Cognitive-Behavioral Treatment of Depression, Part IX: Confronting Predisposing Factors

Cognitive-behavioral therapy can help many depressed clients learn more effective ways of coping with problems in their lives. However, for many clients with chronic or recurrent depression, it can be helpful to examine the biological, psychological, and social/cultural factors that may predispose a person toward depressive episodes. In order to address possible biological predispositions, it is important to assess for a positive family history of depression, evaluate family members' response to previous treatments, and refer for medications when needed. In order to address possible psychological predispositions, it is useful to evaluate long-standing personality styles, identify negative events from childhood, examine the client's relationship with his or her parents, evaluate the history of abuse, and identify early loss experiences. Cultural factors may play an influential role in the etiology of depression, and can be useful to incorporate into a broad treatment plan. However, cultural factors are difficult to modify through individual psychotherapy. Hence, they are unlikely to play a central role in cognitive-behavioral therapy for depression. Overall, therapists working with depressed clients should be prepared to confront a broad range of biological, psychological, and environmental factors that can create or perpetuate a client's risk for depression.     

The Boulder Model in Academia: Struggling to Integrate the Science and Practice of Psychology

For many professionals, the Boulder model captures the ideals of clinical psychology. Unfortunately, it can be extremely difficult to integrate science and practice in many work settings. The present paper provides several recommendations for encouraging the scientist-practitioner model in academia. Faculty can strive to integrate teaching, research, and clinical services in weekly activities. First, it is important for the professional to retain a strong and clear focus on clinical psychology, without straying into allied fields. Second, it is essential for anyone who works in academia to learn to juggle many different activities that demand the professional’s time. Third, it is important to maintain a consistent focus on specific areas of interest in order to cultivate them into domains of expertise. Fourth, it is helpful to appreciate the synergism whereby work in one area can enhance the other domains. Fifth, it is helpful to integrate several activities into one multi-purpose task. Finally, it can be useful to view professional involvement in many different activities that could help to advance the field.     

Emotional reliance and social loss: effects on depressive symptomatology

A reactive form of dependence has been proposed to occur when a person is undergoing a period of substantial stress and change. The present study assessed 114 psychiatric inpatients categorized according to the presence or absence of social loss and their level of emotional reliance on others. Both emotional reliance and social loss were related to a variety of depressive symptoms. A significant interaction was observed between emotional reliance and social loss on depression severity as measured by the Beck Depression Inventory (BDI). In general, subjects high in emotional reliance but experiencing no social loss displayed higher levels of depression than emotionally reliant subjects who had undergone a social loss. Patients reporting high emotional reliance on others, in the aftermath of a social loss, may be reacting to the loss and suffer from less-severe and less-chronic pathology. Subjects reporting excessive emotional reliance in the absence of any precipitating exit event may be displaying more of a trait-like pathology. Personality disorder pathology should occur with such frequency and intensity so it can be observed even when obvious eliciting stimuli are absent.     

Suicidal ideation in adolescent psychiatric inpatients as associated with depression and attachment relationships

Examined suicidal ideation in adolescent psychiatric inpatients as associated with depressive symptoms and attachment to mother, father, and peers. Fifty-nine adolescent psychiatric inpatients (25 male, 34 female) completed self-report measures of suicidal ideation, depressive symptoms, and attachment. Attachment to mother accounted for significant variation in levels of depressive symptoms and suicidal ideation. In addition, attachment to peers accounted for significant variation in suicidal ideation and girls' (but not boys') depressive symptoms. However, after adjusting for depressive symptoms, attachment variables failed to contribute additional variance in suicidal ideation. Self-reported depressive symptomatology remained the strongest predictor of suicidal ideation, regardless of its order in the regression analyses. Prevention and treatment efforts may focus on mother-adolescent attachment and peer attachment (particularly in girls) to reduce risk for depression and suicidal ideation.     

Where Has All the Psyche Gone? Searching for Treatments That Focus on Psychological Issues

The field of psychotherapy can be aided by adopting an integrative model that follows a comprehensive biopsychosocial perspective. Unfortunately, recent advances in the field of psychopharmacology have appeared to overshadow the gains that can be made through psychotherapy. Psychotherapists need to protect the psyche that lies at the core of their treatment. Psychotherapy can promote changes in cognitive processes that help to reduce psychiatric symptoms and enhance adaptive functioning. Psychotherapists should not neglect the role of biological or social factors in the etiology or treatment of mental illness. Many clients benefit from a comprehensive biopsychosocial model and interdisciplinary collaboration among mental health professionals. Psychotherapists can maintain a strong emphasis on psychological functioning, while colleagues from other fields focus on the biological and social aspects of mental illness. Furthermore, it seems important for psychotherapists to emphasize the unique qualities of psychotherapy that are distinct from the social support that is provided from a close and confiding friendship.     

Cognitive-Behavioral Treatment of Panic Disorder: Confronting Situational Precipitants

Panic Disorder is a common, debilitating psychological problem which is often effectively treated through cognitive behavioral approaches. Cognitive-behavioral treatment incorporates education, relaxation training, cognitive therapy, behavioral exposure, and relapse prevention treatment strategies. A case illustration demonstrates how cognitive-behavioral treatment facilitated a client's ability to identify and confront situational precipitants to panic in a gradual and systematic manner. A therapeutic and collaborative relationship provided the foundation for treatment, while education helped the client to understand the vicious cycle between somatic symptoms, catastrophic thoughts, and anxiety. Passive relaxation training incorporated deep breathing, muscle relaxation, and positive imagery generated from the client's own experience. Cognitive restructuring involved identifying automatic thoughts related to panic, challenging dysfunctional beliefs associated with the client's depression and low self-esteem, and generating alternative ways of thinking. Behavioral exposure (e.g., imaginal exposure, behavioral rehearsal, in vivo techniques) helped the client gain a greater sense of mastery over panic attacks triggered by his fear of hypodermic needles. Over the course of treatment, the frequency and intensity of the client's panic attacks decreased. Furthermore, the client's sense of mastery over panic had beneficial effects on his mood and self-esteem. Treatment gains were maintained at one-year follow-up.