Researchers have focused specifically on the quality of the marital and romantic relationships of depressed individuals to better understand the role of interpersonal factors in the onset, maintenance, and recurrence of depressive symptoms. This focus is warranted for several reasons. First, there is converging evidence for a robust cross-sectional association of marital distress and depression across different populations (e.g., clinical and subthreshold depression) and different assessment methods (e.g., self-report vs. interview). There is also evidence suggesting that depressed individuals’ interpersonal problems and difficulties are most likely to manifest in their interactions with significant others. Furthermore, living with a depressed spouse has been associated with negative outcomes for the non-depressed spouse. The strong association between depression and marital distress has prompted researchers to investigate whether the two variables are causally related. Efforts to elucidate the longitudinal association between depression and marital dysfunction should be informed by epidemiological Read more [...]
Depression Symptoms Treatment
Archive for May, 2011
Childhood maltreatment, including physical abuse, emotional maltreatment, sexual abuse, and neglect, has long been implicated in the development of depression in children, adolescents, and adults. Child maltreatment places individuals at markedly elevated risk for the development of major depressive disorder, depressive symptomatology, and dysthymia. Child maltreatment has also been related to higher likelihood of a relapse after an initial remission of depression. Studies have consistently found high prevalence rates of depression among individuals with histories of child maltreatment. For instance, one study found that, among non-clinically referred samples of protective services cases, 18% of preadolescents and 40% of adolescents with histories of child maltreatment met the diagnostic criteria for major depressive disorder. In general, compared to their nonmaltreated counterparts, individuals with histories of childhood sexual abuse or physical abuse exhibit more symptoms of depression and anxiety, higher attempted suicide rates, and earlier onset and more chronic levels of depression. Various Read more [...]
The notion that painful life experience is critically linked with depressive illness is in no way new. On the one hand within orthodox psychiatry, well before World War II, despite acknowledgment that many depressions were endogenous (and thus presumed biological), there was also the accepted notion that just as many were reactive to circumstances. On the other hand, Freud’s insights in his “Mourning and Melancholia” (1971) show how the experience of loss as a candidate to explain depression was also already current on the other side of the ideological divide, in psychoanalytic circles. By the 1960s the notion of hopelessness and/or helplessness as central to the depressive experience had gained prominence in many schools of thought. The founder of cognitive behavioral therapy had embodied it in his famous cognitive triad — that the self seems worthless, the world seems pointless, and the future hopeless; animal research had charted the process of “learning helplessness” through entrapping experiences; and it was but a step for those with a psychoanalytic background to highlight the link between Read more [...]
Many patients with depression, like those with posttraumatic stress disorder (PTSD), experience unwanted memories of one or more significant events in their lives that intrude frequently into their minds. These memories are vivid, distressing, absorbing, and associated with intense negative emotions. Most research has concerned unipolar depression, but recent research suggests intrusive memories are also a feature of bipolar disorder. In studies to date, the proportion of depressed unipolar patients reporting intrusive memories has varied from 44% to 87%. Typically, frequency of intrusions (and the amount of effort put into blocking them out) is related to depression severity, so that intrusions are more likely to be a feature of severe depression. The first systematic study of intrusive memories focused on memories of child abuse in depressed female patients. Intrusions were more likely when the abuse had been more severe. Typical features of depressive cognition such as lower self-esteem, a more negative attributional style, and the use of avoidant coping were strongly related to the amount memories Read more [...]
Interpersonal Psychotherapy (IPT) is a time-limited psychotherapy specified in a manual and tested in numerous clinical trials that have established its efficacy. Initially developed for adult patients with depression, it has been adapted for adolescents and the elderly with depression, medical patients, and pregnant and postpartum depressed women, and for dysthymia and bipolar depression. It has been tested as acute and as maintenance treatment for depression. The most exciting recent work has been the successful adaptation and testing in Uganda for adults and adolescents with depression. Interpersonal Psychotherapy has been translated into French, German, Italian, and Spanish. International training and studies are ongoing in China, Japan, Goa, Thailand, United Kingdom, Spain, Sweden, Ethiopia, and numerous other countries. There is an International Society of Interpersonal Psychotherapy (www.interpersonalpsychotherapy.org/). Designed for administration by experienced and trained mental health professionals including physicians, psychologists, social workers, and nurses, it can also be taught Read more [...]
