIDENCE

More than 300 depressed parents participated in group therapy sessions for eight weekly meetings. Through 90-minute group session

Throughout the eight-month study, rates of new depressive episodes were lower among those receiving therapy compared to those in traditional care. – 21.4 percent vs. 32.7 percent, respectively.

The Journal of the American Medical Association, 2009;301:2215-2224

GOOD SLEEP HYGIENE

Protect your need for sleep Ensure that 7.5-8 hours set aside for sleep every

day Keep regular sleep hours

an irregular sleep schedule messes up biological clock and can make getting a full night’s sleep more difficult

go to bed at the same time every night and get up at the same time every morning

Thank You