Mereka cantik. Mereka berpendidikan. Mrk memiliki karir yg bagus. Sempurna! Hmm.. Mrk jd penyusup dlm hub/perkawinan org lain.
This review provides a summary of literature pertaining to Beck's Cognitive Theory of Depression, as well as a general overview of the theory. Beck believed that the cognitive symptoms of depression actually precede the affective and mood symptoms of depression, rather than vice versa. According to Beck, what is central to depression are the negative thoughts, instead of hormonal changes or low rates of reinforcement as postulated by other theorists. It shall be seen how his contributions have been used in recent studies concerning depression, whether related to his work on negative automatic thoughts, biases and distortions, or his Cognitive Model of Depression.
Another study, which was performed on Beck's Theory, was Sato and McCann's (2000) study on the Beck sociotropy-autonomy scale. The scale had originally meant to identify self-feelings that would lead to depression, mainly solitude/interpersonal insensitivity, independence, and individualistic achievement. However, the results of the study showed that the independence did not correlate with depression, and the sociotropy, not autonomy was a precursor of depression. As they described, "sociotropy can be characterized by an individual's emphasis on interpersonal interactions involving intimacy, sharing, empathy, understanding, approval, affection, protection, guidance, and help…tend to place importance on seeking approval from others and on trying to avoid disapproval from others as much as possible." (Sato, & McCann, 2000, p.66) So it is seen that a strong correlation with sociotropy and depression was found, which is a trait that is strong when relating to underlying thoughts and emotions. This support for cognitively caused depression is an interesting use of Beck's Theory.
Moilanen's (1995) study of adolescent depression also attempts to validate Beck's theory in a new way, as Beck worked mostly with adults. Indeed, she found that the student's depression was often associated with dysfunctional beliefs and negative future attitudes. She suggests that the cognitive theory has reasonable validity for describing the symptoms of depression for nonreferred adolescents, and that the subject's depression is closely correlated with his or her ability to deal with dysfunctional attitudes and beliefs, as well as doubt towards the future. Her findings may not sound truly convincing, because she did find some discrepancies: "However, the results of this study were not entirely consistent with Beck's theory, particularly the proposition that a predominantly negative self-schema underlies the information processing of depressed individuals." (Moilanen, 1995, p.440) We see how perhaps, at least in adolescents, the idea of the negative self-schema is not a clear as Beck wishes it to be.
An earlier study by Molianen (1993) showed even stronger results when evaluating college students. This study showed much more clearer results: "In support of Beck's cognitive theory of depression, the student's current depressive states were consistently found to be related to their negative processing of personal information" (Moilanen, 1993, p.345). The students' cognitive thoughts were shown to be affecting them, and as a result they developed symptoms of depression. Molianen, impressed by the findings, seems to suggest that Beck's theory should be used in further research in the college student population and how depressed students are treated, as counselors and therapists would do well to closely look at a student's cognitive thoughts as a way of assisting the student in recovery. These results are positive, because there is enough evidence for Molianen to suggest a cognitive treatment for depression via Beck's Theory. Molianen's work with Beck's Theory is no doubt a welcome look at cognitive thinking.
Beck's Theory has formed into what is called Beck's Depression Inventory, which is used to measure depression in many studies. One such study done by Saisto et al (2001), attempted to show how different approaches to becoming a mother could stave off depression common with such a major life event. They hypothesized that if the individual set self-focused goals they would be able to think rationally about their situation. "As expected, the results showed that women who adjusted their personal goals to match the particular stage-specific demands of the transition to motherhood showed a decrease in depressive symptoms, whereas those who disengaged from the goals that focused on dealing with such demands showed an increase in depressive symptoms" (Saisto et al., 2001, p.1154). As they used Beck's Theory as a background for their study, we can extrapolate that the subject's who had a goal were able to avoid negative thinking patterns more often then the subjects whom did not have focused goals, so we see that many modern theories of depression are actually based off of Beck's Cognitive Theory.
In another study, Hewitt et al (2003) attempts to improve on Beck's inclusion of dichotomous reasoning as a fuel for the negative cognitive triad. They explain that in "Beck's…model the self-related and socially based features of perfectionism are combined and regarded as similarly influencing the development and maintenance of depression…In Hewitt and Flett's model, perfectionistic self-expectations and perfectionistic interpersonal dynamics are conceptualized as three distinct personality traits." (Hewitt et al., 2003, p.373) Their results were interesting, and showed to clarify the current understanding of how perfectionism relates to depression in terms of Beck's Theory. "Contrary to the widespread understanding of perfectionistic attitudes as a clear-cut representation of the self-related features of perfectionism, socially prescribed perfectionism--not self-oriented perfectionism--was most strongly related to perfectionistic attitudes." (Hewitt et al., 2003, p.383) In this case Beck's theory has been expanded with another theory in the field of cognitive psychology. Beck's Theory also includes the fact that these negative cognitions are fueled by distortions of rationale, such as all-or-none reasoning, selective abstraction, and overgeneralization.
