0 psychological models of depression

psychology

1. PSYCHOLOGICAL MODELS OF DEPRESSION

2. INTRODUCTION Evidence-based psychological theories Provide explanations for why people think, behave, and feel the way they do. Early experiences, interpersonal relationships and personality factors are seen as important factors in causing depression

3. Psychological models of depression Proponents (Year) Model Mechanism Scientific and Clinical Implications Karl Abraham (1911) Aggression turned inward Transduction of aggressive instinct into depressive affect Hydraulic mind closed to external influences; nontestable Sigmund Freud (1917) John Bowlby (1960) Object loss Disruption of an attachment bond Ego-psychological; open system; testable Edward Bibring (1953) Self-esteem Helplessness in attaining goals of ego ideal Ego-psychological; open system; social and cultural ramifications

4. Aaron Beck (1967) Cognitive Negative cognitive schemata as intermediary between remote and proximate causes Ego-psychological; open system; testable; predicts phenomenology; suggests treatment Martin Seligman (1975) Learned helplessness Belief that one's responses will not bring relief from undesirable events Testable; predicts phenomenology; predicts treatment Peter Lewinsohn (1974) Reinforcement Low rate of reinforcement, Testable; predicts phenomenology; predicts treatment

5. Psychodynamic Theories Early 20 th century - dominant school of thought within Psychiatry Early Psychodynamic - focused on the interrelationship of the mind Mental, emotional, or motivational forces within the Mind Interact to shape a Personality.

6. Psychodynamic Aspects of depression Psychoanalysis Attention to intrapsychic , unconscious pressures psychological symptoms.

7. Psychoanalytic Descriptions of Major Depression Response to loss / anger turned inward Guilt Impairment in self-esteem regulation Inadequacy of early care-givers

8. Response to Loss/Anger Turned Inward Karl Abraham, Freud, and Sandor Rado Emphasized depressed patients' reactions to object loss, in reality or in fantasy. .

9. In these formulations, the profound response to loss is believed to occur in part The current loss invokes an earlier, childhood loss, also either of a fantasy or a reality nature

10. Joseph Sandler and Walter Joffe Hampstead Index - phenomenon of loss leading to depression. Comprehensive clinical registry of childhood responses to abandonment and loss, for cases of childhood depression Basic affective response to loss.

11. Emphasize a symbiotic or narcissistic tie to the object. Individuals predisposed to depression Struggling against feelings of helplessness and injured self-esteem in childhood.

12. Guilt Melanie Klein Depressed pts fear - cannot protect an idealized, or good, internalized “other” from destructive, rageful impulses. As a result, the depressed patient's characteristic guilt, inhibitions, and punitive superego develop.

13. Impairment in Self-Esteem Regulation More recent psychodynamic models Shift the focus towards the individual’s sense of self-worth or self-esteem

14. Edward Bibring Conflicts about aggression and object loss . Secondary determinants in depression

15. Depression results from sense of helplessness, impaired self-esteem, self-directed anger triggered by failures to live up to the narcissistic aspirations of any developmental phase

16. Charles Brenner De-emphasized the classic psychoanalytic focus on object loss Connect with organizing fantasies of narcissistic injury (castration). These fantasies are accompanied by reactive aggression against those blamed for the painful affects, with consequent guilt.

17. Edith Jacobson Emphasized - development of self & object representations in depressed patients. Depressed pts' disappointment with parental figures. Resulting in devaluation and degradation of their images & self-representation.

18. Inadequacy of Early Caregivers Hans Kohut Psychoanalyst tried to explain connection between parental depression & subsequent depression in children. Connected to experiences of profound emptiness in patients whose parents were unable to empathize with their early affective experiences

19. These patients crave compensatory relationships: self-object relationships mirroring experiences idealizing relationships Real relationships cannot live up to these compensatory fantasies thus leaving them vulnerable to disappointment.

20. Stone suggested that depressed patients unconsciously coerce objects They are disappointed in them and prone to envy and rage because of early h/o “oral frustration.” Aggressive fantasies about disappointing and hurting loved ones give rise to the severe guilt with which these patients struggle.

21. Sidney Blatt Anaclitic depressed patients: - Anxiously attached individuals -struggle with excessive dependence on others -suffer - feelings of loneliness, helplessness and weakness Introjective depressed patients: -Compulsively self-reliant -Suffer -sense of worthlessness, self-criticism, and guilt

22. 2. Interpersonal Theories Adolf Meyer, Harry Stack Sullivan, Erich Fromm, Frieda Fromm-Reichmann Emphasized the influence of the real impact of current life events on their patients' psychopathology, Focused on environmental and interpersonal encounters rather than underlying intrapsychic drives and structures.

