when keeping it real goes wrong (remember that Dave Chapelle skit?)…

I don’t really know what the 3 articles were about.  Well, let me restate.  The Kendler et al. article is about the link between adversity, sex, and high neuroticism.  Coyne essentially spends 20 pages arguing why his initial graduate work is not the seminal work of depression, so we should get over it (by thinking interactionally). Finally, Cuellar et al. spend a tremendous amount of time exploring past literature to tease apart differences between unipolar and bipolar depression, to whit I am still unsure of whether they achieved their goal or not.  But after sitting on a toy toss-about plane where the couple sitting across from me continued their disgusting streak of PDA, I about had it with the Coyne article.  And then an airport employee was acting wildly inappropriate, though hilarious, throughout my ingestion of the Kendler article.  And poor Cuellar was subject to a ‘pause for the cause’ as I broke down the graduate school process to my WAIS volunteer (it was the least I could do for her, after subjecting her to a 3 hour test!).

Anywho, enough with my diatribe against all things airplain/airport/and graduate process related. 

The most interesting link I found between the articles was the exploration of trauma as it effects youth from the Coyne article.  Coyne explains that children tend not to develop severe depression from major traumatic events, and that if they do, it will appear as early on-set depression.  Rather, it is suggested that depression is a factor of various events that occur somewhat later in one’s life, coupled with the type of support that individual has.  This was also mirrored through the Cuellar et al. article, in that social support is extremely helpful in either uni or bipolar depressions.  In fact, without it, we see an increase in relapse, which ties in well with our readings from last week.

In essence, it’s all about support.  Kendler et al. brought about evidence that women are unfortunately lacking in this category.  Either unmarried, in a negative relationship, or suffering from a nasty divorce, women tend to be highly neurotic regarding the adverse events in their lives, and not only can relapse be improved by such data, depression in general can be minimized by it.  Female support groups, organizations, ministries, etc. can support the needs and welfare of women who have or may be prone to experiencing negative life events.  It’s not enough to be there a month after the divorce, but to have been there before and for years to come. 

Psychologists can definitely mediate such stressors by creating focus groups, or offering preventative, or ‘mind-grooming’ services, as I call it, to adult women.  It has been evidenced that women tend to need different emotions met than men, so, armed with this knowledge, we should certainly cater to these clients in a way that mediates preventable depression.

p.s. best benjabrunch/brunchamin EVER ladies (and ben, who is SURE to read this!! ;o) )

eyes wide shut

I want to immediately address two statistically significant findings in these articles:

1) The University of Michigan rocks.
2) Including super-huge portraits of each author in the article negates the fact that their writing is totally discombobulated and way too verbose.

Now, getting to the topic of stimulus control (SC) and stressors and abuses that lead to depression.

The techniques highlighted in the SC article as well as the sleep hygiene handout seemed to express the validity of using this therapy with sleep deprived clients.  I only questioned how the average person would be able to stick to such a regime, or participate it in the first place.  The therapeutic push, however, of suggesting that nothing else has worked so take a stab at this, was fairly convincing to me.  I wish I knew of it when I used to suffer from insomnia in college. But then I worked for Teach For America.  That would be the second most effective cure after SC, I'm sure.

I really enjoyed the Voelker article entitled Stress, Sleep Loss, and Substance Abuse Create Potent Recipe for College Depression not because it was published from Michigan (well, not solely because of that), rather it had a great mix of clinical and neuropsych, as well as social commentary.  In general, our executive functioning allocates specific areas and hormones to address stressors that can rewire the brain to handle stress, but this action takes away from its original function.  Meg commented in assessment yesterday that research appears to advocate less specific function related to one hemisphere only.  This is true, but from what I can recall this summer in neuropsych research, when trauma occurs in one hemisphere, the other hemisphere can compensate for this lack by performing the duties once associated with its other half.  This, understandably, burdens the lone hemisphere, so while there is certainly hemispherical interplay, there will be lessened functioning throughout the entire brain because one is inundated with double the tasks.

In reference to the depression model proposed by Voelker, this makes a world of sense.  People who compensate coping with their psychiatric disorders by overindulging in substances are placing an abundant request on their brains to sort everything out, which likely only further complicates their disorder.  This, coupled with social pressures and economic woes, leads to a lack of sleep, and in more recent cases, extreme violent behavior by those who are just unable to cope with the demands placed on their bodies and minds.

As stated, combing out the various kinks in our lives, i.e. monitoring the amount we eat, drink, sleep, and have time to address our maladaptive thoughts, will act as prevention for the large increase we're seeing in the obesity, substance abuse, insomnia, and depression in college campuses, which are sure to increase as a result of the flailing economy.

put me in [life] coach...i’m ready to play!