Pemilihan obat antidepresan bagi pasien kanker untuk mengobati depresinya tidak hanya sekedar efektivitasnya saja, melainkan potensial efek samping yang ditimbulkan oleh obat tersebut, problem medis dari masing-masing pasien dan respon pasien sebelumnya terhadap pengobatan antidepresan jika memang sudah pernah diberikan. Oleh karenanya, penanganan kondisi kejiwaan pasien patut dilalakukan dengan seksama, baik oleh dokter ahli onkologi yang mengangani pasien atau ditangani oleh dokter ahli jiwa. Selain pengobatan, psikoterapi juga bisa diberikan dengan teknik khusus dan waktu yang cukup panjang dan sepertinya hal ini sangatlah penting untuk dilakukan.
Beberapa penelitian terhadap obat antidepresan terus dilakukan untuk melihat efeknya bagi pasien depresi dengan kanker, sama halnya yang dilakukan terhadap Sertraline dalam penelitian awal ini ternyata dapat juga dipakai untuk mengatasi depresi pada pasien kanker. Dalam Support Care Cancer. edisi Septembe 2007, pemberian Sertraline dapat memperbaiki alam perasaan “mood” serta meningkatkan kualitas hidup pasien. Sebelumnya memang pernah diteliti mengenai penggunaan Sertraline bagi pasien kanker yang mengalami gangguan mood, mengalami kelemahan dan cemas tetapi tidak bisa ditegakkan sebagai kriterian gangguan depresi, pasien tersebut semuanya sedang menjalani terapi paliatif dan ada pula yang telah mengalami metastasis. Semua pasien tersebut sengaja diberikan antidepresan Sertraline selama 3 bulan untuk mengatasi gejalanya, hasilnya tidak menunjukkan bukti bahwa pemberian antidepresan tersebut memberikan pengaruh dalam perbaikan gejala yang bukan tergolong gangguan depresi, bagaimanapun juga penggunaan antidepresan tetap harus diberikan sesuai dengan indikasi dan pasien sebelumnya harus ditegakkan terlebih dahulu bahwa mengalami depresi mayor.
Penelitian terhadap Sertaline masih tetap dilakukan, kali ini dilakukan terhadap 35 pasien kanker yang sedang menjalani rawat jalan dan didiagnosis mengalami depresi, selama menjalani kemoterapi, dicoba dikumpulkan dan diterapi dengan Sertraline selama 12 minggu dan diamati 3 kali yaitu pada awal penelitian, minggu ke-4 dan minggu ke-12. Respon pengobatan terhadap depresinya dilakukan perhitungan dengan Skor Hospital Anxiety and Depression Scale (HADS) yang digunakan untuk menilai gejala depresi dan ansietas dimana apabila skalanya menurun menunjukkan perbaikan yang nyata pada pasien, Selain itu, skala dari Montgomery Asberg Depression Rating Scale (MADRS) juga dinilai, pemeriksaan dengan menggunakan skala Mini-MAC untuk menilai mental si pasien juga dianggap perlu dilakukan. Semuanya ini digunakan untuk menilai respon pengobatan bagi pasien yang terdiagnosis kanker tak lupa juga dilakukan penilaian dengan menggunakan skala CGI atau Clinical Global Impression untuk menilai keadaan pasien dalam menghadapi sakitnya, dosis dan gejala dari setiap dosis selalu dilakukan pencatatan dengan rapi, dan tak lupa indeks kualitas hidup juga dilakukan penilaian. Hasil dari perhitungan beberapa skor atau skala memperlihatkan skala dari HADS dan MADRS untuk menilai depresinya dan skala ansietas dari HADS mengalami penurunan secara bermakna selama 12 minggu. Hasil perhitungan skor MINI-MAC memperlihatkan pasien sedikit sekali yang mengalami kecil hari atau putus asa atau merasa terbuang secara bermakna setelah diamati dengan seksama, dan tidak ditemukan adanya efek samping pada penelitian tersebut. Dari hasil penelitian awal yang ditujukan pada pasien kanker menunjukkan bahwa Sertraline efektif serta dapat ditoleransi oleh pasien depresi yang mengalami kanker dan mejalani perawatan di luar RS.
