Interpersonal Psychotherapy for Depression and Emotional Disorders - Essay Example

Psych688 s Describe how the IPT Model proposes that one becomes depressed. Review the psycho-educational components of IPT (mood state associated with interpersonal losses, medical condition, temporary assumption of sick role etc) and describe the assessment and interventions for the 4 interpersonal focus areas. Give examples. The IPT model’s definition of depression is simple and clear to understand. According to the IPT model two basic principles define the ways in which one maybe depressed. An IPT therapist may define depression as one of those common medical problems which shows predictable symptoms and can be easily identifies and managed, In this manner, the therapist succeeds in decreasing the patient’s anxiety over the illness and prevents him from becoming more depressed with his present state. However, the therapists already assumes that the etiology of the problem is complex and is possibly a result of interaction between factors such as life history, important event, health etc. Secondly, a patient’s current or past life history plays an important role on his depressive behaviour. Stressful events have the ability to modify a person’s mood and behaviour and make him more vulnerable to current situations. IPT can be used a successful tool for treating depression at any stage of life (Schaik et al, 2007). IPT being a time limited treatment has several components which increases the treatment’s efficacy. Psychoeducational components of IPT IPT being an interpersonally focussed and psychodynamically informed psychotherapy consists of a few psychoeducational components (Robertson et al, 2008).The psychoeducational components of IPT treatment are basically tackled in the initial phase of treatment itself within the first few sessions. Diagnosing Major depression- The therapist first reviews the depression according DSMV or ICD-10 and also looks into any history of depression that the patient might have. The therapist needs to be sure that the patient has MDD. In the initial phases the therapists provides psychoeducation to the patient telling him about depression, its symptoms and how it affects one’s personal and social life. This helps the patient to understand his/her own depression symptoms and manage them in a much better manner. The therapist may also consider prescribing medication to help in the treatment process. Sick Role One of the psychoeducational components of IPT treatment includes the sick role where the patient is given a sick role by the therapist. The sick role is a temporary role that the therapist gives to his patient to help the patient realize that he/she is suffering from a problem and identify the associated symptoms. This helps the patient to not blame his/her self. Bestowing the sick role also makes the patient more aware of the health status and makes him/her more responsible towards working for treatment. The therapist also includes educating the patient about depression and the various problems associated with depression. He furthermore may help the patient explore ways in which the patient can reveal the emotional disorder with his/her family and friends and seek support. Interpersonal inventory IPT treatment requires a thorough review of the patient’s history, current social status, relations, relation patterns, expectations from relations etc. The interpersonal inventory helps the therapist to understand his patient more closely and analyze the way in which his patient behaves in the social settings. This information also sheds light on what relations or events could have contributed to the patient’s present mental status and also how the patient’s present state of mind may be affecting his/her interactions with others. The interpersonal inventory gives the therapist a look into the patient’s actual and potential ability to form relations. This requires the therapist to ask detailed questions to the patient about his/her past and current relations. Such questions may include – Who is your present boyfriend/girlfriend? Describe your relation with your spouse. Do you miss your ex? What is your relation with your sister? What do you like or don’t like about her?, etc Such questions make it easier to identify the patterns in the patient’s past relations, measure his capacity for intimacy and evaluate the patient’s present status based on the history (Markowitz and Weissman, 2004). Identification of interpersonal problem Areas One of the major features of the questions asked by the therapist to add to the interpersonal inventory is to analyze and determine the interpersonal problem areas which are responsible for the patient’s depression. It is the duty of the therapist to correctly identify the interpersonal problem areas and proceed with the appropriate treatment strategy. To determine the problematic areas to be focussed and worked upon the therapists needs to ask questions related to significant life events including home, workplace, relationships etc. It is up to the therapist to be able to identify the most important problematic area and treat it. It is only after the areas of concern have been identified that the therapist with the patient’s agreement proceeds to the next treatment phase. Treatment Contract and IPT Approach Before the therapist proceeds with the treatment it is required that the patient is adequately educated about his/her condition and the treatment is explained using words that he/she may easily understand and abstaining from usage of medical jargons. Both the therapist and the patients discuss about