Treating Depression: Tools for EFT Therapists

Transcription

1 Treating Depression: Tools for EFT Therapists Ting Liu, Ph.D., LMFT Andrea K. Wittenborn, Ph.D., LMFT 2017 EFT Summit Presentation Overview } Background } Unipolar depression and marital conflict } Outcome research on EFT for depression } Assessment Recommendations } Treatment modality assessment } Gender specific diagnostic assessment } Treatment Recommendations } Recommendations for using EFT to treat depression and relational conflict } Video example 1

2 Background Major Depressive Disorder } Depression is remarkably destructive } Depression is the world s second leading cause of medical disability (WHO, 2010) } 1 in 6 U.S. adults will be affected (Kessler et al., 2005) } 40-60% of those affected will have more than 1 episode } Economic burden exceeds $210 billion/year in the U.S. (Greenberg et al., 2015) } Depression is resistant to change } Despite decades of widespread public awareness campaigns, research, and intervention, population-level prevalence rates remain stable (Ferrari et al., 2013) } Intervention findings } Antidepressants have not shown a consistent advantage over placebo pills (Kirsch et al., 2008) } Only half of psychotherapy patients recover after their first course of treatment (e.g., Barber et al., 2012) 2

3 Figure 3. Cognitive, social, environmental, and biological dimensions of depression Wittenborn, Rahmandad, Rick, & Hosseinichimeh (2016). Depression as a systemic syndrome: Mapping the feedback loops of major depressive disorder. Psychological Medicine, 46, A Strong Relation Exists Between Marital Distress and Depression } Marital quality and depression are: } Highly intertwined (Whisman, 2001) } Among the most frequent presenting problems in psychotherapy (Doherty & Simmons, 1996) } Prevalence } At least ½ of depressed adults experience co-occurring relationship discord } Maritally dissatisfied couples are 2.7 times more likely to meet criteria for a major depressive episode 3

4 How is treatment affected when depression and marital distress co-occur? } Marital distress can cause occurrence, nonremission, and relapse of depressive symptoms } Marital distress accounted for 30% of new depressive episodes in treated individuals (Whisman & Bruce, 1999) } Distressed clients were less likely to remit (34%) than nondistressed clients (61%) after depression treatment (antidepressants, psychotherapy, or both) (Denton et al., 2010) } The best predictor of relapse of depression is the level of criticism experienced by one s partner (Hooley & Teasdale, 1989) Couple Therapy Can Relieve Depression } Meta-analysis of 6 controlled trials comparing couple and individual therapy (Barbato & D Avanzo, 2008) } Depression improves at similar rates in couple and individual therapy } Marital distress only improves in couple therapy } An RCT compared couple therapy and antidepressants } Couple therapy was at least as efficacious (if not more so), as cost-effective, and had significantly lower drop-out rates (15% vs 57%, p<.0001) 1 (Leff et al., 2000) 1 However, possible selection bias and differences 2017 in measurement EFT SUmmit should be taken into consideration 4

5 Studies on EFT for Depression and Distress } Tested 12 women randomly assigned to pharmacotherapy or EFT (Dessaulles, Johnson & Denton, 2003) } At termination, EFT and pharmacotherapy were equally effective at reducing women s depressive symptoms } Six months after termination, women who received EFT reported significantly less symptomatology than those who were treated with pharmacotherapy } Tested 24 women randomly assigned to pharmacotherapy or pharmacotherapy and EFT (Denton, Wittenborn, & Golden, 2012) } Both treatments effectively reduced women s depressive symptoms } Only the women receiving EFT reported improved marital quality } Tested 28 couples randomly assigned to EFT or usual care (Wittenborn, Liu, Ridenour, & Seedall) } EFT was associated with greater increase in relationship satisfaction for both genders and in depression for men Wittenborn, Liu, Ridenour, & Seedall (2017). Emotionally focused therapy 2017 for EFT depression: SUmmit A rigorous pilot randomized controlled trial. 5

6 Wittenborn, Liu, Ridenour, & Seedall (2017). Emotionally focused therapy 2017 for EFT depression: SUmmit A rigorous pilot randomized controlled trial. Figure 1: Within-person Granger Causality Model 6

7 Assessment Recommendations Assessing for the Appropriate Behavioral Treatment Modality Couple therapy may be more beneficial than individual therapy if: 1. Marital problems predate depressive episode 2. Client views marital problems as related to and/or causing depressive symptoms 3. Both the depressed person and his/her partner is willing to attend and participate in couple therapy 4. Neither partner has decided to leave the relationship 5. Violence is not a concern in the relationship 7

8 Gender Specific Symptom Expression } Women } More traditional symptoms (e.g., depressed mood, sadness) } Men who don t conform to masculine social norms and men with severe depression } Likely to report traditional depressive symptoms } Men who adhere to masculine norms often express external and somatic symptoms instead of traditional symptoms (Magovcevic & Addis, 2008; Rochlen et al., 2010) } Denying sadness } Increased anger, aggression, hostility } Suicide } Co-occurring substance abuse } Fatigue, bodily pain, sleep problems } Increased involvement at work } Underdiagnosed Advantages of EFT for treating relationship distress and depression } Focus on interrupting negative interaction cycles } Interrupting demand-withdraw cycle that is common to this population is a goal of treatment to eliminate vicious cycles of marital distress and depression } Seeking support from one s partner is encouraged } Depressed persons often feel lonely and permission to depend on loved ones can be an antidote to their symptoms } Non-pathologizing } The negative cycle is framed as the problem and is targeted rather than the individual functioning of the depressed person } Empirical support } Strong support for targeting couple relationships and preliminary support for treating distress and depression 8

9 Working with Depressed Couples Intrapsychic Interaction Behavior Here & Now Cognition Emotion Past Future 9

10 Challenges for Clinicians } How to work with sadness, helplessness, grief without sinking into another depressive episode or eliciting shame and hopelessness that feed back into their vicious cycle? } How much is too much emotional intensity? } How to identify and work with atypical symptoms of depression (anger, resentment, defensiveness)? } How to differentiate a burnt out, depressed pursuer from a withdrawer? } How to empower and encourage depressed partners without sounding like an overly optimistic and enthusiastic cheerleader? } How to set goals that both partners can work together (not to fix the depressed partner or ask the non-depressed partner to take on more care-taking responsibilities)? Solutions to those Challenges 10

11 Empathic Reflection is Essence of EFT An Empathic Stance } Empathy is a key component of therapeutic alliance } Four attributes define empathy (Davis, 1984): Fantasy, perspective taking, empathic concerns, toleration of personal distress } Therapists demonstrate balanced, neutral, and genuine empathy to both partners } Identify red flags of losing empathy??? 11

12 A Video Example: Change in Internal Working Model Improve Empathy & Attunement } Quickly self-regulate to mild-moderate level of emotional arousal (anger, disgust, anxiety, shame, helplessness, etc) } Maintaining curiosity and non-blaming stance (there must be reasons for their reaction) } Client is the center focus of therapy } Accessing the implicit parts of clients experiences (i.e., vulnerable feelings, unmet attachment needs, desperate attempts to save the relationship) } Reflecting the negative impacts of client s reaction/ behaviors } Ask for clients help. 12