10
Feb 19

Is Hopelessness Depression Hopeless?

This week’s assigned readings included chapter 5 in Applied Social Psychology, Understanding and Addressing Social and Practical Problems, by Schneider, Gruman, & Coutts. After reading the assigned chapter called “Applying Social Psychology to Clinical and Counseling Psychology”, I became interested in Abramson, Metalky, and Alloy’s hopelessness theory of depression. Specifically, I wanted to understand the hopelessness theory of depression, what could cause hopelessness depression, and what kind of treatment could be affective for a person with hopelessness depression.

The hopelessness theory of depression states that depressive symptoms are most likely to occur when a vulnerable person experiences negative environmental circumstances (Schneider, Gruman, & Coutts, 2012). This being said, it is important to note that the hopelessness theory of depression specifies that these two factors (vulnerability and negative environmental circumstance) occur simultaneously (Schneider et al., 2012). Schneider et al. (2012) state that a person is deemed vulnerable if they interpret the cause of negative events as something that cannot be changed (stable attribution) and affecting their whole life (global attribution), otherwise known as the pessimistic explanatory style. According to Schneider et al. (2012), a person with these specific traits could be described as having a specific type of depression, called hopelessness depression.

Just while reading the definition of the hopelessness theory of depression it became clear to me that a cause of hopelessness depression could be cognitive distortions, which are defined as thinking errors that are negatively bias that can increase one’s vulnerability to depression (Rnic, Dozois, & Martin, 2016). I am under the impression that someone with hopelessness depression suffers from the following cognitive distortions:

  • All-or-nothing thinking: “If a situation falls short of perfect, you see it as a total failure” (Burns, 1989)
  • Over generalization: “You see a single negative event as a never-ending pattern of defeat” (Burns, 1989)
  • Mental filter: “You pick out a single negative detail and dwell on it exclusively, so that your vision of all reality becomes darkened” (Burns, 1989)
  • Discounting the positive: “If you do a good job, you may tell yourself that it wasn’t good enough or that anyone could have done as well” (Burns, 1989)
  • Jumping to conclusions: “You interpret things negatively when there are no facts to support your conclusion” (Burns, 1989)
  • Magnification: “You exaggerate the importance of your problems and shortcomings, or you minimize the importance of your desirable qualities” (Burns, 1989)

Hopelessness depression seems, well…hopeless, doesn’t it? Is it hopeless to think a person with hopelessness depression could find relief? My answer is no, it is not hopeless. Fixing cognitive distortions like the ones I listed above is a key to treating hopelessness depression. But how does one change distorted thinking? My answer: Cognitive behavioral therapy, which the National Association of Cognitive-Behavioral Therapists defines as a therapy that stresses the importance of thinking about what we do and how we feel (“What is Cognitive-Behavioral Therapy”, 2016).

With the application of the hopelessness theory of depression, a counseling psychologist could practice cognitive behavioral therapy with a patient who has hopelessness depression stemming from cognitive distortions. A counseling psychologist could help their patient recognize their patterns of distorted thinking (vulnerabilities, per the hopelessness theory of depression), show them how they are not valid, and how to work through them when they come up. A counseling psychologist could also help their patient look at a specific negative event (a factor of the hopelessness theory of depression) in a healthy, realistic way.

Through my interest of the hopelessness theory of depression, I not only learned what the hopelessness theory of depression entails, but what could cause hopelessness depression, and what kind of treatment could be affective for a person with hopelessness depression. The hopelessness theory of depression relies on the idea that together, vulnerability and negative environmental circumstances can lead to hopelessness depression. From my research, I am under the impression that cognitive distortions are a cause of hopelessness depression but can be treated through cognitive behavioral therapy. Simply stated, hopelessness depression is not hopeless.

 

References:

Burns, David. (1989). Patterns of Cognitive Distortions. Retrieved from:  http://www.pacwrc.pitt.edu/curriculum/313_MngngImpctTrmtcStrssChldWlfrPrfssnl/hnd

Rnic, K., Dozois, D. J., & Martin, R. A. (2016). Cognitive Distortions, Humor Styles, and Depression. Europe’s journal of psychology12(3), 348-62. doi:10.5964/ejop.v12i3.1118

Schneider, F. W., Gruman, J. A., and Coutts, L. M. (Eds.). (2012). Applied Social Psychology. Understanding and Addressing Social and Practical Problems. CA: SAGE Publications, Inc.

What is Cognitive Behavioral Therapy. (2016). Retrieved from:  http://www.nacbt.org/whatiscbt-htm/

 


10
Feb 19

What’s Behind That Frown?

