172-178


 *  Bernstein et al 1994
 *  Antidepressant drugs are an effective way to treat depression in the short term, significantly helping 60-80% of people according to reports
 *  Kirsch and Sapirstein 1998
 *  Analysed results from 19 studies, covering 2318 patients treated with the antidepressant Prozac
 *  Found that antidepressants were only 25% more effective than placebos, and no more effective than other kinds of drugs such as tranquillizers
 *  Modern drugs provie effective long-term control for mood disorders and may help to prevent suicide in depressive patients.
 *  Ethical issues- unless treatment is regarded as an emergency, cannot be given without patient's consent, except if they can't
 *  Consent must be based on full information as to benefits/drawbacks of drugs concerned.
 *  Main criticism of drug treatments is that the side effects are debillitating or deadly
 *  Do not constitute a cure.
 *  Blumental et al (1999)
 *  Found that exercise was just as effective as SSRIs in treating depression in an elderly group of patients.
 *  Leuchter and Witte 2002
 *  Found that depressive patients receiving drug treatments improved just as well as patients receiving a placebo.
 *  Researchers scanned brains and found changes in both cases, but changes were different.
 *  Patients who got placebos showed incraesed activity in the prefrontal cortex, patients receiving the antidepressant showed decreased changes happening in the same area.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Changes happened within 48 hours of starting treatment in the drug group, one to two weeks in the placebo group.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Shows that placebos are better than no treatment at all
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Elkin et al 1989
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Carried out study in depression
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Included 28 clinicians working with 280 patients diagnosed as having major depression.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Individuals randomly assigned to using antidepressant drug, inter-personal therapy or cognitive-behavioural therapy. Also, a control group was given a placebo pill together with weekly therapy sessions
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Double-blind design, so neither the patients nor the doctors knew which was which.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> All assessed at the start, after 16 weeks of treatment and after 18 months
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Results showed that 50% of patients in CBT ad IPT and drug groups recovered
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> 29% recovered in the placebo group
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Drug treatment provided faster results, but no real difference in effectiveness
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Study shows it does not matter which treatment patients received.
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> INDIVIDUAL APPRAOCHES TO DEPRESSION TREATMENT
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Aaron Beck 1960s
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Cognitive restructuring theory- CBT
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Principles:
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Identify negative, self-critical thoughts that occur automatically
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Note connection between negative thought and depression
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Examine each negative thought and decide whether it can be supported
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Replace distorted negative thoughts with realistic interpretations of each situation
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> CBT
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Used in treatment of adults and children with depression
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Focuses on current issues and symptoms.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Typically, 18-20 weekly sessions with daily practice exercises.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Aim is to correct faulty cognitions and unhealthy behaviours
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Based on assumption that people's interpretations and inferences about the things that happen to them affect their thinking and behaviour.
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Beck argues six patterns of faulty thinking:
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Arbitrary inference
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Drawing wrong conclusions about oneself by making bad connections.
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> IE it rains on your picnic day, you have bad luck and world is against me.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Selective abstraction
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Drawing conclusions by focusing a single part of a whole
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Looking at the bad grade and ignoring your 8 As
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Overgeneralization
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Applying a single incident to all similar incidents
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Relationship problem with one friend means you have no friends
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Exaggeration
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Overestimating significance of negative events
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> She glared at you, all girls hate you.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Personalization
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Assuming that others' behaviour is done with the intention of hurting or humiliating you.
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> She didn't smile at you, she hates you.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Dichotomous thinking
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> All-or nothing way of seeing world
 * <span style="direction: ltr; direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> You are with me or against me
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Second, behavioural aim is to encourage people to increase rewarding activities
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Sport, concerts, meeting new people
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Teasdale 1997
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Best to teach meta-awareness;
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Ability to think about own thoughts.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Teaches clients to monitor thought processes and test them against reality.
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Effectiveness
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Riggs et al 2007
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Studied effectiveness of CBT in combination of placebo or drug therapy
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Randomized double-blind study with 126 adolescents, aged 13-19 who suffered from depression, substance use disorder and conduct disorder.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Participants recruited from social service and juvenile justice systems.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Clinicians often less willing to prescribe antidepressants to them because they think that the adolescents should first and foremost stop abusing drugs
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> 67% of participants in CBT+placebo group were judged to as 'very much improved' or 'much improved' compared to 76% in SSR rug + CBT group.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Notes and self-reports suggested that depression had decreased and so had behavioural problems.
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Cognitive therapy is cost-effective- don't require prolonged treatment
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> No negative effects have been found
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Criticized for focusing on symptoms rather than causes
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> GROUP APPROACHES
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Often couples' therapy, due to strong link between depression and marital problems.
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Jacobsen et al 1989
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Found that this form of group therapy is just as effective in others at treating symptoms of depression, but most effective at improving quality of marital relationships.
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Toseland and Siporin 1986
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Reviewed 74 studies comparing individual and group treatment
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Group was found to be as effective as individual treatment in 75% of cases, and more efficient in the remaining 25%.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> 31% more cost-effective
 * <span style="direction: ltr; direction: ltr; margin-bottom: 0in; margin-left: .2902in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Factors to consider in group therapy:
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Group cohesion. No one person should be different from the rest- has to be a sense that all people 'belong' in the group.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Exclusion. Are there any characteristics that should be excluded from the group?
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Confidentiality. People must trust they can speak freely in the group.
 * <span style="direction: ltr; direction: ltr; direction: ltr; margin-bottom: 0in; margin-bottom: 0in; margin-left: .2902in; margin-left: .375in; margin-top: 0in; margin-top: 0in; margin-top: 0in; unicode-bidi: embed; unicode-bidi: embed; unicode-bidi: embed; vertical-align: middle;"> Relationship with therapist. Group therapy compensates for the fact that the therapist is not 'one of us'. Therapist must show empathy for the members of the group and attempt to understand their reality