Early Intervention for Adults at High Risk of Recurrent/Chronic Depression: Cognitive Model and Clinical Case Series

Abstract

This paper describes a cognitive model for first/second onset depression that has been precipitated by major life stress, entrenched for several months and is unresponsive to pharmacotherapy. These conditions create high risks for recurrent/chronic depression and early intervention is proposed to identify, treat and protect against relapse/recurrence. Severe life stress interacts with an individual's core self-representations and personal values, identity is disrupted and depression is maintained by dysfunctional goal engagement and disengagement. Treatment aims to restore functional self-regulation by increasing self-diversification and creating balanced goal investments. Outcome and follow-up data are reported in a case series of five consecutive patients. There was good therapist adherence to the prescribed targets and pre-post effect sizes were comparable or larger than published outcome studies. At the 12 month follow-up, three of the four treatment completers (75%) had made reliable and clinically significant changes and were in full remission. This provides encouraging preliminary evidence for the model's validity and the therapy's efficacy. , M. L., Gladis, M. M., Brown, L. L. and Gallop, R. (2005). Cognitive therapy versus medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409-416.

A controlled trial of a needs‐based, nurse‐led psychoeducation programme for Chinese patients with first‐onset mental disorders: 6 month follow up

“…Achievement of this basic competency is considered to constitute an essential part of the treatment plan in the early contact with mental health-care service, upon which additional psychosocial interventions such as individual cognitive-behavioural therapy, self-assertiveness training and family-focused programmes can be built. [29][30][31] As suggested by McGorry, 32 multi-component early interventions for severely mentally ill people can include an introductory stage with evidence-based pharmacotherapy and supportive psychotherapy, an intermediate stage with family-oriented intervention and therapeutic alliance and a final stage with focused problem solving, social skills training and strategies for reintegration into the community. 33,34 There has been increasing supporting evidence of the use of the needs-based approach to interventions to provide therapeutic care and support for various physical and mental illnesses.…”

Evaluating a visual timeline methodology for appraisal and coping research

“…We developed an initial template with which to code the timelines (see Table 1), based on a priori assumptions (derived from the literature) as to the themes that might emerge from our analysis (King, 2008). In considering what factors might influence appraisal we expected the following to be most influential: event type -whether it has an impact on identity (Barton et al, 2008;Thoits, 1991), and whether it is individually triggered or externally driven by others (Chudzikowski et al, 2009); the situational demands of the event -its familiarity, predictability, and clarity (Lazarus, 1999); and temporal factors -whether the event is occurring at a "good" or "bad" time (Lazarus, 1999). We coded each of the timelines, using the emoticons as a guide to positive/negative appraisal.…”

“…A recurring image was the use of wavy lines or barriers to indicate such "breaks" in personal, professional, or national identity highlighting the impact such events can have on an individual and how difficult it can be to cope with them (Barton et al, 2008) .…”

“…One participant highlighted the loss of organizational identity after a company merger, and two participants Occurring at a 'good' time/expected to be over relatively quickly/not imminent discussed loss of national identity as a result of relocation. A recurring image was the use of wavy lines or barriers to indicate such 'breaks' in personal, professional, or national identity highlighting the impact such events can have on an individual and how difficult it can be to cope with them (Barton et al, 2008). Several participants included events such as a new manager, organizational restructure, or the implementation of new working procedures, and the impact these had had on their sense of professional efficacy, indicating the importance that individuals may place on what might be considered small-scale organizational changes.…”

The experiences of therapy from the perspectives of carers of people with dementia: An exploratory study

“…Informed by the work of the stress and coping model by Folkman (1997), Sørensen et al (2008) also argue that the mediators of the change processes of counselling interventions may be due to the occurrence of more positive psychological states. Furthermore, other authors have defined concepts such as ‘role investment’, suggesting that therapy can help to address loss of personal identity, which can result from the caring role interfering with other roles that are important to a person (Barton, Armstrong, Freeston, & Twaddle, 2008).…”