Depression is a significant mental illness with devastating relational and economic effects in terms of lost productivity and lost relationships.  16.2 million adults have at least one major depressive episode in a given year (Depression: Facts, n.d.).  Depression is of great concern to clinicians who want to help alleviate their clients’ symptoms and increase their life satisfaction.  But what is really behind that frown?  If counselors are focused on increasing self-esteem, building resilience and coping strategies, they may miss the very real possibility that the root cause of a woman’s depression lies in her intimate partner relationship.  Depression is strongly correlated with intimate partner violence (Spencer, Mallory, Cafferky, Kimmes, Beck, & Stith, 2019).  IPV, or domestic violence, can lead to depression and might not be diagnosed without proper screening tools (Gibbs, Dunkle, & Jewkes, 2018).  Abuse is extremely common with 20 people experiencing IPV every minute (Statistics, n.d.).  7/10 of psychologically abused women have PTSD or depression symptoms but nearly 1/3 are never treated (Statistics, n.d.).  It’s my strong belief that women who present with depression should be screened for IPV.  Otherwise clinicians may continue to treat the symptoms while the real problem continues to rage unfettered and unaddressed.  One meta-analysis suggests that clinicians working with couples in an intimate partner violence situation should screen both partners for mental health (Spencer, et al., 2019).  I suggest the opposite as well, that clinicians working with depressed women in particular should screen them for domestic or intimate partner violence.

Intimate partner violence includes a variety of behaviors used to create a sense of power over a victim and to control her in every way, including controlling her emotional self.  It happens in all income levels.  In fact, women who earn more than 65% of their household income are more likely to experience psychological abuse (Statistics, n.d.).  Physical violence such as hitting, punching and strangling is easy to diagnose.  Even overt verbal abuse can be readily recognized, such as when an abuser calls his partner names or criticizes her in public.  More covert and difficult to identify without specific training are the covert forms of abuse.  Treating a spouse well in public but poorly behind closed doors can make the public not believe her when she does speak up.  Using subtle forms of intimidation such as raised eyebrows can send her a signal that she is out of line and will be dealt with at home.  Even more covert are things like ignoring a partner, redirecting a conversation without addressing her concerns, subtly inferring that she has once again done something wrong.  It’s at this level of abuse that victims don’t even know that they are being abused.  They sense that something is not right, they start to feel bad about themselves and eventually they feel like nothing they can do is good enough.  If there is no overt physical or verbal abuse, they may not identify as a victim and may not talk about these subtle things to their therapist, if they even have one.  So IPV often remains undetected and untreated (Feltner, Wallace, Berkman, Kistler, Middleton, Barclay, Jonas, 2018). Women may describe their loss of zest for life and their feelings of hopelessness that can be easily identified as depression, but neither they nor a therapist might think to screen them for IPV.

Learned helplessness occurs when someone has tried and tried different approaches to changing their situation but nothing helps (Schneider, Gruman, & Coutts, 2012).  Many previously positive minded women become depressed in abusive situations. Even those whose outlook on life generally is hopeful can in fact learn helplessness and hopelessness when every effort they try to change things is met with further abuse.  While some depressed women do have a depressogenic attribution style, many do not.  This type of bias describes a person who characteristically across situations believes that bad things in their life are based on underlying factors that will never change (Schneider, et al., 2012).  Instead many victims’ situations have led them to correctly believe that more negative incidents will happen to them.  Coping methods and survival skills leave them to adjust their behavior in ways that inhibit openness and zestful living, such as speaking up less about their own opinions in order to prevent abuse or avoiding certain places and people.  And depression sets in.

Symptoms of depression include anxiety and restlessness, thoughts of death or suicide, anger management issues, loss of interest in activities, irritability over minor things, focus on negatives or on the past (Depression: Facts, n.d.), decreased energy, hopelessness, difficulty sleeping or concentrating, and anhedonia, (Depression in women, n.d.).  Abuse can change a woman’s self perception, causing her to feel unworthy of better treatment or unable to change her situation.  Psychological abuse causes long term mental health damage to a victim (Statistics, n.d.).  Women in IPV may develop depression and many other health consequences including PTSD, suicidal thoughts, anxiety, substance abuse problems, chronic pain (Feltner, et al., 2018).  Higher levels of abuse correlate to more severe levels of PTSD and depression (Wood, Voth Schrag, & Busch-Armendariz, 2018).  One of the antidotes to depression is understanding and adjusting the person’s mindset (positive self talk, increase self worth and autonomy) but if she’s still in the abuse it can be like running on a treadmill where you never get off and get a break, you stay beaten down just as quickly as you try to build your internal self up.