the problem areas and reach an understanding about the treatment method to be adopted. The therapist needs to explain to the patient about IPT reminding him that IPT is one of the most widely used and exemplary antidepressant treatments. The therapist also needs to help the patient understand any discomfort that the patient may feel and ask questions about the treatment as well. The basis of the treatment lies from understanding four important interpersonal areas. Assessment and Intervention for 4 Interpersonal focus areas: According to IPT four important interpersonal areas are present-Grief or complicated bereavement, role disputes, role deficits and Interpersonal deficits (Markowitz and Weissman, 2004). Grief- Grief mostly overtakes at the time of bereavement when a significant other passes away. The basic duty of the therapist at this stage is to initiate and encourage the natural mourning process in the patient and encourage the person to move on, form new relations and indulge in other activities that can compensate for the loss experienced by the patient. In many cases some patients who have had complicated relation are seen to suffer from negative emotions. This also happens when sometime the patient blames himself for the loss. At this stage the therapist needs to understand the causal factors for the negative emotions. The patient is then encouraged to release the negative emotions so as to diminish the intensity of such feelings. The therapist also tries to explore the presence of positive feelings that could be cultivated to help the patient cope up with the situation at hand. Role dispute- Role disputes often arise when the patient has conflicts of interest with a near one such as parents, spouse, siblings, friends, co-worker etc. With proper cooperation from the patient the therapist explores the depth of the conflict, the case of the conflict and options for resolving such conflicts. In many cases it has been seen that patients with emotional problems have the tendency to subdue their own interests and put the interest of others before their own. They lack the confidence to put their interests above others and show appropriate emotions which makes it tough for them to handle interpersonal conflicts. In this case, the therapist discusses the problems openly with the patient and validates the patient’s emotions. By doing this the therapists actually works his way into the subdued feelings of the patient by allowing him to open up without much hesitation. Once the therapist is sure of the nature of feelings of the patient he tries to teach the patient how to express the feelings. Role-playing is often employed to help the patient learn communication strategies to communicate their own thoughts, feelings and frustrations to others in an appropriate fashion. Role Transitions A role transition marks a very important event such as beginning or ending of a relationship, gaining or losing a job, new settlement etc. It denotes a significant change in one’s life. In mnay cases the sudden change induced a change in the behaviour of the patient as well. The patient may experience depression owing to introduction of such changes. Intervention by therapist includes exploring the reasons behind the mourning and depression. The patient is encouraged to understand his own self and the way in which he is capable of handling the change that had occurred in his life. The therapist helps the patient to accept the change and gain control of the situation and adapt to the new role. For example if a patient suffers from depression over a job loss the therapist may help the patent explore his own potential and reassure that the loss actually marks the opportunity to extend one’s ability and pursue a better job. Interpersonal Deficits This is the least developed of the four interpersonal areas since this is only conducted when the patient does not report the therapist of any significant life event and therefore the case cannot be categorized into any of the above three interpersonal focus areas. It has been seen that patients who are put in this category suffer from social isolation and have few relations, In fact these patients have difficulty in forming and maintaining relations. The therapists intervenes by helping the patient open up about relationships and since the patient has almost no relations currently, the therapist may either help to build upon the older relations or help the patient form new ones. An important feature of this intervention is that the therapist also needs to work with the patient to help the patient develop a relation with the therapist and feel safe to confide and trust the therapist. The main aim of the therapist is to first allow the patient to open up about relationships and try and identify probable target areas in the relation that may hinder progress. In this case the therapist-patient relation serves as a model for the patient to build new relations with others. In all probability patients with interpersonal deficits respond least among the four interpersonal focus areas since they lack events in their life. 2. Describe treatment model and treatment approach/ modules/ components/ targets for the Emotional Disorders Unified Transdiagnostic Protocol The Unified Transdiagnostic Protocol is an integrated approach consisting of an amalgamation of various therapeutic approaches adopted to treat emotional problems. It is a trasndiagnostic, emotion-focused, cognitive-behavioural treatment which has undergone extensive development (Boisseau et al, 2010). Previously a wide number of different protocols existed to treat anxiety