Trauma,personality disorders and chronic depression – the role of the conversational model of psychodynamic psychotherapy in treatment resistant depression

Objective: To report preliminary data describing the interim treatment outcome of 44 patients referred with treatment-resistant depression (TRD), comorbid personality disorders and histories of early childhood trauma using the Conversational Model (CM) of psychodynamic psychotherapy. Method: Patients (N = 44), 13 males and 31 females with long histories of depression ranging from 2 to 30 years, resistant to multiple trials of treatment, were referred by mental health practitioners, including psychiatrists. They were treated with twice weekly CM psychotherapy by multidisciplinary trainees and supervised by experienced trained clinicians. Questionnaires were administered at assessment and at 12 months to assess symptoms, functioning, self-esteem, history of trauma, personality functioning and suicidality. In this preliminary study, there was no separate control group, and patients served as their own controls. Results: Patients with TRD were found to have comorbid severe personality disorders and histories of early childhood trauma. Significant improvement in symptoms, self-esteem, functioning and suicidality was noted after 12 months. Conclusion: Patients responded with symptomatic and functional improvement to twice weekly CM therapy.     

Are sex-role attitudes useful in explaining male/female differences in rates of depression?

This study used an untreated sample of husbands and wives to investigate the effect of a wife's employment status on her spouse's depression score. A consistency between attitudes toward appropriate sex-role behavior and actual situation was expected to enhance mental well-being. Data demonstrate that when a measure of sex-role attitudes was paired with situation, it was a significant indicator of depression scores for unemployed females. Housewives with liberal views toward sex roles felt more restricted and were more depressed than were traditional housewives. Sex-role orientation was not effective in explaining depression scores for working wives or for husbands in the sample. The findings emphasize the necessity for examining the impact of sex-role orientation on depression both by sex and by situation.     

Modes of action of family interventions in depression and schizophrenia: the same or different?

The role of relatives' expressed emotion (EE) in mediating the efficacy of family interventions has been studied in randomized controlled trials (RCTs) involving people with schizophrenia and depression. Reanalysis of two RCTs (n=48) by Leff (1989) indicated that lowering relatives' EE and/or reducing social contact between the patient and family members accounted for the efficacy of the intervention for schizophrenia. However, this relationship has not been investigated previously with regard to depression, and this paper presents the results of a recent RCT which included measurement of EE and other possible mediating variables. In this study, amelioration of the critical attitude of the partner did not account for the superiority of couples therapy over antidepressant medication, since the same change occurred in the drug group. However, reducing the patient's exposure to the partner's hostility partially explained the efficacy of couples therapy. Further research on the process of change in families undergoing therapy is indicated to identify the variables that account for the efficacy of therapy.     

The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America?

The expectation that Chinese people present distress somatically is a central prediction of cultural psychopathology and has been the subject of considerable theoretical speculation. At the same time, empirical studies have been infrequent and have yielded mixed results. The authors examined symptom presentation in Chinese (n=175) and Euro-Canadian (n=107) outpatients, using spontaneous problem report, structured clinical interview, and symptom questionnaire methods. All 3 methods yielded cross-culturally equivalent somatic and psychological symptom subscales. Chinese outpatients reported more somatic symptoms on spontaneous problem report and structured clinical interview compared with Euro-Canadians, who in turn reported more psychological symptoms on all 3 methods. The relation between culture and somatic symptom presentation was mediated by a tendency toward externally oriented thinking. Difficulties with identifying emotions or describing them to others did not differ significantly across cultures, supporting a nonpathological interpretation of observed differences. Psychological symptom effects were larger and more consistent than somatic symptom effects; because other studies have confirmed the ubiquity of somatic presentations worldwide, these results suggest that Western psychologization may be more culturally specific than is Chinese somatization.     

Is depression best viewed as a continuum or discrete category? A taxometric analysis of childhood and adolescent depression in a population-based sample

The authors examined the latent structure of depression in a population-based sample of children and adolescents. Youth's self-reports and parents' reports of the youth's Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) major depressive symptoms were assessed via a structured clinical interview. The authors used Meehl's (1995) taxometric procedures to discern whether youth depression is dimensional or categorical. Taxometric analyses that explicitly took into account the skewness of depressive symptoms suggested that depression is a dimensional, not categorical, construct. The dimensional structure of depression was obtained for all of the DSM-IV major depressive symptoms as well as for different domains of depression (emotional distress symptoms and vegetative, involuntary defeat symptoms), youth and parent reports, and different subsamples (i.e., boys vs. girls and younger vs. older youth).     