Treatment for depression and for intimate partner violence is not the same.  While a victim may need positive self talk and coping strategies to increase her mental health, she first needs safety.  When she receives enough support and people believe her, and she gets to a safe place, some of the effects of the abuse will naturally start to diminish. Her joy will return simply from no longer having to live with abuse.  Other mental cognitions may have to be adjusted through therapy.  Even something like learned helplessness can be reversed.  She will learn over time that she does have control over her life and that her efforts to heal will bring positive results.  Because an abusive person continually undermines the victim’s sense of self, it leads to internal causal attributions in the victim. She starts to believe that she really is at fault for the crazy things that he does because he tells her this so often.  This leads her to continually try to adjust her behavior to avoid his angry reactions.  Eventually she learns helplessness when nothing that she tries solves the problem.  Part of healing includes the recognition that he is 100% responsible for his behaviors and they aren’t because of anything she has done.  Then she is able to move towards external causal attribution, realizing that he is causing his behavior, rather than internalizing and thinking it is about her.

Clinicians should regularly screen depressed women for IPV especially if they are in a relationship or have recently left one.  Research shows that screening for IPV can successfully identify it (Feltner, et al., 2018). However some assessment tools only assess the level of physical violence or what is called the lethality assessment.  In order to accurately assess whether a woman with depression has been in an emotionally abusive relationship, you need an assessment tool that also includes questions about self-esteem and emotional well being related to the partner.  For example, “Do you feel that nothing you do is ever good enough for your partner?” (Grohol, 2018).  This question refers to the tendency of abusers to put down their mates regularly, using everything from demeaning language to the silent treatment.  “Do you feel anxious or nervous when you are around your partner?” is a question that signifies the walking on eggshells feelings many victims get with a partner who explodes for any little thing.  Depression is devastating and so is violence in the home.  Both need appropriate treatment.  But without screening for domestic violence, we may be actually treating a symptom but not the cause.

References

Depression: Facts, statistics, and you.  (n.d.).  Healthline.  Retrieved on Feb. 9, 2019 from: https://www.healthline.com/health/depression/facts-statistics-infographic#1.

Depression in women: Five things you should know.  (n.d.)  National Institute of Mental Health.  Retrieved Feb. 9, 2019 from: https://www.nimh.nih.gov/health/publications/depression-in-women/index.shtml.

Feltner, C., Wallace, I., Berkman, N., Kistler, C., Middleton, J., Barclay, C., Jonas, D.  (2018). Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: Evidence report and systematic review for the US preventive services task force. JAMA: Journal of the American Medical Association, 320(16), 1688-1701.

Gibbs, A., Dunkle, K., & Jewkes, R. (2018). Emotional and economic intimate partner violence as key drivers of depression and suicidal ideation: A cross-sectional study among young women in informal settlements in South Africa.  PLoS ONE, 13(4), 18.

Grohol, J.  (2018).  Domestic Violence Screening Quiz.   Psych Central.  Retrieved Feb. 9, 2019 from: https://psychcentral.com/quizzes/domestic-violence-quiz/.

Schneider, F., Gruman, J., & Coutts, L.  (2012).  Applied social psychology: Understanding and addressing social and practical problems.  Thousand Oaks, CA: Sage Publications.

Spencer, C., Mallory, A., Cafferky, B., Kimmes, J., Beck, A., & Stith, S.  (2019). Mental health factors and intimate partner violence perpetration and victimization: A meta-analysis. Psychology of Violence, 9(1), 1-17.

Statistics.  (n.d.).  NCADV.  Retrieved on Feb. 9, 2019 from: https://ncadv.org/statistics.

Wood, L., Voth Schrag, R., & Busch-Armendariz, N. (2018). Mental health and academic impacts of intimate partner violence among IHE-attending women.  Journal of American College Health.


09
Feb 19

Animals: A Cure to End All Ills?

There has been plenty of research to support the idea that pets do have health benefits for their owners such as: lowering blood pressure, regulating heart rate, decreasing stress and anxiety, lower rates of depression, and increasing social support (Casciotti & Zuckerman, 2017). Because animals are known to help with stress, anxiety, and depression, there has been a recent interest in pet therapy in our country, especially in regards to students at college. According to a recent study, “over the previous six years, the number of students seeking counseling services increased by 29.6% and the total number of counseling appointments increased by 38.4%” (Green, et al., 2017, p. 50). There is a mental health crisis on college campuses, but maybe pet therapy could help.