and emotional problems and there was a dire need for a unified approach which was both user-friendly as well as treatment oriented. The Unified Transdiagnostic protocol is suited to treat a wide array of emotional disturbances as already tested in clinical trials (Boisseau et al, 2010). The components that have been included in the protocol are comprehensive and are applied in a systematic manner. However the best feature of the Unified transdiagnostic protocol is not only its simplicity but the ability of the approach to considered comorbidities associated to emotional disturbances. The treatment variables for the UT protocol are as follows: a. Settings- Complying with the protocol all the patient assessments and treatments needs to be conducted at an institutions which has appropriate settings and other facilities to meet the needs of the patient and the therapist. b. Format- The format for the unified approached is individual in nature. Even though in some cases group format including patients with different emotional problems have also been successfully implemented, individual format is preferred since it allows the patients to receive individual attention during treatment and application of the various components of the therapeutic approach. c. Therapist Variables- According to the UT protocol both junior and senior therapists can easily adapt the approach since it is a user-friendly protocol. However, according to the protocol therapists with prior experience in cognitive behaviour techniques may find the protocol much easier to apply. The implementation of the UT protocol by therapists has a few challenges of their own since it an approach primarily focused on emotion. The main challenge includes creation of emotion provoking exposures and utilizing the same throughout the course of treatment. The therapist also needs to understand patient cues especially when the patient does not accept certain emotion-provoking actions. However the most important challenge for the therapist is to be able to accept and handle the emotion expressed by the patient. In many cases less experienced therapists often overlook these expressions but it is necessary for therapists to be able to encourage expression of the emotions and help patients handle the situation without letting the emotions overtake the case. d. Patient Variables- One of the most important features of the UT protocol is that it allows the therapist to consider the comorbidities associated with the primary problem as well. The thraprist can freely discuss the symptoms of the associated comorbitdies as well during the main course of treatment. For example if a patient with GAD’s primary concern is chronic worry and associated problem is social anxiousness the therapist applying UT protocol may include talking session with strangers allowing emotional exposure cues. The main aim of this protocol is to allow the patient to experience emotions. e. Concurrent Drug treatment- According to the UT protocol it is essential for those patienst who are taking some form of psychoactive medication to have stabilized before the assessment interview. This allows the therapist to analyze the person correctly and acquire actual information of the emotional problems. Components of Treatment According to the basic UT treatment structure there exists five core treatment modules and an additional three modules. These treatment modules need to be delivered during individual sittings in 12-18, 15 to 60 minutes on a weekly basis. During the latter part of the treatment course the modules may be given on alternate weeks to allow the patient to take-in the previous one and settle in. This however depends on the patient’s ability to cope, patient’s progress and therapist’s consideration. The five core treatment module shave been designed to target different aspects of emotions. The modules are as follows: Module 1: Motivation Enhancement for Treatment Engagement This initial module is based on basic therapeutic and motivational approach. The module focuses on building a rapport between the patient and the therapist, increasing motivation and goal-setting (Lopez et al, 2014). In this module the therapist readies the patient for the expected change and motivates the patient to change. He encourages the patients desire to be able to handle emotions. The therapists employs two basic motivational exercises, firstly a decisional balance where the patient measures the pros and cons of staying the same and secondly a goal-setting exercise where the patient visualizes the achievable goals. Module 2: Psychoeducation and emotion tracking In this module the patient is basically schooled to understand the different cognitive and physiological sequences of emotions and how each component interacts. The aim of this is to ensure that after the psychoeducation has been introduced the patient is able to apply the same to recent emotional reactions and understand how each component interacted. During this module the patient also learns how to track his emotions and becomes aware of his emotional behaviours. Psychoeducation also involves the concept of negative reinforcement. During this session the patient learns to understand the association between behavioural responses and emotional reinforcement. So, basically module 2 deals with providing the patient with appropriate information on the emotions and exposing him to the three-component model i.e. cognitive-behaviour therapy, interactions of thoughts and feelings and behaviour (Lopez et al, 2014). Module 3: Emotion Awareness Training After the first module which allows the patient