Melancholy: An elusive dimension of depression?

Journal of Medical Humanities - This paper presents a view of melancholy based on Kierkegaard's insight of the self, showing that this dimension of depression is anticipatory of threat to...     

Is this happiness I see? Biases in the identification of emotional facial expressions in depression and social phobia

The present study was designed to examine the operation of depression-specific biases in the identification or labeling of facial expression of emotions. Participants diagnosed with major depression and social phobia and control participants were presented with faces that expressed increasing degrees of emotional intensity, slowly changing from a neutral to a full-intensity happy, sad, or angry expression. The authors assessed individual differences in the intensity of facial expression of emotion that was required for the participants to accurately identify the emotion being expressed. The depressed participants required significantly greater intensity of emotion than did the social phobic and the control participants to correctly identify happy expressions and less intensity to identify sad than angry expressions. In contrast, social phobic participants needed less intensity to correctly identify the angry expressions than did the depressed and control participants and less intensity to identify angry than sad expressions. Implications of these results for interpersonal functioning in depression and social phobia are discussed.     

Does frontal brain activity mediate the effect of depression prevention in adolescents? A pilot study

We investigated whether (a) depression prevention was associated with depressive symptoms and medial-frontal alpha asymmetry in adolescents; (b) alpha asymmetry mediated the association between participation in a prevention program and depressive symptoms; and (c) gender affects these associations. In our randomised control group study, we compared a universal prevention program (n = 40 adolescents, 14 females) with a non-intervention control condition (n = 39 adolescents, 20 females) in German secondary school students (mean age: 13.53 years, SD = 0.53). We collected data at baseline, post-intervention, 6-month, and 12-month follow-up using the Self-Rating Questionnaire for Depressive Disorders (SBB-DES) and resting medial-frontal alpha activity on F3 and F4. We found that girls benefitted from participating in the prevention program in regards to their depressive symptoms at 12-month follow-up but not alpha asymmetry. In boys, participation in the prevention program was associated with their alpha asymmetry at 6-month follow-up but not their depressive symptoms. Alpha asymmetry did not mediate the effects of the prevention program on depressive symptoms in either gender. Although participation in the prevention program was associated with both depressive symptoms and alpha asymmetry, those associations seem independent from each other. Possible explanations for this result pattern are discussed.     

The MCMI-II depression scales: do they assist in the differential prediction of depressive disorders?

This study examined the diagnostic efficiency of the Millon Clinical Multiaxial Inventory-II (MCMI-II) Major Depression (CC) and Dysthymia (D) scales for the differential prediction of unipolar depressive disorders. The MCMI-II was administered to 109 inpatients at a large private psychiatric hospital in the Midwest. All patients had a primary Axis I diagnosis of a depressive disorder, given at discharge by the attending psychiatrists. When CC scores were compared to clinician diagnoses, results indicated that the sensitivity of the CC scale was improved over what had previously been reported for studies involving the MCMI-I CC scale. However, overall, the D scale functioned slightly better as a predictor of major depression than did the CC scale. One likely factor in explaining this finding is that the CC scale contains very few items assessing vegetative/somatic symptomatology, which are the critical factors in distinguishing major depression from other unipolar depressive disorders.     

Characteristics of congregations that might increase their participants’ risk of depression

This research examines some characteristics of congregations that might increase the risk of their participants being depressed. Analysing data from the Portraits of American Life Study Wave 1 (2006), this research found that those affiliated with a congregation that did not meet their spiritual needs had arguments about traditional versus contemporary beliefs, made them feel like outsiders, and had unsatisfactory decision-making processes which were more likely to feel depressed than their counterparts. The findings of this research suggest that to alleviate the problem of depression, individuals need to choose a congregation that meets their spiritual needs and makes them feel accepted, rather than just attending any congregations.     

Does quality of sleep mediate the effect of depression on hopelessness?