23. Sullivan coined the term “interpersonal” as a rubric for considering current life experience. He scrutinized communications in the social field, a more “external” outlook than traditional psychoanalysis.

24. The consideration of current interpersonal factors is now mainstream clinical thinking Current life events and interpersonal functioning are affected by psychopathology. Psychoanalytically trained therapists like Silvano Arieti and Jules Bemporad emphasized interpersonal factors in the treatment of depressed patients.

25. Researchers did develop a host of related data about interpersonal issues associated with depression. Research showed that interpersonal support protects an individual against depression: Having a confidant to talk to reduces the risk of developing a depressive episode

26. Major life stressors - increase the risk of depressive episodes in vulnerable individuals includes, D eath of a significant other Struggles in important relationships Change in marital status Housing , job status and physical ill-health

27. John Bowlby postulated that people have an evolutionarily determined, instinctual drive to form emotional attachments .

28. This basic component of human nature ensures infant survival: Children need to have parents nearby or available for feeding and protection. Disruptions in this early care-giving connection may lead to vulnerability of attachment style.

29. Eg : loss of one's mother in the first decade of life has been shown to be a risk factor for subsequent depression. Children with insecure childhood attachments may not learn to ask for help from others.

30. When such vulnerable individuals face stressors or feel an absence or inadequacy of interpersonal support during times of stress, They may be helpless to respond effectively and prone to developing symptoms Individuals with insecure attachment styles may have difficulty in developing comfortable relationships on which they can rely for support in times of need.

31. 1970s Gerald L. Klerman , Myrna M. Weissman , and their colleagues - conducting a RCT on OP with major depressive episodes, Recognized that many such patients received psychotherapy in community treatment. They sought accordingly to add a psychotherapy to their trial but realized that it was unclear then of what such community psychotherapy consisted

32. In simplest terms, interpersonal theory as applied to IPT can be understood as a link between mood and events. For biologically or environmentally predisposed individuals, however, a sufficiently disturbing life event can trigger an episode of major depression

33. Once a depressive episode starts, its symptoms compromise functioning, producing more negative life events in a vicious downward cycle. It can be helpful clinically to remind them that they are ill, not defective, and that outside events may have contributed to their distress.

34. IPT therapists do not propose this as an etiological theory of depression, but as a pragmatic one The depressive mood episode can be linked either to a precipitating life event or to consequent life events that become the focus for treatment.

35. The IPT therapist defines major depression as a medical illness—a treatable medical problem that is not the patient's fault—and links it to an interpersonal focus such as a role dispute. The therapeutic contract for the patient is to solve the interpersonal focus within a time-limited period

36. Builds interpersonal skills that may hopefully protect against future interpersonal triggers and depressive episodes. Typical areas of interpersonal skill building are self-assertion confrontation effective expression of anger taking of social risks

37. 3. Behavioral Theories Human behavior has nothing to do with internal unconscious conflicts, repression, or problems with object representations. Uses principles of learning theory to explain human behavior. Dysfunctional or unhelpful behavior such as depression is learned. Because depression is learned, it can also be unlearned.

38. Learning Theory Interactional Theory Joseph Wolpe’s Model of Neurotic Depression

39. Learning Theory Receiving positive reinforcement increases the chances that people will repeat the sorts of actions they have taken that led them to receive that reinforcement.

40. The Role of Reinforcement Peter Lewinsohn Stressors in a person's environment and Lack of personal skills – Depression Environmental stressors cause a person to receive a low rate of positive reinforcement

41. Depressed people do not know how to cope with the fact that they are no longer receiving positive reinforcements like they were before.  Have heightened state of self-awareness about their lack of coping skills - self-criticize & withdraw from other people

42. Interactional Theory James Coyne (1976) Difficulties in social interactions may help explain the lack of positive reinforcement. Based on the concept of reciprocal interaction People’s behavior influences and, in turn, is influenced by the behavior of others

43. Depression-prone people react to stress by demanding greater reassurance and social support from significant others. At first people who become depressed may succeed in garnering support. However, over time their demands and behavior begin to elicit anger or annoyance

44. Depressed people may react to rejection with deeper depression & greater demands, triggering a vicious cycle of further rejection and more profound depression.

45. Joseph Wolpe’s Model Wolpe believed that depression occurred secondary to maladapative anxiety It occurs in 4 ways Secondary to a severe and prolonged conditioned anxiety Consequence of a cognitively based anxiety Secondary to social anxiety or to a feeling of interpersonal intimidation Result of unresolved bereavement

46. Once the focus of the maladaptive anxiety has been identified it should be treated as an anxiety problem which should also resolve the depression.