Counseling services on campus aren’t enough to combat the rise of mental health issues in students, especially since many students do not feel comfortable using these services due to the stigmas surrounding mental health (Green, et al., 2017, p. 52). Colleges have found that Animal-Assisted Therapy (AAT) has helped in the regard as animals are known to help reduce stress, anxiety, and depression and most students are in favor of having pet therapy programs on campus (Green, et al., 2017, p. 52). Several studies have shown that having interactions with dogs significantly decreased stress in college students and in one study, results were seen after only ten minutes of interacting with the dog (Green, et al., 2017, p. 54).

There are some potential drawbacks of relying on animals for psychological health though. Stressful situations can occur at any time, but an animal may not be available for support at that time (Green, et al., 2017, p. 54). Many students have taken to having emotional support animals (ESAs) with them in their dorms, but ESAs do not have public access in the way that service dogs do, so the problem of accessibility remains. There are also the problems of phobias and allergies in regards to animals in public places and so schools must learn to balance the psychological needs of some students while respecting the fears and allergies of other students.

There may not be any perfect solution in regards to the mental health crisis on college campuses, but emotional support animals and pet assisted therapy could be good ways to start. In fact, some colleges are already implementing innovative therapy dog programs for their students. The Yale Law Library has started a pilot program where students can “check out”  Monty, the library’s new therapy dog, for 30 minute play sessions (Allen, 2011). The program started in 2011 and was a great success, so much so that other libraries are following suit and looking into getting their own library therapy dogs (Xu, 2015). Many of these universities, such as the University of San Francisco and Cornell, are bringing in dogs only on occasion, such as before final exams, instead of having the dog there for students all the time (Xu, 2015). No matter what the set up of the program though, the therapy dog programs have been well received by students who wait in lines to get a chance to interact with the dogs (Xu, 2015).

 

References:

Allen, J. (2011, March 24). Checking Out Monty: Yale Law Students Can Reduce Stress With Therapy Dog. Retrieved from https://abcnews.go.com/Health/StressCoping/checking-monty-yale-law-students-reduce-stress-therapy/story?id=13206568

Casciotti, D., & Zuckerman, D. (2017, March 31). Animals play an important role in many people’s lives and often help with therapy, rehab, etc. Learn more about the possible benefits of pet companionship. Retrieved from http://www.center4research.org/benefits-pets-human-health/

Green, McEwen, S., Wrape, A., & Hammonds, F. (2017). The Mental Health Benefits of Having Dogs on College Campuses. Modern Psychological Studies, 22(2), 50–59. Retrieved from http://0-search.ebscohost.com.library.wvm.edu/login.aspx?direct=true&db=a9h&AN=130798576&site=ehost-live

Xu, Q. (2015, December 9). Yale’s therapy-dog program spreads. Retrieved from https://yaledailynews.com/blog/2015/12/09/yales-therapy-dog-program-spreads/


23
Sep 18

You Could Say It Was A Mountain

Depression is like being at the bottom of a mountain and needing to climb it to get back to civilization. You might be thinking it’s like being at the bottom of Everest, except that might be easier. It’s more like being at the bottom of Mauna Kea, which in it’s entirety is a mile higher than Everest and extends 19,700 feet below the Pacific Ocean. Because Depression is being submerged by this invisible force (water) and not being able to breath properly without help ( Therapy or Oxygen tank).

Now that you’re submerged, it’s time to climb that mountain, that mountain starts to represent impossible tasks. Every day tasks you struggle to complete anything from getting out of bed, cooking food for yourself, going two minutes down the block to the store, or finally completing that blog post you were meant to write for that psychology class.

You know those tasks will take you five minutes at the least to complete  if not seconds, and maybe thirty minutes at most, that if you just do the task it will be over and done with. And yet you could say it was a mountain. The task seems daunting, you feel unprepared, and everyone around you is just telling you to do it and be done. But you just can’t seem to find your foot hold on that mountain. Every time you try to pull yourself up you slip back down. And so it goes until one day your foot finds purchase. And you’re moving up the mountain and everything is looking bright above the water level as you break surface until you realized that you don’t have the next foothold and a new task looms ahead and somehow you are right back at the bottom of that mountain.

References:

Chelsea Ritschel in New York. (2018, August 30). How the ‘impossible task’ is a commonly-overlooked symptom of depression. Retrieved from https://www.independent.co.uk/life-style/depression-impossible-task-symptoms-sadness-twitter-a8515436.html

Schneider, F.W., Gruman, J.A., & Coutts, L.A. (2012). Applied Social Psychology: Understanding and Addressing Social and Practical Problems (2nd ed). Thousand Oaks, CA: Sage.


