Conversely, a client that's unable to engage in therapy, for whatever reason, is unlikely to exhibit improvement regardless the awesomeness of the therapist. Dabamf is right, however, the literature on therapeutic research is a quagmire, but an NIH study is generally a decent start. Especially, if you like a bit of evidence in your treatment.
Depression
- Thread starter Tarrant
- Start date
On a psych exam I got docked because I said that the therapeutic alliance had a "limited" benefit, which I feel is fair. It doesn't do a lot on its own but it's necessary. Same with patient cooperation. Lost points because "The therapeutic alliance is THE MOST IMPORTANT THING EVER."
It's still limited...man. Professors and their words.
It's still limited...man. Professors and their words.
Conceptually, I view it as pass/fail. Through helping skills, attempting to establish rapport, and/or motivational interviewing a therapist should be able to everything on their end to establish a therapeutic relationship
--to some degree. However, if the patient is not psychologically-minded, unwilling to change anything about their life/do work, or is otherwise resistant you're not likely to accomplish much. In that context, it would make the therapeutic alliance greater than therapy modalities/other factors. You could CBT/IPT/eclectic-crap-jargon them do death and not get anywhere.
--to some degree. However, if the patient is not psychologically-minded, unwilling to change anything about their life/do work, or is otherwise resistant you're not likely to accomplish much. In that context, it would make the therapeutic alliance greater than therapy modalities/other factors. You could CBT/IPT/eclectic-crap-jargon them do death and not get anywhere.
The therapeutic alliance is essential but it's something that potential patients/clients already seek out. Needing a good match is a well known requirement of therapy
As far as outcome research, it is indeed a bit of a clusterfuck. Definitive evidence has emerged in the past decade, however, pointing to the superiority of specific treatments. Methodologies have become far tighter and our understanding of psychological processes has improved a lot. The biggest problem is the old maids in the field are unadaptive. Its not universally true, but I gravitate toward the younger folks simply because they are less likely to be contaminated with old school Freudian beliefs or less likely to be reliant on clinical "experience," which, as it turns out, is wholly useless
tl;dr: Science is your friend
As far as outcome research, it is indeed a bit of a clusterfuck. Definitive evidence has emerged in the past decade, however, pointing to the superiority of specific treatments. Methodologies have become far tighter and our understanding of psychological processes has improved a lot. The biggest problem is the old maids in the field are unadaptive. Its not universally true, but I gravitate toward the younger folks simply because they are less likely to be contaminated with old school Freudian beliefs or less likely to be reliant on clinical "experience," which, as it turns out, is wholly useless
tl;dr: Science is your friend
Vanderhoof
Trakanon Raider
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Dabamf, I do agree that methodologies are getting tighter and that it's a good thing.
I echo a lot of people's issues with the DSM 5, though. I also don't like that it's "5" instead of "V" now.
I echo a lot of people's issues with the DSM 5, though. I also don't like that it's "5" instead of "V" now.
Xequecal
Trump's Staff
- 11,559
- -2,388
I got hit hard by depression this weekend and it's the first time that I've started wondering if it's the actual medical type of depression.
Some backstory: Like 2-3 years ago I had a decent social life, a circle of friends and a girlfriend, everything was OK in that respect. What I didn't have was a decent job, and after some bad experiences and getting sick of $14-15/hour shit positions and temp jobs with no benefits I went and found an HTL training program with real potential I could get into. I moved across the country to do the program and got hired right out of it. Now I'm making double what I was making before plus really good benefits. So it worked great in that respect. I even bought a house, because fuck renting in this housing market when stuff is this cheap.
However, in the ~2 years I've been here I've yet to make a single real friend, let alone a girlfriend. At first I attributed it to putting all my energy into that training program and keeping myself afloat but now that I've been employed for a year with no progress on that front it's really starting to get to me. One of my old friends from my old city called me this weekend and invited me to his wedding and it all collapsed on me. I got off the phone, sat down on the corner of my kitchen table that seats six people, looked across into the living room with the completely undisturbed furniture as it has literally never been used in six months and I just lost it. I realized that all the friends I made back there came out of the same social circle I was with from college, and now that I'm out of said circle, I don't know what the fuck I'm doing. He's getting married and I'm sitting here alone. I'm 28 and don't know how to meet or interact with people without help, and with it comes a crippling fear that I'm just too boring and depressing for anyone to like. That I somehow missed something important in my 2 years in limbo, everyone else became adults and I didn't.
I know that a guy on a RPG message board that has a shit social life isn't exactly novel or interesting, but this thread was at the top and I needed to vent.
Some backstory: Like 2-3 years ago I had a decent social life, a circle of friends and a girlfriend, everything was OK in that respect. What I didn't have was a decent job, and after some bad experiences and getting sick of $14-15/hour shit positions and temp jobs with no benefits I went and found an HTL training program with real potential I could get into. I moved across the country to do the program and got hired right out of it. Now I'm making double what I was making before plus really good benefits. So it worked great in that respect. I even bought a house, because fuck renting in this housing market when stuff is this cheap.