Researchers find the virtues of gratitude include good health.
In recent years, many scientists have begun examining the links between religion and good health, both physical and mental. Now two psychologists are working to unlock the puzzle of how faith might promote happiness. Dr. Michael McCollough, of Southern Methodist University in Dallas, Texas, and Dr. Robert Emmons, of the University of California at Davis, say their initial scientific study indicates that gratitude plays a significant role in a person's sense of well-being.
From Cicero to Buddha, many philosophers and spiritual teachers have celebrated gratitude. The world's major religions, including Christianity, Judaism, Islam and Hindu, prize gratitude as a morally beneficial emotional state that encourages reciprocal kindness. Pastors, priests, parents and grandparents have long extolled the virtues of gratitude, but until recently, scholars have largely ignored it as a subject of scientific inquiry.
McCollough and Emmons were curious about why people involved in their faith seem to have more happiness and a greater sense of well-being than those who aren't and decided to study the connections. After making initial observations and compiling all the previous research on gratitude, they conducted the Research Project on Gratitude and Thanksgiving. The study required several hundred people in three different groups to keep daily diaries. The first group kept a diary of the events that occurred during the day, while the second group recorded their unpleasant experiences. The last group made a daily list of things for which they were grateful.
The results of the study indicated that daily gratitude exercises resulted in higher reported levels of alertness, enthusiasm, determination, optimism and energy. Additionally, the gratitude group experienced less depression and stress, was more likely to help others, exercised more regularly and made more progress toward personal goals. According to the findings, people who feel grateful are also more likely to feel loved. McCollough and Emmons also noted that gratitude encouraged a positive cycle of reciprocal kindness among people since one act of gratitude encourages another.
McCullough says these results also seem to show that gratitude works independently of faith. Though gratitude is a substantial part of most religions, he says the benefits extend to the general population, regardless of faith or lack thereof. In light of his research, McCullough suggests that anyone can increase their sense of well-being and create positive social effects just from counting their blessings.
The Beck Depression Inventory (BDI, BDI-II), created by Dr. Aaron T. Beck, is a 21-question multiple-choice self-report inventory that is one of the most widely used instruments for measuring the severity of depression. The most current version of the questionnaire is designed for individuals aged 13 and over and is composed of items relating to depression symptoms such as hopelessness and irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex.[1] There are three versions of the BDI—the original BDI, first published in 1961 and later revised in 1971 as the BDI-1A, and the BDI-II, published in 1996. The BDI is widely used as an assessment tool by healthcare professionals and researchers in a variety of settings.
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Historically, depression was described in psychodynamic terms as "inverted hostility against the self".[2] By contrast, the BDI was developed in a novel way for its time; by collating patients' verbatim descriptions of their symptoms and using these to structure a scale which could reflect the intensity or severity of a given symptom.[1] Throughout his work, Beck drew attention to the importance of "negative cognitions": sustained, inaccurate, and often intrusive negative thoughts about the self.[3] In his view, it was the case that these cognitions caused depression, rather than being generated by depression. Beck developed a triad of negative cognitions about the world, the future, and the self, which play a major role in depression. An example of the triad in action taken from Brown (1995) is the case of a student obtaining poor exam results:
The development of the BDI reflects that in its structure, with items such as "I have lost all of my interest in other people" to reflect the world, "I feel discouraged about the future" to reflect the future, and "I blame myself for everything bad that happens" to reflect the self. The view of depression as sustained by intrusive negative cognitions has had particular application in cognitive behavioral therapy (CBT), which aims to challenge and neutralize them through techniques such as cognitive restructuring.
The original BDI, first published in 1961, consisted of twenty-one questions about how the subject has been feeling in the last week. Each question has a set of at least four possible answer choices, ranging in intensity. For example:
When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is compared to a key to determine the depression's severity. The standard cut-offs are as follows: 0–9 indicates that a person is not depressed, 10–18 indicates mild-moderate depression, 19–29 indicates moderate-severe depression and 30–63 indicates severe depression. Higher total scores indicate more severe depressive symptoms. Some items on the BDI have more than one statement marked with the same score. For instance, there are two responses under the Mood heading that score a 2: (2a) I am blue or sad all the time and I can't snap out of it and (2b) I am so sad or unhappy that it is very painful.[1]
The BDI-IA was a revision of the original instrument, published by Beck in 1971. To improve ease of use, the "a and b statements" described above were removed, and respondents were instructed to endorse how they had been feeling during the preceding two weeks.[5][6] The internal consistency for the BDI-IA was good, with a Cronbach's alpha coefficient of around 0.85, meaning that the items on the inventory are highly correlated with each other.[7] However, this version retained some flaws; the BDI-IA only addressed six out of the nine DSM-III criteria for depression. This and other criticisms were addressed in the BDI-II.