17
Sep 18

Gut-Wrenching Anxiety

Source:http://elizabethyarnell.com/WP/wp-content/uploads/2015/04/Gut-brain-microbiome-300×194.gif

Ever “gone with your gut instinct” or had felt “gut-wrenching anxiety” when you’ve been nervous?  You may be getting information from your “second brain.”  The Enteric Nervous System (ENS) is like a second brain in your gut.  That main role of the ENS is to control digestion.  Our guts consist of all of the organs that process, digest and eliminate food.  The ENS is the lining of that gut.  Jay Pasricha, M.D., director of the Johns Hopkins Center for Neurogastroenterology says “The enteric nervous system doesn’t seem capable of thought as we know it, but it communicates back and forth with our big brain—with profound results.”  Our brain can directly affect our stomachs and our stomachs can also affect our brain, meaning, this communication goes both ways.  For example, just the thought of food can cause our stomach to begin releasing acids for digestion.

This adjusts thinking on several levels, does our brain health affect our gut health or can our gut health affect our brain health?  Perhaps therapies that help our brain, can also help our gut health.  More specifically, altering the bacteria in our guts could affect our brain health.  Research shows that changes in the microbiome of our gut can cause symptoms that look like anxiety, depression and even Parkinson’s Disease (Mussell, et al., 2008).  Results suggest that patients presenting with GI problems should be screened for anxiety and depression.   Similar research shows that individuals with anxiety and depression often experience changes in the gut microbiome due to high levels of stress (Posserud et al., 2004). The gut microbiome are the bacteria, viruses and fungi that all live in the gut.  Stress can physically affect the physiology of the gut, in fact, stress and the hormones produced by stress, can influence the movement and contractions of the gastrointestinal (GI) tract. Given the knowledge of these connections, it makes sense that we can experience GI symptoms from stress.

Research on the link between gut and brain health is still relatively new and there is still a lot to learn.  Scientists have learned about prebiotics and probiotics that can specifically change brain health.  Specifically, omega-3 fatty foods, foods that are fermented or high-fiber foods can be beneficial to brain health.  There are millions of nerves connecting the brain to the gut and this communication goes both ways.  It will be exciting to see what researchers come up with to combat mental illness using this gut-brain connection knowledge.

 

References:

Harvard Health Publishing. (n.d.). The gut-brain connection – Harvard Health. Retrieved September 17, 2018, from https://www.health.harvard.edu/diseases-and-conditions/the-gut-brain-connection

Mussell, M., Kroenke, K., Spitzer, R. L., Williams, J. B. W., Herzog, W., & Löwe, B. (2008). Gastrointestinal symptoms in primary care: Prevalence and association with depression and anxiety. Journal of Psychosomatic Research, 64(6), 605-612. http://dx.doi.org/10.1016/j.jpsychores.2008.02.019

Posserud I, Agerforz P, Ekman R, Björnsson ES, Abrahamsson H, Simrén M. Altered visceral perceptual and neuroendocrine response in patients with irritable bowel syndrome during mental stress. (2004). Gut. Aug 1;53(8):1102-8. https://gut.bmj.com/content/53/8/1102

The Brain-Gut Connection. (n.d.). Retrieved September 17, 2018, from https://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/the-brain-gut-connection


16
Mar 18

“Social Media” Disorder

Research has demonstrated that media can influence the ways in which people behave. For example, violent media can lead to a temporary increase in aggressive thoughts or long-term imitation of aggressive behaviors (Schneider, Gruman, & Coutts, 2012). Nonviolent pornography has been demonstrated to alter the attitudes of men and women towards their families and has even been shown to alter men’s views towards women in general (Schneider et al., 2012). Even worse, media has the power to influence an individual’s perception of societal issues due to a technique called framing. This technique refers to the way in which an issue or story is presented, either in a negative or positive way (Schneider et al., 2012). Simply put, these findings confirm the influence of media on behavior. Unfortunately, it seems that many of these influences result in negative outcomes. As such, can certain types of media exposure lead to psychological disorders, such as depression or anxiety?

To answer that question, it is important to emphasize the ways in which people can be exposed to media. No longer is media exposure limited to television, print or radio. Now, people have numerous ways in which to access media. Tablets, smartphones, computers and smartwatches are all devices that keep people “connected.” The problem is that people are constantly engaging with media activity, so the level of overall connectedness remains quite high (Khang, Kim, & Kim, 2013). With respect to this discussion, the focus will remain solely on social media usage. Additionally, an important distinction to make is that social networking and social media are not the same. While typically used interchangeably, social media relates to the capabilities of sharing, collaborating or producing content online, through a variety of platforms; whereas, social networking is specific to connecting people, more accurately described then as a type of social media (Kuss & Griffiths, 2017).

