Upload
sarath-nair
View
124
Download
0
Embed Size (px)
Citation preview
PSYCHOLOGICAL MODELS
OF DEPRESSION
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
PSYCHOLOGICAL MODELS OF DEPRESSIONProponents (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
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
PSYCHODYNAMIC THEORIES
Early 20th 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.
PSYCHODYNAMIC ASPECTS OF DEPRESSION
Psychoanalysis
Attention to intrapsychic, unconscious pressures
psychological symptoms.
PSYCHOANALYTIC DESCRIPTIONS OF MAJOR DEPRESSION
Response to loss / anger turned inward
Guilt
Impairment in self-esteem regulation
Inadequacy of early care-givers
RESPONSE TO LOSS/ANGER TURNED INWARD
Karl Abraham, Freud, and Sandor Rado
Emphasized depressed patients' reactions to
object loss, in reality or in fantasy.
.
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
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.
Emphasize a symbiotic or narcissistic tie to
the object.
Individuals predisposed to depression
Struggling against feelings of helplessness
and injured self-esteem in childhood.
GUILTMelanie 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.
IMPAIRMENT IN SELF-ESTEEM REGULATION
More recent psychodynamic models
Shift the focus towards the individual’s sense
of self-worth or self-esteem
Edward Bibring Conflicts about aggression and object loss.
Secondary determinants in depression
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
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.
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.
INADEQUACY OF EARLY CAREGIVERSHans 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
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.
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.
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
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.
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.
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.
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
Major life stressors - increase the risk of depressive episodes in vulnerable individuals includes,
Death of a significant other Struggles in important relationships Change in marital status Housing, job status and physical ill-health
John Bowlby postulated that people have an evolutionarily
determined, instinctual drive to form emotional attachments.
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.
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.
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.
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
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
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.
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.
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
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
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.
Learning Theory
Interactional Theory
Joseph Wolpe’s Model of Neurotic Depression
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.
THE ROLE OF REINFORCEMENTPeter 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
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
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
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
Depressed people may react to rejection with
deeper depression & greater demands,
triggering a vicious cycle of further rejection
and more profound depression.
JOSEPH WOLPE’S MODEL Wolpe believed that depression occurred
secondary to maladapative anxiety It occurs in 4 ways1) Secondary to a severe and prolonged
conditioned anxiety2) Consequence of a cognitively based anxiety3) Secondary to social anxiety or to a feeling
of interpersonal intimidation4) Result of unresolved bereavement
Once the focus of the maladaptive anxiety
has been identified it should be treated as an
anxiety problem which should also resolve
the depression.
4. COGNITIVE THEORIES Aaron Beck's Cognitive Theory
Albert Ellis' Cognitive Theory
Bandura's Social Cognitive Theory
Learned Helplessness
Hopelessness Theory
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.
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
A. Theoretical Model:
1. The Negative Cognitive Triad is the Primary Feature of Depression
Beck’s assumption is that depression is principally a cognitive disorder,
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
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.
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
These include:
(1)Selective abstraction
(2)Arbitrary inference
(3)Overgeneralization
(4)Absolutistic or dichotomous thinking
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
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.
Early Experience
Formation of Dysfunctional beliefs
Critical Incident(s)
Beliefs activated
Negative automatic Thoughts
Symptoms of Depression
Behavioral Motivational Affective Cognitive Somatic
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
3 irrational beliefs - depressive thinking1. I must be completely competent in
everything I do, or I am worthless."2. "Others must treat me considerately, or
they are absolutely terrible."3. "The world should always give me
happiness, or I will die."
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
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
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
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
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
HOPELESSNESS THEORY
An adaptation of this theory argues that
depression results not only from
helplessness, but also from hopelessness.
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
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
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.
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.
THANK YOU