The BDI-II was a 1996 revision of the BDI,[6] developed in response to the American Psychiatric Association's publication of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, which changed many of the diagnostic criteria for Major Depressive Disorder. Items involving changes in body image, hypochondria, and difficulty working were replaced. Also, sleep loss and appetite loss items were revised to assess both increases and decreases in sleep and appetite. All but three of the items were reworded; only the items dealing with feelings of being punished, thoughts about suicide, and interest in sex remained the same. Finally, participants were asked to rate how they have been feeling for the past two weeks, as opposed to the past week as in the original BDI. Like the BDI, the BDI-II also contains 21 questions, each answer being scored on a scale value of 0 to 3. The cutoffs used differ from the original: 0–13: minimal depression; 14–19: mild depression; 20–28: moderate depression; and 29–63: severe depression. Higher total scores indicate more severe depressive symptoms. One measure of an instrument's usefulness is to see how closely it agrees with another similar instrument that has been validated against clinical interview by a trained clinician. In this respect, the BDI-II is positively correlated with the Hamilton Depression Rating Scale with a Pearson r of 0.71, showing good agreement. The test was also shown to have a high one-week test–retest reliability (Pearson r =0.93), suggesting that it was not overly sensitive to daily variations in mood.[8] The test also has high internal consistency (α=.91).[6]
Depression can be thought of as having two components: the psychological or "cognitive" component (e.g. mood) and the physical or "somatic" component (e.g. loss of appetite). The BDI-II reflects this and can be separated into two subscales. The purpose of the subscales is to help determine the primary cause of a patient's depression. The cognitive subscale contains eight items: pessimism, past failures, guilty feelings, punishment feelings, self-dislike, self-criticalness, suicidal thoughts or wishes, and worthlessness. The somatic subscale consists of the other thirteen items: sadness, loss of pleasure, crying, agitation, loss of interest, indecisiveness, loss of energy, change in sleep patterns, irritability, change in appetite, concentration difficulties, tiredness and/or fatigue, and loss of interest in sex. The two subscales were moderately correlated at 0.57, suggesting that the physical and psychological aspects of depression are closely related rather than totally distinct.[9][10]
The development of the BDI was an important event in psychiatry and psychology because it represented the shift of healthcare professionals' view of depression from a Freudian, psychodynamic perspective, to one guided by the patient's own thoughts or "cognitions". [2] It also established a principle followed in the development of further self-report questionnaires, that items can initially be gathered by verbatim reports from patients themselves, with validation studies suggesting theoretical constructs (e.g. using factor analysis), rather than trying to develop an instrument from a purely theoretical basis which may prove to be invalid. The instrument remains widely used in research. A search on Pubmed returns 3,209 peer-reviewed articles that have used the inventory in the measurement of depression, and it has been translated into multiple European languages as well as Arabic, Japanese, Persian, and Xhosa.
The BDI suffers from the same problems as other self-report inventories, in that scores can be easily exaggerated or minimized by the person completing it. Like all questionnaires, the way the test is administered can have an effect on the final score. For instance, if a patient is asked to fill the form out in front of other people in a clinical environment, social expectations might elicit a different response compared to administration via a postal survey. [11] Another serious limitation is that in participants with concomitant physical illness, it has been suggested that the BDI's reliance on physical symptoms such as fatigue might artificially inflate scores due to symptoms of the illness, rather than of depression.[12] In response to this criticism, Beck and his colleagues have developed a measure called the "Beck Depression Inventory for Primary Care" (BDI-PC). This is a short screening scale consisting of seven items from the BDI-II considered to be independent of physical function. Unlike the standard BDI, the BDI-PC produces only a binary outcome of "not depressed" or "depressed" for patients above a cutoff score of 4. [13] Researchers and clinicians who work with medically ill populations might also consider using the Center for Epidemiologic Studies - Depression Scale (CES-D) or the Hospital Anxiety and Depression Scale (HADS) as alternative measures. The BDI provides a measure of severity of symptoms, rather than a diagnosis. Some may consider it inappropriate to make a diagnosis of depression solely on the basis of a self report inventory. [14]