Does this near-constant connection with social media influence our emotional or psychological well-being? Interestingly, there are a few different answers to that question. In one seven-year longitudinal study, 308 of 4,142 participants (7.4%) reported symptoms of depression, which is argued to have resulted from social media use and exposure. Further, the higher the level of exposure to social media, the higher the likelihood of developing full-blown depression (Primack, Swanier, Georgiopoulos, Land, & Fine, 2009). Hawi and Samaha (2016) found that there was no relation between social media and life satisfaction, which has also been demonstrated in previous studies. However, it was found that social media does have an influence on overall levels of self-esteem, with higher social media use resulting in lower levels of self-esteem (Hawi & Samaha, 2016). It was found in a separate study that the use of multiple social media platforms resulted in higher levels of depression and anxiety; however, it was suggested that symptoms were not a result of time spent on social media but a result of the number of platforms utilized (Primack et al., 2017).

The last finding is especially intriguing, as the argument seems to typically be that individuals who spend more time interacting with social media are those more likely to experience anxiety or depression. Instead, it seems that higher levels of anxiety and depression result from the use of multiple social media platforms. To further support this argument, a national survey of 1,787 young adults found that those who reported using the most social media platforms – seven to 11 (i.e. Reddit, Tumblr, Vine) – were three times more likely to experience depression or anxiety (Zagorski, 2017). Two potential reasons for this stem from multitasking and social acceptance. With respect to multitasking, individuals are typically switching from one social media platform to another, and studies have shown that multitasking leads to poorer attention, mood or even cognition (Zagorski, 2017). With respect to social acceptance, individuals might feel pressured to keep up with current trends or the culture of each platform, thus leading to higher levels of anxiety (Zagorski, 2017).

Given all the information above, it seems plausible to argue that social media use can lead to negative psychological outcomes such as depression and anxiety. Granted, it must also be made clear that the suggestion here is not that social media causes these disorders. However, there is strong evidence to demonstrate that the risk of experiencing these disorders increases relative to the number of social media platforms that are utilized. In all, additional research must be completed to provide a better understanding of social media relative to psychological health. Without this research, a true “social media” disorder may become our new reality.

References

Hawi, N. S., & Samaha, M. (2016). The relations among social media addiction, self-esteem, and life satisfaction in university students. Social Science Computer Review, 35(5), 576-586. doi: 10.1177/0894439316660340

Khang, H., Kim, J. K., & Kim, Y. (2013). Self-traits and motivations as antecedents of digital media flow and addiction: The internet, mobile phones, and video games. Computers in Human Behavior, 29(6), 2416-2424. doi: 10.1016/j.chb.2013.05.027

Kuss, D. J., & Griffiths, M. D. (2017). Social networking sites and addiction: Ten lessons learned. International Journal of Environmental Research and Public Health, 14(3), 311. doi: 10.3390/ijerph14030311

Primack, B. A., Swanier, B., Georgiopoulos, A. M., Land, S. R., & Fine, M. J. (2009). Association between media use in adolescence and depression in young adulthood. Archives of General Psychiatry, 66(2), 181-188. doi: 10.1001/archgenpsychiatry.2008.532

Primack, B. A., Shensa, A., Escobar-Viera, C. G., Barrett, E. L., Sidani, J. E., Colditz, J. B., & James, A. E. (2017). Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among U.S. young adults. Computers in Human Behavior, 69, 1-9. doi: 10.1016/j.chb.2016.11.013

Schneider, F. W., Gruman, J. A., & Coutts, L. M. (2012). Applied Social Psychology: Understanding and Addressing Social and Practical Problems (2nd ed.) Thousand Oaks, CA: SAGE Publications, Inc.

Zagorski, N. (2017, January 17). Using many social media platforms linked with depression, anxiety risk. Psychiatric News. Retrieved from https://psychnews-psychiatryonline-org.ezaccess.libraries.psu.edu/doi/10.1176/appi.pn.2017.1b16


07
Oct 16

The Rejection: Hopelessness Theory of Depression

I’d like to use a case example to illustrate the hopelessness theory of depression in this blog post.