The objectives of the study were to evaluate the relationship between sleep quality, depression, and hopelessness in advanced cancer patients and whether sleep quality mediated the effect of depression on hopelessness. The final sample consisted of 102 advanced cancer patients under palliative treatment. Patients completed the Greek Pittsburgh Sleep Quality Index, a sleep quality instrument, the Greek Beck Depression Inventory for measuring depression, and finally the Beck Hopelessness Scale. Patients' performance status was assessed by their overall physical functioning, as defined by the Eastern Cooperative Oncology Group. Depression was highly associated with hopelessness (r = .52, p<.001). Statistically significant associations were found between sleep quality with hopelessness (r = .37, p<.001), as well as with depression (r = .36, p<.001). Mediation analyses indicated that depression influenced hopelessness directly as well as indirectly by its effect on sleep quality. About 14.58% of the variation in hopelessness was explained by depression; 4% of the variance in hopelessness explained by depression was accounted for by the mediation pathway indicating that sleep quality mediated the relationship between depression and hopelessness. Similarly, in the reverse mediation analysis, depression mediated the relationship between sleep quality and hopelessness; 43% of the variation in hopelessness was explained by sleep quality. In conclusion, some of the effect of depression on hopelessness was mediated by sleep quality, but depression had a direct effect on hopelessness as well. Additionally, some of the effect of sleep quality on hopelessness was mediated by depression. The current findings are important because improving sleep quality by treating depression may contribute to decreased hopelessness scores and vice versa: Treating depression by improving sleep quality may also contribute to lower hopelessness scores.     

Mood-congruent memory in depression: emotional priming or elaboration?

We investigated whether mood-congruent memory (MCM) bias in depression is a function of implicit or explicit memory. Implicit memory is taken as a measure of ease of activation, whereas explicit memory also taps elaboration. As expected, MCM bias was found in the explicit memory task but not in the implicit memory task. We believe this finding supports the involvement of elaborative mechanisms in MCM. In addition, memory bias was found with words related to depression but not with words denoting physical threat. Thus, the MCM bias in explicit memory was found to be specific to information that was congruent with depression rather than to all negative information.     

Till depression do us part? Examining the prospective associations between depression and marital adjustment in older adults

IntroductionThe association between marital adjustment and depression in young couples is well established. However, little is known about the longitudinal associations between marital adjustment and depression in older adults.ObjectiveTo explore if such associations are significant in older adults and determine their direction of effects.MethodThe cross-sectional and 12-month prospective associations between diagnostic depression and marital adjustment in a representative sample of community-dwelling older adults (age ≥ 65 years, n = 847) from Quebec, Canada, were assessed through cross-lagged, multiple regression analyses.ResultsData suggest a cross-sectional association between marital adjustment and depression. As for longitudinal associations, marital adjustment predicted subsequent diagnostic depression but there was no support for the inverse path, suggesting a unidirectional relation between these variables.ConclusionWhile significant, the association between initial marital adjustment and later depression was weak. Based on our and previously reported findings, the importance of the prospective relations between marital quality and depression in older adults is discussed.     

The effect of group psychological counselling in Greek university students’ anxiety,depression, and self-esteem

Objective: During the last decades there has been a marked increase in both the number of students with severe psychological problems on campus and the number of students seeking counselling services. The present study measured the effect of a group psychological counselling program on university students’ anxiety, depression, and self-esteem. Design: Data were derived from six separate groups and a total of 53 participants (19 male, 34 female). The intervention was based on Cognitive-Behavioural Group Therapy (CBGT) and included cognitive and behavioural techniques in eight, two-hour weekly sessions. The quasi-experimental longitudinal study used a pretest/posttest group design. The participants completed the Spielberger's State–Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), and the Rosenberg Self-esteem Scale (RSE) before and after the intervention. Data were analyzed using t-tests. Results: The results indicated the existence of meaningful differences in terms of state and trait anxiety, depression and self-esteem from pre-treatment to post-treatment. Conclusion: The program was effective in decreasing significantly participants’ anxiety and depressive symptoms, as well as increasing their self-esteem. These are encouraging results demonstrating an effective form of the intervention on student population.     

Testing the cognitive catalyst model of depression: does rumination amplify the impact of cognitive diatheses in response to stress?

