This article is a press release from Katherine L. Cruise, Director of Communications and Marketing, Screening for Mental Health, Inc. There is more on depression [here]. Assess your risk at [www.HelpYourselfHelpOthers.org] **** There are more than 19 million adults in the United States living with depression and many more people could be suffering but are unaware that what they are feeling is depression, according to the National Institute of Mental Health.
_ This is the second in a series of articles on emotional intelligence for personal growth. The first part is here._ Mindfulness is a non-judgmental, present-centered awareness in which each thought, feeling, or sensation that arises is acknowledged and accepted as it is. It is a skill that is learned by committed practice. The object is to focus one’s attention on thoughts, feelings and events in the present moment while remaining curious, open, and accepting whatever occurs.
This is a topic that gets scant attention leaving the consuming public largely in the dark. Even though I work in the field, I’ve not hear this information except from my own reading. Fortunately, SSRIs are not as susceptible to problems crossing from brands to generics or between generics. But buproprion in other forms may not be as good as Wellbutrin. Image via Wikipedia Medical News “Antidepressant and antipsychotic drugs have become blockbusters for the firms that developed them, making them hot markets for generic competition.
Image via Wikipedia Not surprisingly,the biochemical theory regarding “chemical imbalance” is under attack again. The theory has always been an oversimplification of actual research data. All the research has said is that (1) anti-depressants have worked on average slightly better than placebo and (2) anti-depressants and therapy works slightly better than one or the other alone. Key to understanding what this means are the words “on average”, “placebo” and “slightly better”.
Aaron Beck, considered the Father of Cognitive Therapy, is an American psychiatrist and a professor emeritus at the Department of Psychiatry at the University of Pennsylvania. He is President of the Beck Institute for Cognitive Therapy and Research that is directed by his daughter, Judith S. Beck, Ph.D.. He is noted for his research in psychotherapy, psychopathology, suicide, and psychometrics, and the Beck Depression Inventory (BDI), one of the most widely used instruments for measuring depression severity. At age 87, the man is still publishing, building on his pioneering work on the cognitive model of depression. In his latest article published in the American Journal of Psychiatry, he recalls his early work:
“Caught up with the contagion of the times, I was prompted to start something on my own. I was particularly intrigued by the paradox of depression. This disorder appeared to violate the time-honored canons of human nature: the self-preservation instinct, the maternal instinct, the sexual instinct, and the pleasure principle. All of these normal human yearnings were dulled or reversed. Even vital biological functions like eating or sleeping were attenuated. The leading causal theory of depression at the time was the notion of inverted hostility. This seemed a reasonable, logical explanation if translated into a need to suffer. The need to punish one’s self could account for the loss of pleasure, loss of libido, self-criticism, and suicidal wishes and would be triggered by guilt. I was drawn to conducting clinical research in depression because the field was wide open–and besides, I had a testable hypothesis. I decided at first to make a foray into the “deepest” level: the dreams of depressed patients. I expected to find signs of more hostility in the dream content of depressed patients than nondepressed patients, but they actually showed less hostility. I did observe, however, that the dreams of depressed patients contained the themes of loss, defeat, rejection, and abandonment, and the dreamer was represented as defective or diseased. At first I assumed the idea that the negative themes in the dream content expressed the need to punish one’s self (or “masochism”), but I was soon disabused of this notion. When encouraged to express hostility, my patients became more, not less, depressed. Further, in experiments, they reacted positively to success experiences and positive reinforcement when the “masochism” hypothesis predicted the opposite (summarized in Beck). Some revealing observations helped to provide the basis for the subsequent cognitive model of depression. I noted that the dream content contained the same themes as the patients’ conscious cognitions–their negative self-evaluations, expectancies, and memories–but in an exaggerated, more dramatic form. The depressive cognitions contained errors or distortions in the interpretations (or misinterpretations) of experience. What finally clinched the new model (for me) was our research finding that when the patients reappraised and corrected their misinterpretations, their depression started to lift and–in 10 or 12 sessions–would remit.” We owe a lot to Dr. Beck. His cognitive model of depression still dominates how I and most of my colleagues write treatment plans for persons suffering with depression. Our goal is to inspire and teach our clients to change their negative self-evaluations, correct distorted memories, and create an expectation of success. The only problem is depression is not that simple. Try as they might, many clients are able to recognize what they need to do, understand how their thoughts about themselves and their world need to change, are able to state those changes, and diligently practice them. But when they really need to be able to master their fate, when ruminative thoughts spiral downward into the depths of depression, their efforts quickly collapse and they succumb. So is the Cognitive Model of Depression wrong? No, I think it’s incomplete. There is the biomedical model of depression involving errant neurotransmitter levels treated by various anti-depressants. That discussion is beyond this article’s purpose. I’m more interested in what we as therapists can do differently in the counseling office. Of course we need to be sure a severely depressed client is referred for a medication review. But I want to know how we might better facilitate our clients attempts to master their mood. To this end, I will review my recent reading on the subject of emotion and argue to include emotion in a new Cognitive Theory.
Image via Wikipedia Hat tip to Psych Central for an report on a higher than expected prevalence of suicidal thoughts among college students. Researchers surveyed 26,000 students across 70 colleges and universities. Half reported having at least one episode of suicidal thinking at some point in their lives. Fifteen percent of students surveyed reported having seriously considered attempting suicide and more than 5 percent attempted at least once. “Presenting at the 116th Annual Convention of the American Psychological Association, psychologist David J.
Image via Wikipedia Horwitz and Wakefield (2007) have released what may prove to be a highly influencial book titled The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder. The title implies that psychiatry transformed sadness into depression. It’s an unfortunate catchy title that misleads the uninformed reader. Instead, the book explores in a scholarly way a fundamental principle upon which The Diagnostic and Statistical Manual (DSM) was developed.
This looks like a good one. I’m going to watch for sure. You can even buy the DVD now. “DEPRESSION: Out of the Shadows is a 90-minute documentary about recognizing, treating, and researching depression.
DEPRESSION: Out of the Shadows . Video Preview | PBS A lot of Americans are keeping an important, possibly deadly secret. The National Institute of Mental Health reports that approximately 18.8 million American adults have a depressive disorder.
Shame has been a particular interest for me. It has appeared repeatedly as a major barrier in therapy, especially in those for whom therapy has failed in the past. It takes a lot of courage to re-enter therapy after feeling it was previously insufficient. Fortunately, a person returning to therapy after a less than satisfactory experience is significant motivated to try new ideas. Agreeing to therapy is a humbling experience in and of itself.
BPS RESEARCH DIGEST reviews recent research articles in professional journals. It’s a good place to try to keep up with the literature. It has been a pleasant surprise indeed that many psychodynamic principles have recently demonstrated in research. Unconscious motivations, emotion based early learning have repeatedly been demonstrated. Now I was pleased to find the begins of a research demonstration of one of the most important insights into the obstacles for change that emerge in therapy: the labeling effects of diagnosis and the self-destructive nature of shame.