However, in the ~2 years I've been here I've yet to make a single real friend, let alone a girlfriend. At first I attributed it to putting all my energy into that training program and keeping myself afloat but now that I've been employed for a year with no progress on that front it's really starting to get to me. One of my old friends from my old city called me this weekend and invited me to his wedding and it all collapsed on me. I got off the phone, sat down on the corner of my kitchen table that seats six people, looked across into the living room with the completely undisturbed furniture as it has literally never been used in six months and I just lost it. I realized that all the friends I made back there came out of the same social circle I was with from college, and now that I'm out of said circle, I don't know what the fuck I'm doing. He's getting married and I'm sitting here alone. I'm 28 and don't know how to meet or interact with people without help, and with it comes a crippling fear that I'm just too boring and depressing for anyone to like. That I somehow missed something important in my 2 years in limbo, everyone else became adults and I didn't.
I know that a guy on a RPG message board that has a shit social life isn't exactly novel or interesting, but this thread was at the top and I needed to vent.
Xequecal
Trump's Staff
- 11,559
- -2,388
Honestly, not really. I'm not morbidly obese or anything, in fact I'm pretty much the opposite of that at 6'1" and 165lbs, but that's mostly due to not eating much rather than exercising, I'm not in very good shape. I've never been on meetup.com though, I might give that a shot.
Eomer
Trakanon Raider
- 5,472
- 272
Meetup is just a suggestion. I'm sure wherever you're located has lot of co-ed adult sport leagues and shit like that. I've personally never used Meetup so I can't really comment on how it is. But if you're not getting out and doing shit and meeting people, it's going to be hard to make friends and/or bone women. Hope shit turns around for you.
Any physical-related meetup group is gold. Its just a different, more friendly kind of people. I met lots of people on hiking trips through that site, but I'm sure there are groups for other activities.
It also sounds like you have some fear of social interaction that is probably to some extent conditioned and would probably benefit highly from therapy. You spent a lot of time away from social situations, which can create a bit of a fear of engaging socially, which is then reinforced when you avoid or don't seek out social interactions because avoidance reduces the anxiety associated with being social.
Therapy will probably get you back on the boat to a normal life, which is what it sounds like you had in the past, which means you are capable of getting that back.
Holy run on sentences batman
It also sounds like you have some fear of social interaction that is probably to some extent conditioned and would probably benefit highly from therapy. You spent a lot of time away from social situations, which can create a bit of a fear of engaging socially, which is then reinforced when you avoid or don't seek out social interactions because avoidance reduces the anxiety associated with being social.
Therapy will probably get you back on the boat to a normal life, which is what it sounds like you had in the past, which means you are capable of getting that back.
Holy run on sentences batman
Korrupt
Blackwing Lair Raider
- 4,832
- 1,228
Damn X it doesnt sound like youre that bad off, the sports league suggestions are an awesome idea. I was in a kickball and flag football one with my ex GF and it was fun to practice (silly not serious) and after most games and even on weekends we'd all hang out as a group and go eat etc.
Buying a house for me also when I was younger (24) made me feel weird, even living with my girl back then it felt empty. Renting my house and moving to a nice condo with people my age really helped both of us I think because we were in an urban and social area with a lot of people our age condensed into it. When I was living in my first house I dont know why but I would look outside at my neighbors and see all these old people doing house / garden work and thought this is what in store for me? MF Gardening?
Buying a house for me also when I was younger (24) made me feel weird, even living with my girl back then it felt empty. Renting my house and moving to a nice condo with people my age really helped both of us I think because we were in an urban and social area with a lot of people our age condensed into it. When I was living in my first house I dont know why but I would look outside at my neighbors and see all these old people doing house / garden work and thought this is what in store for me? MF Gardening?
Korrupt
Blackwing Lair Raider
- 4,832
- 1,228
Nothing is wrong with it just felt out of place for me at that time period in my life. Funny I just went home for lunch and walked around my back yard for a bit admiring my trees, it made me feel old. I was so happy with my gardenia bushes haha, my 24 yr old inner self is sad.
Angelwatch
Trakanon Raider
- 3,053
- 133
Have you considered online dating? It's a good way to meet women and get yourself out of the house.
TrollfaceDeux
Pronouns: zie/zhem/zer
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As my clinical psych education and training advances, I come with more science:
Of all clinical trials evaluating the efficacy of anti-depressants, 31% were never published. Of studies showing the positive effects of anti-depressants, 37/38 studies were published. Of studies showing negative or questionable results of anti-depressants, 3 were published, 22 were not published, and 11 were published in a way that (in the opinion of the authors of this study) put a positive spin on the results. When the FDA reevaluated all anti-depressant studies, the overall effects were found to have been inflated by drug companies about 32%. All things considered, the overall effect size (a measure of improvement, in approximate units of standard deviations) of anti-depressants is 0.31, a "moderate" effect. This is the approximate effect size consistently achieved from placebo across nearly all studies of this type.