47. 4. COGNITIVE THEORIES Aaron Beck's Cognitive Theory Albert Ellis' Cognitive Theory Bandura's Social Cognitive Theory Learned Helplessness Hopelessness Theory

48. Beck’s Cognitive Theory of Depression Self-esteem theories emphasize - people’s feelings toward themselves are risk factor for depression. These theories assume - depression is perhaps caused by the manner in which people think about themselves & process personal information.

49. Aaron Beck was one of the first therapist. Began – precise description of the disorder. Special attention given to distinguishing primary symptoms from more secondary ones. As he assumed that if he cured the primary symptoms, the secondary ones would resolve as well

50. Theoretical Model: The Negative Cognitive Triad is the Primary Feature of Depression Beck’s assumption is that depression is principally a cognitive disorder,

51. Characterized by three negative, self-relevant beliefs: (1)A negative view of the self (2)A negative view of the world (3)A negative view of the future

52. These beliefs as negative cognitive triad - central feature of all types of depression. Other aspects of depression, such as somatic disturbances ,motivational disturbances and affective disturbances arise in response to these beliefs In extreme cases-virtually dominate thinking, making difficult to concentrate and engage in normal activities.

53. 2. Negative Self-Schemas in the Maintenance of Depression People who are depressed possess a negative self-schema That leads them to process personal information in a negatively biased and distorted fashion

54. These include: (1)Selective abstraction (2)Arbitrary inference (3)Overgeneralization (4)Absolutistic or dichotomous thinking

55. 3. Dysfunctional Beliefs as a Vulnerability Factor in Depression These beliefs are excessively rigid beliefs about oneself and the world Develop early in childhood and involve unrealistic and perfectionistic standards by which people judge themselves

56. B. Empirical Research Depressed people do not show strong evidence of negative thinking. Claim - process negative personal information in an automatic, unintentional fashion. Concluded - dysfunctional beliefs are symptoms or concomitants of depression rather than predisposing, causal factors.

57. Early Experience Formation of Dysfunctional beliefs Critical Incident(s) Beliefs activated Negative automatic Thoughts Symptoms of Depression Behavioral Motivational Affective Cognitive Somatic

58. Albert Ellis' Cognitive Theory of Depression Depressed people's irrational beliefs - absolute statements Ellis' ideas led him to develop Rational Emotive Therapy, later renamed Rational Emotive Behavior Therapy

59. 3 irrational beliefs - depressive thinking I must be completely competent in everything I do, or I am worthless." "Others must treat me considerately, or they are absolutely terrible." "The world should always give me happiness, or I will die."

60. Bandura's Social Cognitive Theory of Depression Depressed people's self-concepts are different from non-depressed people's self-concepts. Consider themselves solely responsible for bad things in their lives Full of self-recrimination & self-blame Low levels of self-efficacy

61. Seligman's Learned Helplessness In 1965 He discovered an unexpected phenomenon related to human depression while studying the relationship between fear and learning in dogs

62. It has also learned that trying to escape from the shocks was futile -dog learned to be "helpless." This research was then extended to human behavior as a model for explaining depression

63. According to Seligman, depressed people have learned to be helpless. Depressed people feel that whatever they do will be futile & they have no control over their environments

64. Later Seligman modified the learned helplessness theory- Incorporated person's thinking style as a factor determining whether learned helplessness would occur Depressed ppl use more pessimistic explanatory style when thinking about stressful events than did non-depressed people

65. Hopelessness Theory An adaptation of this theory argues that depression results not only from helplessness, but also from hopelessness.

66. Negative thinking in which people blame themselves for negative life events View the causes of those events as permanent Overgeneralize specific weaknesses to many areas of their life

67. Seligman’s Attribution Model Meaning given to negative events will determine risk of depression 3 attributional dimensions are: Internal vs External Global vs Specific Stable vs Unstable If negative events interpreted as Internal, Global & Stable leads to Clinical depression

68. CONCLUSION Depression is a mood disorder which prevents individuals from leading a normal life, at work socially or within their family. Psychodynamic theory has the longest historical tradition. Both cognitive theory & psychodynamic theory focus on intrapsychic phenomena.

69. Interpersonal theory focuses more on interpersonal, extrapsychic reality Theories may also allow us to make predictions about treatment mechanisms and outcomes. Hence understanding the theoretical backgrounds of psychotherapies is crucial.

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