The interpersonal approach to depression focus on interactional patterns as a primary source of the onset and maintenance of depression. The interpersonal approach to depression also serves as the theoretical foundation of an approach to the treatment of depression (see Interpersonal Psychotherapy in this site). The interpersonal model stems from two historical foundations. As Gotlib and Schraedley (2000) have noted, the first can be found in the work of the Harry Stack Sullivan and Adolph Meyer in the 1950s. Unlike the predominant psychoanalytic models of the day, which located the causes of psychopathology in interpersonal factors such as psychic conflicts and unacceptable impulses, interpersonal models suggested that psychopathology was caused in large part from problematic interpersonal interactions. The second historical foundation of the interpersonal model can be seen in the evolution of the behavioral approach to psychology, which in the case of application to depression, also evolved to some degree in opposition to cognitive models of depression. Unlike the cognitive model, which also Read more [...]
Reynolds (1992) described internalizing disorders in children and adolescents as “a class of disorders that are considered to be inner-directed, in which core symptoms are associated with overcontrolled behaviors”. The term internalizing, ironically, was not born out of a disorder-based classification scheme, but rather from an empirical approach to understanding the organization of children’s emotional and behavioral symptoms. Over time, those disorders whose symptoms were related to these dimensions became referred to as internalizing disorders. Internalizing disorders are generally conceptualized as emotional disorders that cause distress for the youth, as opposed to externalizing disorders, which are often described as behavioral disorders that result in distress for others. Internalizing disorders have been said to include anxiety, mood, psychosomatic, eating, gender identity, and psychotic disorders, the most prevalent of which are anxiety and mood disorders in child and adolescent populations. Internalizing problems not specific to particular disorders include suicidal behavior and social Read more [...]
The idea of an internal working model was proposed by Bowlby (1980). Internal working models are seen as so-called cognitive-interpersonal blueprints that form the basis of how interpersonal interactions are to be processed and interpreted. These blueprints encompass implicit beliefs about the self and others, along with procedural rules and knowledge for processing information and determining behavioral, emotional, and verbal responses to interpersonal situations. This knowledge also includes internal representations of the self and others, expectations for self and others in interactions, rules for assigning meaning to the behavior of self and others, and tendencies for the selection of information and how information is encoded, stored, and retrieved. In theory, such blueprints are developed through generalizations that are abstracted from real or perceived regularities in past experience, frequently from past experience with important attachment figures. Internal working models thus form a link between past interpersonal experiences and current interactional patterns. Westen (1991) points out Read more [...]
Therapeutic lifestyle change (TLC) is a 14-week behavioral intervention for depression based on a set of six principal lifestyle elements of established antidepressant efficacy: physical exercise, omega-3 fatty acid supplementation, bright light exposure, enhanced social connection, antiruminative activity, and adequate nightly sleep. Predicated on the assumption that the burgeoning depression epidemic in North America and Europe is attributable in part to the loss of key protective features that characterized life in the distant past, therapeutic lifestyle change has as its focus the reclamation and integration of these salubrious lifestyle elements into the fabric of modern life. Theoretical Foundations of Therapeutic Lifestyle Change Therapeutic lifestyle change is based upon the premise of evolutionary mismatch, which posits a poor fit between the modern postindustrial milieu and the Pleistocene-era adaptations that still characterize the human brain. According to this conceptualization, the human brain — in particular, the neurological architecture underlying affect regulation, stress response, Read more [...]
Expressed emotion (EE) is a relational construct that provides a measure of the family environment. Its origins come from schizophrenia research. However, expressed emotion is an important variable for those interested in depression. This is because high levels of expressed emotion reliably predict increased risk of relapse and recurrence of illness in depressed patients who have achieved clinical remission. Measurement EE is assessed during an interview with the patient’s key relative. For most people with depression, this is a spouse. However, the relative could be a parent, sibling, or other caretaker. The relative is interviewed, in the absence of the patient, using a semistructured interview (the Camberwell Family Interview; CFI), that takes 1 to 2 hours to administer. During the interview, the relative is given the opportunity to talk about the patient and his or her symptoms and difficulties and also is asked more generally about how he or she gets along with the patient. After the interview is completed a trained coder listens to the recorded interview and rates expressed emotion. EE is Read more [...]