Citation: Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358(3), 252-260.
In one of the largest and most methodologically sound randomized control trials comparing anti-depressant medication (one of the SSRIs) with cognitive therapy and behavioral activation (a component of behavioral therapy), all were found roughly equivalent for low severity depression (this is not to say they ARE equivalent - it may be that the study had insufficient power to detect a difference due to the relative low improvements someone with mild depression can obtain - this is also known as a floor effect). For those with severe depression, behavioral activation achieved significantly higher rates of remission than both cognitive therapy and antidepressant medications, which were roughly equal. On continuous measures (in contrast to remission or no remission), behavioral activation was not significantly different from anti-depressants, which were both superior to cognitive therapy.
Cite: Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., ... & Jacobson, N. S. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of consulting and clinical psychology, 74(4), 658.
Several studies have found that anti-depressants are no different from placebo for low severity depression. For high severity depression, anti-depressants are shown more effective. The thing to note, however, is that the data suggest not that anti-depressants are more effective for more severe depression, but that placebo just becomes less effective for high severity depression. I don't have a citation for this as it was talked about in several classes and I forgot to ask for one.
All in all, seek CBT (cognitive behavioral therapy) or behavioral therapy for depression. These are generally short (~12 sessions) and are just as if not more effective than medications. The improvement is also long-lasting for most (some will relapse in all treatments), whereas medications work only as long as you take them. Considering the extreme side effects of anti-depressant medications and the cost of long-term use, there is no question which is more beneficial.
Of all clinical trials evaluating the efficacy of anti-depressants, 31% were never published. Of studies showing the positive effects of anti-depressants, 37/38 studies were published. Of studies showing negative or questionable results of anti-depressants, 3 were published, 22 were not published, and 11 were published in a way that (in the opinion of the authors of this study) put a positive spin on the results. When the FDA reevaluated all anti-depressant studies, the overall effects were found to have been inflated by drug companies about 32%. All things considered, the overall effect size (a measure of improvement, in approximate units of standard deviations) of anti-depressants is 0.31, a "moderate" effect. This is the approximate effect size consistently achieved from placebo across nearly all studies of this type.
Citation: Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358(3), 252-260.
In one of the largest and most methodologically sound randomized control trials comparing anti-depressant medication (one of the SSRIs) with cognitive therapy and behavioral activation (a component of behavioral therapy), all were found roughly equivalent for low severity depression (this is not to say they ARE equivalent - it may be that the study had insufficient power to detect a difference due to the relative low improvements someone with mild depression can obtain - this is also known as a floor effect). For those with severe depression, behavioral activation achieved significantly higher rates of remission than both cognitive therapy and antidepressant medications, which were roughly equal. On continuous measures (in contrast to remission or no remission), behavioral activation was not significantly different from anti-depressants, which were both superior to cognitive therapy.
Cite: Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., ... & Jacobson, N. S. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of consulting and clinical psychology, 74(4), 658.
Several studies have found that anti-depressants are no different from placebo for low severity depression. For high severity depression, anti-depressants are shown more effective. The thing to note, however, is that the data suggest not that anti-depressants are more effective for more severe depression, but that placebo just becomes less effective for high severity depression. I don't have a citation for this as it was talked about in several classes and I forgot to ask for one.
All in all, seek CBT (cognitive behavioral therapy) or behavioral therapy for depression. These are generally short (~12 sessions) and are just as if not more effective than medications. The improvement is also long-lasting for most (some will relapse in all treatments), whereas medications work only as long as you take them. Considering the extreme side effects of anti-depressant medications and the cost of long-term use, there is no question which is more beneficial.
1.) The first and foremost thing you can do is to start exercising. This WILL have benefits that will change your attitude and help reverse or stave off depression. I started exercising 6 months ago and my goal was to go 30 days of running/hiking 3/week. Once I met that goal (and I lost 12 lbs) I switched to weight lifting 2 or 3 times a week. The confidence and health benefits both mentally and physically are enormous. I will never stop exercising now that I have seen and lived the benefits.
2.) Meetup groups are amazing. I started going a month ago. The first night I had 3 girls give me the numbers and this weekend I hooked up with one of them. I am not a very outgoing person either...I am an introvert and it was a bit hard for me to show up at the first one but after the first one, it's all downhill. You end up running into the same people quite often (even across groups) and everyone is friendly. There are groups for everything.....literally...want to sit around naked and talk about life...? There's a group for that. Want to learn how to knit ? There's a group for that.....I go to the happy hour groups and having fun groups in my area, along with a few hiking groups.
I just turned 35 and had a few months of WTF am I doing with my life and dealing with a bit of depression myself.....I decided I needed to shut off the computer and get out more. Exercise and meetup have been amazing tools to help make that happen.