INTEGRATION OF THEORIES AND THERAPIES FOR UNIPOLAR DEPRESSION
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No one theory of depression-not the biological, not the psychodynamic,
not the behavioral, and not the cognitive-explain all the phenomena of
depression. But each of them seems to have a piece of the truth and most
important of all, the theories are not, by and large, incompatible. Depression
is, in fact, a disorder that occurs on at least four levels. There are clear
thought deficits-hopelessness and worthlessness being the most prominent;
there are clear behavioral deficits-passivity being the most prominent;
there are clear biological deficits-the somatic symptoms and their
biogenic amine correlates; and there may well be psychodynamic
predispositions- the dependent and helpless personality style.
Cognitive, behavioral, biological, and psychodynamic factors all may play a role in
accounting for the predisposition, the symptoms, the causal mediation, and
in producing success in therapy (Akiskal and McKinney, 1973, 1975).
Predisposition
Predisposition to become depressed and invulnerability from depression
may have determinants at all levels of analysis. Biological evidence suggests
that individuals who are predisposed to alterations in functional level of
biogenic amines may be more vulnerable to depression. At the psychodynamic
level, individuals who are heavily dependent on other people and
who set such high standards that they frequently find themselves helpless
before these standards may also be more vulnerable. At the cognitive and behavioral
levels, individuals who have had early experience with loss and
who have developed an attributional style in which loss is construed as internal,
global, and stable may be more vulnerable to depression.
Precipitating Incidents
Cognitive theory explains precipitating incidents well: the expectation of
loss or threat of loss seems to set off most depressions, at least those in which
precipitants can be identified. In addition, biogenic amine changes, as postulated
by the biomedical model, may explain why depression begins when
no obvious loss has occurred.
Symptoms
The symptoms of depression can be described at the cognitive, behavioral,
and biological levels of analysis. Thought symptoms, motivational symptoms,
mood symptoms, and physical symptoms all make up depression.
The duration and generality of these symptoms may be governed by the
attributions an individual makes about loss, with those losses that stem from
internal, stable, and global causes producing the most sweeping and long lasting
symptoms.
Mediation
There seem to be two likely candidates for the internal state that immediately
sets off depression. The first is at the cognitive level and is the expectation
of future uncontrollable bad outcomes. The second is at the biological
level and may be a depletion of biogenic amines, specifically, norepinephrine.
The evidence is not in about which of these causes is primary, but we
suspect that neither is the sole cause and that either taken alone will produce
many of the symptoms of depression. There is one fact about depression
that none of the four theories has yet adequately accounted for; the episodic
rather than permanent nature of depression. Any complete theory of causal
mediation must tell us not only how depression starts but also why it will, in
and of itself, usually stop.
Therapy
All four levels of analysis have contributed insights into therapy for depression.
An episode of depression, even severe depression, is no longer cause for
despair. A combination of the biological treatments and the cognitive-behavioral
treatments of depression can probably alleviate severe depression
roughly 90 percent of the time. In addition, to the extent that there is a depressive
personality, dependent and inclined to helplessness, psychodynamic
therapies may help to prevent the recurrence of depression.
Thus, biological, psychodynamic, behavioral, and cognitive views can all
be usefully brought to bear on depression. By taking the best from each, a
woven fabric may be created in which the predisposition, the symptoms, the
mediation, the precipitating incidents, and the symptoms may be understandable.
Most important of all, depression can now be effectively treated.
~~~~~~~~~~~~~~~
Treating:
Depression
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
~~~~~~~~~~~~~~~~~~~~~~~~
For the Therapy I recommend click here:
The Liberator Method
not the behavioral, and not the cognitive-explain all the phenomena of
depression. But each of them seems to have a piece of the truth and most
important of all, the theories are not, by and large, incompatible. Depression
is, in fact, a disorder that occurs on at least four levels. There are clear
thought deficits-hopelessness and worthlessness being the most prominent;
there are clear behavioral deficits-passivity being the most prominent;
there are clear biological deficits-the somatic symptoms and their
biogenic amine correlates; and there may well be psychodynamic
predispositions- the dependent and helpless personality style.
Cognitive, behavioral, biological, and psychodynamic factors all may play a role in
accounting for the predisposition, the symptoms, the causal mediation, and
in producing success in therapy (Akiskal and McKinney, 1973, 1975).
Predisposition
Predisposition to become depressed and invulnerability from depression
may have determinants at all levels of analysis. Biological evidence suggests
that individuals who are predisposed to alterations in functional level of
biogenic amines may be more vulnerable to depression. At the psychodynamic
level, individuals who are heavily dependent on other people and
who set such high standards that they frequently find themselves helpless
before these standards may also be more vulnerable. At the cognitive and behavioral
levels, individuals who have had early experience with loss and
who have developed an attributional style in which loss is construed as internal,
global, and stable may be more vulnerable to depression.
Precipitating Incidents
Cognitive theory explains precipitating incidents well: the expectation of
loss or threat of loss seems to set off most depressions, at least those in which
precipitants can be identified. In addition, biogenic amine changes, as postulated
by the biomedical model, may explain why depression begins when
no obvious loss has occurred.
Symptoms
The symptoms of depression can be described at the cognitive, behavioral,
and biological levels of analysis. Thought symptoms, motivational symptoms,
mood symptoms, and physical symptoms all make up depression.
The duration and generality of these symptoms may be governed by the
attributions an individual makes about loss, with those losses that stem from
internal, stable, and global causes producing the most sweeping and long lasting
symptoms.
Mediation
There seem to be two likely candidates for the internal state that immediately
sets off depression. The first is at the cognitive level and is the expectation
of future uncontrollable bad outcomes. The second is at the biological
level and may be a depletion of biogenic amines, specifically, norepinephrine.
The evidence is not in about which of these causes is primary, but we
suspect that neither is the sole cause and that either taken alone will produce
many of the symptoms of depression. There is one fact about depression
that none of the four theories has yet adequately accounted for; the episodic
rather than permanent nature of depression. Any complete theory of causal
mediation must tell us not only how depression starts but also why it will, in
and of itself, usually stop.
Therapy
All four levels of analysis have contributed insights into therapy for depression.
An episode of depression, even severe depression, is no longer cause for
despair. A combination of the biological treatments and the cognitive-behavioral
treatments of depression can probably alleviate severe depression
roughly 90 percent of the time. In addition, to the extent that there is a depressive
personality, dependent and inclined to helplessness, psychodynamic
therapies may help to prevent the recurrence of depression.
Thus, biological, psychodynamic, behavioral, and cognitive views can all
be usefully brought to bear on depression. By taking the best from each, a
woven fabric may be created in which the predisposition, the symptoms, the
mediation, the precipitating incidents, and the symptoms may be understandable.
Most important of all, depression can now be effectively treated.
~~~~~~~~~~~~~~~
Treating:
Depression
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
~~~~~~~~~~~~~~~~~~~~~~~~
For the Therapy I recommend click here:
The Liberator Method