0 psychological models of depression

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.

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