A 25-year-old man who had trained for years in animation and game design received admission to a Canadian university for a course in game design. He applied for a student visa to Canada, and settled in to wait for his paperwork to be processed. He bought his flight tickets and started to look for places to stay in Toronto, where he would be studying. The weeks passed, and his course start date came and went, but his visa didn’t come through. He went repeatedly to the consulate office to ask for expedition of the process, but got no answers. Thoroughly frustrated, he delayed his flight tickets twice, and still didn’t get his visa. Finally, he got his passport back in the mail. There was no visa stamp in his passport. His application had been rejected.

Thus ensued a period of major depression for this young man. He had applied for loans, bought flight tickets, and paid his tuition fees to the university. He was set to lose a large sum of money, and he had no backup plan of action. No job, no money, and seemingly, no future. He was in a situation where he felt he had no control over his future outcome. He had experienced a huge setback.

This life experience, wherein he had experienced such an unpredictable and uncontrollable setback, made the man feel thoroughly helpless, and as per Seligman’s (1975) learned helplessness model of depression, the man gave up his efforts to cope. Instead of looking for other options like a job in his hometown or further developing his portfolio, the man lay in bed and grew increasingly depressed.

Abramson, Seligman, and Teasdale (1978) proposed the attributional reformulation of the learned helplessness model of depression, which suggested that depression was caused by pessimistic attributions on the part of the person, leading to a negative outcome expectancy, that is, helplessness. The man believed that his visa was rejected because he was simply no good, had no luck, and was not meant to succeed in life. This belief was an internal, stable, and global attribution—the man believed that nothing would ever go well in life again, and that this setback was proof of his inadequacy.

The hopelessness theory of depression (HTD), as proposed by Abramson, Metalsky, and Alloy (1989), suggests that depression occurs in people with a negative attribution style, known as a pessimistic explanatory style or a depressogenic attribution style. The man believed that the cause of the aversive life event, the visa rejection, was internal (he was not good enough), stable (was absolute and forever-lasting), and global (he had no luck). Hopelessness, as defined as “the expectation that highly desirable outcomes will not occur and that one is powerless to change the situation” (Needles & Abramson, 1990, p. 156), thus set in.

The man began to show signs characteristic of hopelessness depression—low self-esteem, lethargy, and apathy (Abela, Gagnon, & Auerbach, 2007). He became more dependent on people around him, while at the same time attempting to isolate himself. This contradictory behavior naturally did not lead to positive outcomes for him. However, he was lucky enough to have plenty of social support, in the form of friends, who nudged him towards a more positive attribution style—what Needles and Abramson (1990) call an enhancing attribution style. He began to consider his future options in a more positive light. He reevaluated his professional outlook, judged himself to be a skilled animator and designer, and recognized that he had jobs that were open to him. He received a job offer, and he evaluated the cause of this offer in a stable, internal and global way—he was a skilled professional, and he now had a path open for his future. He also decided to reapply for the Canadian student visa, and had hopes for his acceptance.

References

Abela, J. R. Z., Gagnon, H., & Auerbach, R. P. (2007). Hopelessness depression in children: An examination of the symptom component of the hopelessness theory. Cognitive Therapy and Research, 31(3), 401–417.

Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theory-based subtype of depression. Psychological Review, 96, 358–372.

Abramson, L. Y., Seligman, M. E. P., & Teasdale, I. (1978). Learned helplessness in humans: Critique and reformulation. Abnormal Psychology, 87, 49–74.

Needles, D. J., & Abramson, L. Y. (1990). Positive life events, attributional style, and hopefulness: Testing a model of recovery from depression. Journal of Abnormal Psychology, 99, 156–165.

Seligman, M. E. P. (1975). Helplessness: On depression, development and death. San Francisco: Freeman.


27
Sep 15

What a shame

I’ve had a front-row view of depression the last few years as I’ve watched several people’s lives change and decline as they struggled with the condition.  One person in particular, who I will call Bob here, suffers from major clinical depression.  He is out of work and his life consists of sleeping and playing video games.  To make matters worse, he has the opportunity to file a wrongful termination suit that was estimated to result in a six-figure settlement, yet hasn’t been able to summons the motivation to call the lawyer who was located and prescreened for him.  Bob is a wonderful person with a generous soul who has a genius level IQ and is college educated, and accordingly, he has broken the heart of all those who love him and feel helpless to change his demise.  Freud famously described depression as “aggression turned inward” and I believe that to be true (as cited in Sapolsky, 2004, p. 299).  Bob is caught in a matrix of paralysis that prevents him from trying to improve his situation, and that non-action is a self-sabotaging behavior that perpetually causes self-loathing, which then translates into further inertia.

