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Problem solving & behavioural activation

“ No act of kindness, however small, is ever wasted. ” - Aesop

Here are a series of forms, questionnaires and handouts that I use regularly in my work.  The problem solving diagram is a recurring theme - both at the start of therapy and as a sheet to return to when reviewing and considering additional therapeutic options.  Other sheets are classic variants on the tools used by many cognitive behavioural therapists - with occasional alternatives and additions, that I've come up with over the years, thrown in as well.

Depression assessment

Do you want to hear my favourite procrastination joke?  I'll tell you later.

- Piers Steel

Depression assessment scales come in two basic forms - interviewer/clinician rated and sufferer/patient rated.  As stated in the background information on the IDS/QIDS questionnaires (see below) "There are several accepted clinician rated and patient self report measures of depressive symptoms. The most commonly used clinician rated scales are the 17, 21, 24, 28, and 31 item versions of the Hamilton Rating Scale for Depression (HRSD) (Hamilton 1960, 1967), and the 10-item Montgomery-Asberg Scale (Montgomery and Asberg 1979). The most frequently used self-reports include the 13, and 21 item version of the Beck Depression Inventory (BDI) (Beck et al. 1961), the BDI-II (Beck et al. 1996), the Zung Depression Rating Scale (Zung 1965), the Carroll Rating Scale (CRS) (Carroll et al. 1981), and the Patient Health Questionnaire - 9 (PHQ-9) (Kroenke et al.

Depression information

Keep on sowing your seed, for you never know which will grow - perhaps it all will.

- Einstein

Here are a few handouts that I've put together over the years to provide background information about depression.  The development/maintenance diagram is probably the handout here that I use most - both to explain issues about depression and also for many other psychological disorders as well. 

Some interesting articles from February ‘08

Here are details and links for a couple of dozen mainly February articles that I found interesting. Most of these articles (and many others) are also listed on my searchable Connotea online database.

Barbui, C. M. D., T. A. M. D. Furukawa, et al. (2008). "Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials." CMAJ 178(3): 296-305. [Abstract/Full Text]
Blakely, T., M. Tobias, et al. (2008). "Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies." BMJ 336(7640): 371-375. [Abstract/Full Text]
Bradley, R. G., E. B. Binder, et al. (2008). "Influence of Child Abuse on Adult Depression: Moderation by the Corticotropin-Releasing Hormone Receptor Gene." Arch Gen Psychiatry 65(2): 190-200. [Abstract/Full Text]

Are antidepressants useless? – recent research

"The truth is rarely pure, and never simple"  Oscar Wilde

There has been a lot of media publicity about the article on the value of antidepressants by Irving Kirsch and colleagues which was published in PLoS Medicine last month (Kirsch, Deacon et al. 2008). The authors wrote "We obtained data on all clinical trials submitted to the US Food and Drug Administration (FDA) for the licensing of the four new-generation antidepressants for which full datasets were available. We then used meta-analytic techniques to assess ... effects of initial severity on improvement scores for drug and placebo groups and on drug-placebo difference scores." The four antidepressants studied were fluoxetine, paroxetine, nefazodone and venlafaxine.

Diagnosis of psychological disorders

“ How you do anything is how you do everything. ” - Zen Proverb

Making a formal psychological diagnosis can be a mixed blessing. It has several potential advantages. If many of my symptoms can be accurately grouped under a specific psychological diagnosis, it may well help to understand what is happening, to clarify the likely time course of my symptoms, and to choose treatments that have the best chance of being effective. It's worth noting that often people suffer from more than one psychological disorder at the same time - this is called comorbidity and it is common.

Both negative & positive emotions can be functional or dysfunctional

Unpleasant, negative emotions can be highly functional. For example, anxious hypervigilance in a dangerous situation can keep me on my toes, very aware of potential threats and more able to react rapidly and appropriately. Healthy anger when I am being taken advantage of can help me respond strongly and assertively to protect my rights. In her book "Productive & Unproductive Depression" the psychotherapist Emmy Gut suggested that even depression can at times be functional. She wrote " ... in the wilderness in which the human race developed its current genetic characteristics, individuals who had the capacity to respond to dangerous or otherwise significant circumstances with an adequate set of emotions, and acted accordingly, had a better chance to survive, to have children, and to raise them than individuals who were deficient in that respect."

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