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 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.

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,
 Death 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
1) Secondary to a severe and prolonged
conditioned anxiety
2) Consequence of a cognitively based anxiety
3) Secondary to social anxiety or to a feeling of
interpersonal intimidation
4) 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. 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,

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
1. 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."

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

62. 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

63.  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

64.  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

65.  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

66. HOPELESSNESS THEORY
 An adaptation of this theory argues that depression
results not only from helplessness, but also from
hopelessness.

67.  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

68. 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

69. 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.

70.  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.

71. THANK YOU