Cognitive Therapy and Depression

¶ … Depression is a state of sadness and gloom where one feels dull and overwhelmed by the challenges of life. People tend to say that they are "depressed' any time they feel very unhappy. More likely than not, it could just be a mere response to fatigue, sad thoughts or events. This improper use of this term causes confusion between an ordinary mood swing and a medical condition. While it is normal for all human beings to experience dejection every now and then, a few people may experience unipolar depression. Ordinary dejection is rarely serious enough to significantly affect a person's day to day activities and does not persist for long. Mood downcasts can even have some benefits. Time spent contemplating can help an individual explore their inner self, values and way of life. They often come out of it feeling stronger, resolved and with a greater sense of clarity.

Unlike normal dejection, clinical depression does not have any characteristics of redemption. It causes severe and persistent psychological pain that can get worse with time. The victims may find that they have no will to do simple activities in life; the will to live is lost in some cases (Comer, 2013).

Behaviors Associated with Depression

Different people may have different forms of depression. Most of the victims feel dejected and melancholic. They describe how they feel with words such as "empty", "humiliated" or "miserable". The sense of humor is often lost, depressed persons rarely get pleasure from any activity, and in some cases, they display the inability to feel pleasure (anhedonia). Several of them experience anger, agitation or anxiety. This immense misery may cause crying spells (Comer, 2013).

People suffering from depression tend to lose the desire to engage in their normal activities. A majority of them report to have lost their drive, spontaneity and initiative. They may find that they have to push themselves to work, obey meals, have sex or even chat with friends. This is a state known as "paralysis of will". Victims of depression are not usually very active or productive. They spend more time with no company and may be in bed for extended periods. They hold very negative opinions about themselves. They tend to consider themselves inferior, undesirable, inadequate and even evil. They also lay the blame for almost all unfortunate events on themselves even when they are not responsible in any way and seldom take credit for their positive achievements.

Pessimism is another cognitive sign of depression. Victims tend to be convinced that things can never get better and feel like they cannot change anything in their lives. Since they expect a negative outcome, they are more likely to fall into procrastination. They are vulnerable to suicidal thoughts due to the sense of helplessness and lack of hope (Wilson & Deane, 2010).

Depressed people tend to claim that they have poor intellectual abilities. They lack focus, feel confused, have poor memory and lack the ability to solve some basic problems. In studies carried out in laboratories, people with depression perform poorly on tasks requiring reasoning, attention and memory as compared to people who are not depressed. However, it is possible that these challenges are not a reflection of cognitive problems but those related to motivation (Hammar et al., 2011).

Depressed persons frequently suffer from physical illnesses such as indigestion, headache, dizziness, general pain and constipation. As a matter of fact, numerous depressions are at first misdiagnosed as a medical problem. Sleep and appetite problems are particularly common. A majority of depressed people report feeling more fatigued, and eating and sleeping less than they did before. However, there are some who sleep and eat excessively.

Biological Influences on Depression

According to studies conducted on biochemical, anatomical, genetic and immune systems, it is evident that biological factors have an influence on depression. Four different researches -- molecular biology gene studies, adoption, twin and family pedigree -- suggest that there are people who have an inherited depression predisposition (Elder &Mosack, 2011). Family pedigree studies pick individuals who are depressed as probands (people who are the main focus in a genetic study), conduct examinations on their relatives and find out whether there are other family members who suffer from depression. If the unipolar depression predisposition is hereditary, the relatives of a proband have a higher chance of getting depression than the general public. According to researchers, up to 20% of the victim's relatives have depression as compared to only 10% of the population. If a monozygotic twin becomes depressed, the other twin has a 46% chance of having depression. Contrary to this, when a dizygotic (fraternal) twin has depression, there is only a 20% chance of the other twin developing depression (Comer, 2013).

Adoption studies also imply that there are genetic factors involved, at least in severe depression cases. A study in Denmark examined families with adopted children who had been hospitalized because of depression. It turned out that the adoptees' biological parents have a higher chance of developing severe (but not mild) depression than the biological parents of adoptees who are not depressed. These findings are interpreted by some theorists to mean that genetic factors are more likely to cause severe depression than mild depression.