Recent studies have found that rumination functions as a catalyst of cognitive vulnerability to depression. Specifically, these studies have reported synergistic effects between rumination and negative cognitive content (beliefs and attitudes), such that rumination amplifies the association between negative cognitive content and depression (Ciesla & Roberts, 2002, 2007; Robinson & Alloy, 2003). The current study extended this work by testing whether cognitive vulnerability involving the combination of negative cognitive content and rumination increases the impact of stress on the course of depressive symptoms. One hundred ninety-one college students with elevated depressive symptoms participated in a two-wave longitudinal study. Results indicate that the maintenance of depressive symptoms was predicted by the three-way interaction of negative cognitive content, rumination, and stressful life events. More specifically, students who endorsed both maladaptive cognitive content and a tendency to ruminate were particularly vulnerable to the deleterious impact of life stress.     

‘What do you mean by depression?’—A study of the relationship between antidepressive activity and personal concepts of depression

This study explores the relationship between a subject's concept of depression and his reported antidepressive activities. A pilot study is reported which was used to develop a method of classification of subjects' concepts of depression in terms of depth of depression and degree of external causality perceived. The majority of the subjects studied fitted into a group who see depression as a major disturbance of mood unrelated to external events; this was true for both the pilot and main studies. The main study applied the depressive classification method to an investigation of the relationship between depressive concept group and qualitative and quantitative aspects of reported repertoires for coping with depression. A major concept of depression was shown to be associated with a high frequency of reported antidepressive activity, but ANOVAR revealed no other significant main effect on quantitative analysis. Various complex interactions of sex. depth of concept and locus of concept were observed. A group of psychiatric inpatients were seen to differ in quantitative and qualitative aspects of reported antidepressive behaviour from the remainder of the population studied; the implications of these findings for further research are discussed.     

Maternal depression and the timing of mother–child dialogue

Turn-taking in dialogue is an essential part of communication and early language experience. The prevalence of utterances and the timing of responses in dialogue were examined at 14 and 36 months of age in 104 mother–child dyads from the Early Head Start Research and Evaluation Project (EHSREP). Mothers varied in their level of depression risk (measured with the Center for Epidemiological Studies-Depression scale; CES-D). Although maternal utterance rate did not vary significantly across any factors, the latency of mothers' responses to their children decreased with development (12 ms/month) and was significantly related to that of their own children (i.e., slow-responding children had slow-responding mothers). Mothers with higher levels of depressive symptoms were 11% slower in responding to their children than mothers with low depression risk, suggesting that the interactive timing of speech to children may be particularly sensitive to maternal depression, modifying the contingent properties of children's early language experience.     

Does neuroscience hold promise for the further development of behavior therapy? The case of emotional change after exposure in anxiety and depression

Over the last few years, the integration of biological and psychological models has become increasingly important in clinical psychology. This paper presents a neurobiological framework for exploring how neuroscience research may be valuable in the context of new developments in behavior therapy. The importance of the cortical-subcortical circuitry of emotion processing for investigating the working mechanisms of exposure therapy is illustrated by current neuroimaging research. The implication is that during exposure therapy the focus of attention must be fully directed towards the emotional content of the threatening situation to facilitate prefrontal control over the amygdala and that new contextual information, of emotional salience, must be added to create inhibitory projections from the hippocampus. In addition, some possible mechanisms of action for different therapeutic approaches to both anxiety and depression and the role of neuroimaging techniques in predicting treatment outcome are discussed.     

Can't a mother sing the blues? Postpartum depression and the construction of motherhood in late 20th-century America

Popular depictions of 20th-century American motherhood have typically emphasized the joy and fulfillment that a new mother can expect to experience on her child's arrival. But starting in the 1950s, discussions of the "baby blues" began to appear in the popular press. How did articles about the baby blues, and then postpartum depression, challenge these rosy depictions? In this article, we examine portrayals of postpartum distress in popular magazines and advice books during the second half of the 20th century to examine how the unsettling pairing of distress and motherhood was culturally negotiated in these decades. We show that these portrayals revealed a persistent reluctance to situate motherhood itself as the cause of serious emotional distress and a consistent focus on changing mothers to adapt to their role rather than changing the parameters of the role itself. Regardless of whether these messages actually helped or hindered new mothers themselves, we suggest that they reflected the rarely challenged assumption that motherhood and distress should not mix.