It’s 6:30 a.m. and you’re driving along a winding Atlanta road.  You can only envision the horrible day you had yesterday, and the day before, and the day before that.  You start to anticipate what a horrible day you’re likely going to have today.  Tears well up in your eyes, and you ponder, maybe, just maybe, if enough tears fill up in your eyes, you can claim that the reason you crashed your car was because you couldn’t see, not because you were actually attempting to kill yourself…

I encountered this scenario on a few dark mornings while driving to teach in a notorious neighborhood within Atlanta, Georgia.  I bring up this reality to respond directly to the claims made by psychologists who are proponents of Behavioral Activation Treatment for Depression.  There are two major flaws within the theory of activating behavior without addressing the cognition:

1)    Severely depressed patients may not have options to change their environments.

2)    If we engage in “coaching,” we have no jobs as psychologists.

In my situation above, I was so depressed that I did in fact follow the behavioral patterns of people within the reading by Jacobson et al.  The cyclical nature of depression is a beast, because surely the behaviors that we engage in cause further depression, and intensified depression only leads to further social withdrawal and personal negligence.  It took phone calls from my at-the-time-boyfriend to my roommate, in fact, to force me to eat and get out of my dark room where I would lay in bed from the time I got home from school to the time I woke up.  This routine antagonized my depression, but the reality was that only those few behaviors could be addressed.  The essence of my depression – the school environment that I encountered every day – was still there, waiting for me, mocking me.  I was able to address the fact that my behavior was exacerbating my depression, but I was not able to get to the root of it, as Jacobson’s title even suggests Behavioral Activation (BA) does.  It wasn’t until my cognitions about my work environment were addressed that I could truly wake up in the mornings ready for the challenge of a new day.

Additionally, if we engage in the coaching techniques described within the model of BA, even if through terminology, we are in essence diminishing our profession to someone who guides the actions of others.  In that realm, we could have forgone school and the 6 years of intensive training of empirically based techniques to partake in a counseling model that simply aims to shift individuals’ cognitions through behavioral modification.  Perhaps this is just being egregious, but I have the skills and will have the knowledge to affect substantial change within clients’ lives that goes beyond activity charts and forced social engagement.  I’m quite sure that some mindset changes will come as a result of those things, but I’m more confident that addressing the behavior as well as the cognitions surrounding it will provide the client with a more suitable way of coping with the impending stress involved with his/her environment.  Viva la CBT!

you down with CBT? yeah you know me!

(That's probably the corniest thing I've ever written to date!)

Our articles this week hinged around cognitive and behavioral therapies, both in the fashion of CBT (Cognitive Behavioral Therapy) and RE[B]T (Rational Emotive [Behavioral] Therapy). Of note, I found the Ellis article to be particularly amusing, in that the father of such a treatment seemed apologetic and provided a plethora of excuses or caveats throughout this entire article for why REBT is essentially CBT before CBT became what it is today!

In general, however, I was enthralled by the CBT articles, particularly that of the British Association for the Behavioural and Cognitive Psychotherapies' Mapping Psychotherapy - What is CBT? This guideline presented the perfect framework for the type of treatment I would like to practice in inner-city communities where mindsets are often the largest factor keeping those citizens enslaved. Bob Marley speaks to us through song about this concept, urging residents to "emancipate yourselves from mental slavery/none but ourselves can free our minds." (Redemption Song)

The map shown explicitly in Appendix 1 on page 6 highlights the necessary methods both clients and therapists must engage in to yield results. Through our exploration of EBP/ESTs, we acknowledge that assessment allows opportunities to establish rapport, as supported by Rogerian theory, as well as time to postulate which CBT assessment would best fit our client. Formulation closely follows this assessment in order to discover the presenting problem of our client while giving us a baseline with which to measure our client's success. Intervention stems from our hypothesis and involves a trusting relationship between client and therapist, so that outside homework can be achieved by each individual in order to benefit the client seeking behavioral modification through cognitive shifts - i.e. attempting exposure or addressing a fallacious belief. Finally, evaluation measures the impact both participants in the CBT have had on the outcome of the client, and long-term effects can be measured during this stage as well.

These four stepping stones to behavior changes, as well as cognition restructuring, are key to urban youth developing a more positive attitude about the impact that they can make in this world. As Butler et al's work displays, CBT is highly effective in treating adolescent depression and anxiety disorders. If children who live in these areas are constantly exposed to negative rhetoric about their existence, it is natural to assume that they would internalize these messages. CBT works for this age population, so it is worth the effort to administer this form of treatment on such groups. It will be interesting to note whether this treatment works across racial and class lines in such strong effect sizes.

The lab I work in for my research conducts a longitudinal study on the effectiveness of a prevention program targeting the parents of children with poor behavioral outcomes. Reading these articles really leads me to believe that as the children increase in age, offering CBT directly to some of the children will allow us to compare whether this type of intervention, mixed with preventative measures, will truly minimize the risk associated with growing up in inner-city neighborhoods. If this is the case, we may be able to revolutionize the way children within these environments perceive the world around them, thereby affecting both behavior and cognition - the basis of CBT!

...

what can one even say about the senseless killing of another? since we didn't have to write this week, i decided to dedicate this to something i enjoy - inner-city discussion.

but i really can't even speak after watching the video within this blog:

http://ow.ly/rDn6

speechless.

-R