There is a strong connection between depression and the low activity of serotonin and norepinephrine (neurotransmitter chemicals). It was believed that the low activity of any of these two chemicals could lead to depression for many years, but investigators have found that there is a more complicated relationship (Goldstein, Potter, Ciraulo, & Shader, 2010). According to research, the interaction between the activity norepinephrine and serotonin or between these neurotransmitters and other neurotransmitters present in the brain may be responsible for unipolar depression as opposed to the operation of one neurotransmitter alone. For instance, some studies suggest that there is an imbalance in dopamine, serotonin, acetylcholine and norepinephrine neurotransmitter activity in people who have depression. Some researchers, in this theory's variation, hold the belief that serotonin actually plays the role of a neuromodulator and its main purpose is to regulate other important neurotransmitters' activities. If this is the case, it is possible that low activity of serotonin is responsible for the disruption of the activities of other neurotransmitters thus causing depression.

Personality Theories and Depression

Understanding how personality and depression are related will help to shed light on comorbidity and etiology, identify people who are at risk and foster treatment development.

The personality continuum/spectrum theory puts emphasis on the conceptual overlap that exists between some personality traits and depressive disorders and argues that they exist in fundamental continuity. The role of a depressive disorder is considered to identify people with extreme relevant trait scores. The continuum/spectrum model, as is the case with the common cause model, makes the assumption that depression and personality originate from causal factors that are similar, probably identical. The continuum/spectrum model, however, continues to posit that the trait-disorder connection should be fairly certain since they belong to one continuum. In addition, it is expected that this relationship should be nonlinear such that most of the people below the trait's definitional threshold have no diagnosis while most of those who meet the threshold meet the criteria. The continuum/spectrum model would therefore be based on evidence that depression and the trait are connected to similar etiological influences and the connection is nonlinear and fairly specific (Klein, Kotov, & Bufferd, 2011).

According to the precursor theory, personality is a "formefruste" or incomplete manifestation of depressive disorder. Similar to continuum/spectrum and common cause models, the precursor model suggests that the cause of depressive disorder and personality are the same etiologic factors. It also implies that there is significant phenomenological similarity between depression and the relative trait, just like the continuum/spectrum theory. However, contrary to the two other theories, the precursor theory posits a certain sequence of development, with evidence of personality traits before depressive disorder begins. The precursor model implies that traits escalate to disorder over a period of time while the other two models assume traits or disorder are a fixed clinical expression. Evidence of similar etiological factors associated with trait and depression, and the fact that people with high trait levels are at a higher risk of developing the disorder, would support the precursor model (Klein, Kotov, &Bufferd, 2011).

Effectiveness of Therapies for Treating Depression

Interpersonal Psychotherapy (IPT), a form of treatment, has been quite successful in clinical trials. IPT is founded on the concept that there is a close relationship between interpersonal problems and depression. The therapy is centered on the examination of primary interpersonal issues such as interpersonal conflicts, isolation, transition of roles and bereavement. The therapist typically helps the patient focus on one or two of these issues with the aim of identify feelings, making decisions and taking action to solve problems that arise from these issues. IPT, like the treatment of cognitive behavior, is usually short, comprising of around 16 sessions. The methods used include discussion of interpersonal problems, exploration of negative emotions and encouraging patients to express them, improvement of communication (verbal and nonverbal), solving problems and encouraging new modes of behavior that are more satisfying (Kring, Johnson, Davison, & Neale, 2010).

There are a number of studies that suggest that IPT relieves MDD effectively and if the treatment is not stopped after recovery, it could prevent relapse. Additionally, it has been found that IPT can be an effective treatment for MDD among postpartum women and adolescents. A study conducted in a village in Uganda states that IPT group sessions helped relieve symptoms of depression (Bolton et al., 2003). It has also been found that IPT is effective in dysthymia treatment. However, recent studies conducted on elderly patients suggest that IPT is similar to placebo and not as effective as antidepressants (Dombrovsky et al., 2007). IPT however appears to be effective in most studies.