to understand their emotions much better, this module helps the patients to understand their emotions and responsive behaviours in a more subjective and present manner. It allows the patient to understand both his primary and secondary emotions (Lopez et al, 2014). In this module present day emotions experiences helps the patient to understand the underlying pattern of emotional behaviours and responses. Furthermore the therapist helps the patient to explore the secondary reaction. The module enables the patient to become develop a more non-judgemental stance towards the behavioural emotions. The module employs usage of mindfulness and emotion induction exercises. Module 4: Cognitive Appraisal and Re-appraisal Increasing cognitive flexibility is one of the basic approaches of the UT protocol. Patients with emotional problems have the tendency to have biased opinions of external events. Therefore cognitive therapy helps the patient to do away with negative behaviours and look at events in a more realistic manner. The aim of this module is to induce greater flexibility in the thinking ability of the patient by identifying thinking traps and also challenging faulty though pattern (Lopez et al, 2014). This flexibility is brought about by helping the patient first analyze how they tend to look at situations and how such stances initiate their emotional responses. Next, the patients are taught to look at the situations from different perspective. They are also taught different reappraisal strategies to help interpret situations in a more positive manner and attain more flexibility in their thinking. Module 5: Prevention of Emotional Avoidance and Modifying EDBs This module generally lasts for 2 sessions. Most patients seek avoiding emotional situations in places where physical avoidance is not possible. It is possible for the patient to physically remain in a situation and engage in certain behaviours which inhibits the arousal of emotions. In this protocol, emotional avoidance strategies include any behaviour that the patient employs to mask his emotions or down regulate the development or arousal of such emotions which often becomes risky since it feeds the negative reinforcement cycle. For example a person with social phobia can talk to people but escape the situation once his tolerance level is reached or he may also continue to remain in the situation by engaging in other activity preventing him from interactions. In both cases the socially phobic person is avoiding interaction and in this cases the emotional avoidance and EBD may be hard to distinguish. In this regard the therapist needs to be able to understand the distinction between emotional avoidance and emotion-driven behaviours or EBDs. The focus of the module is not only to change the emotional avoidance behaviours but also change the EBDs. It is also possible to allow the patient himself to understand the behaviours on his own and track them appropriately. Module 6: Awareness and Tolerance of Physical sensations This module introduced the patients to the role of physical sensations and the effect on emotional responses. Interoceptive exposure exercises are employed to induce physical sensations similar to those that are experienced during the arousal of an emotional distress such as breathlessness, dizziness etc. Research has proven the efficacy of IE as a treatment strategy for a wide spectrum of emotional disorders (Boswell et al, 2013). These could be done by practicing simple exercises such as breathing through straws or running around in a place. After each exercise is completed during the session the patient may be asked to rate the distress and the similarity of the experiences. This helps the patient to identify and tolerate the physiological aspects of their emotional distresses. Module 7:Interoceptive and Situational exposures In this module the treatment strategies that had been specially designed for the patient are practiced and include exposure to emotional triggers. Here, the therapist asks the patient to act opposite situations. It clears the concept of the patient about emotional avoidance and EBDs and helps them tackle the situations in a much better manner. It has been basically designed to allow effective completion of all the applied exposures (Lopez et al, 2014) In most cases the very last module includes reviewing of the major therapeutic approaches and the patient is encourages to practice the modules. The therapist reminds the patient that it is possible for the patient to practice the acquired skills and prevent relapse on their own. References Boisseau,C.L. et al .(2010).”The Development of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: A Case Study.” Cognitive Behavior Pract. 17 (1), 102-113. Boswell,J.F. et al (2013). “Anxiety Sensitivity and Interoceptive Exposure: A Transdiagnostic Construct and Change Strategy.” Behav Ther. 44 (3):417-431. Lopez,M. et al .(2014). Examining the Efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in the Treatment of Individuals With Borderline Personality Disorder. Cognitive and Behavioral Practice. Cognitive and Behavioral Practice. doi: 10.1016/j.cbpra.2014.06.006 Markowitz,J.C. and Weissman, M.M. (2004). “Interpersonal psychotherapy: principles and applications.”World Psychiatry. 3(3): 136-139. Robertson, M et al. (2008).”Interpersonal Psychotherapy: An Overview.” Psychotherapy in Australia, 14 (3), 46-53. Schaik,D. et al .(2007). Interpersonal psychotherapy (IPT) for late-life depression in general practice: uptake and satisfaction by patients, therapists and physicians. BMC Family Pract. 8:52-58. Read More