The hopelessness theory of depression helps explain Bob’s depression when his psychological vulnerability and challenging environmental circumstances collided.  He’s struggled with depression for decades but it wasn’t until he was first injured and then laid off recently that he descended to this level of incapacitation.  He was neurologically at risk after a car accident in adolescence which put him in a coma and resulted in some brain damage, but even before that he was inclined towards a depressogenic explanatory style.  My mom swears he was born that way.  So when he lost his job, I think he looked at things like he was being unjustly punished, yet subconsciously felt like he deserved it.  He took the one incidence of wrongful termination and overgeneralized it to his entire world.  He used  global and stable attributions to explain that one negative event: “I lost my job which was beneath me to begin with and now I’m even more of a loser with no money and no career who plays video games all day long” (global), and “Things will never change; my life is doomed” (stable).  With such all-encompassing negative perceptions, it’s no wonder he doesn’t feel any motivation to try different coping mechanisms.  Instead, he fell prey to learned helplessness when his best efforts to succeed in life failed, which lead him to give up hope (Siero, Bakker, Dekker, & van den Burg, 1996).

In the discussion of how stress and depression are related, Sapolsky (2004)  explains that for depressed people everything about life feels overwhelming, this activates the stress response and elevates glucocorticoids like cortisol, which in turn tells the brain to produce more cortisol since it is clearly needed, and these increased glucocorticoid levels create more depression symptoms, and so on.  It’s a vicious mind-body hormonal feedback loop that is self-perpetuating.  Sapolsky (2004) also talks about how intense guilt plays a large role in depression.  He says that most people suffering from depression are aware of how their state has affected their lives and how it has pained their family, and that they feel incredibly guilty about it.  They feel guilty for being depressed, and this is depressing so it prevents attempts at healthy coping mechanisms, but then this triggers more guilt and down they descend into another merciless feedback loop (Sapolsky, 2004).  This absolutely mimics Bob’s habitual pattern of being withdrawn from family and friends, and then beating himself up over it which consists of alternating long bouts of angry silence and crying fits lamenting over how he doesn’t want to be that way but can’t help it and hates himself for it.

The deeper layer of guilt is shame, and Dr. Brené Brown shot out of the cannon a few years ago researching this deeply embedded, yet rarely discussed, human phenomenon.  She’s a research professor and writer out of the University of Houston Graduate College of Social Work, and gained international attention with her 2010 TED talk entitled “The Power of Vulnerability”: http://www.ted.com/talks/brene_brown_on_vulnerability?language=en.  It’s only twenty minutes and I highly recommend watching it during a study break or even just listening to it while folding laundry.  I discovered her work earlier this year when I saw Oprah interview her on Super Soul Sunday and have since read a couple of her books.  She defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging” and links it to mental illnesses like anxiety, depression, and addiction (Brown, 2010, p. 39).  She’s been studying shame and vulnerability through qualitative research for the last fifteen years and has conducted over 10,000 interviews.  She acknowledges the new-agey association with the concept of “owning your story” and yet she insists that this is a crucial foundation of mental and emotional wellbeing in combating the universal feelings of shame that we all experience.  Regardless of where people fall on the anxiety/depression/addictive behavior spectrum, her explanation of shame is something that everyone can relate to:

Shame keeps worthiness away by convincing us that owning our stories will lead to people thinking less of us. Shame is all about fear. We’re afraid that people won’t like us if they know the truth about who we are, where we come from, what we believe, how much we’re struggling, or, believe it or not, how wonderful we are when soaring (sometimes it’s just as hard to own our strengths as our struggles). (Brown, 2010, p. 39)

Again, this resonates deeply when I think of Bob.  I think he feels like if we knew exactly how deep and gnawing his emotional pain was that we’d lose respect for him, lock him up in the loony bin, or both. But that’s the insidious irony of shame: it blooms in the dark and withers in the light.  The more that depressed people can learn to expose their vulnerabilities by talking about their feeling and fears without judgment, the more they make space for new healthier thought patterns to emerge.  While I wish I could make Bob read Dr. Brown’s research and get him to see an excellent therapist to help him work through his shame, he’s too depressed to take any productive action; therein lies the ongoing problem which is a debilitating construct for many people suffering with depression.  It keeps you on a sad, dim island, spinning in circles while standing in place.  Depression is marked by the incredible ambivalence of wanting things to be better and perceiving that notion to be impossible.  In addition to standard treatment like the hopefulness approach, educating patients about shame and vulnerability as part of cognitive-behavioral therapy seems like an important piece for long-term healing.  Learning how to feel comfortable understanding and expressing the authentic self (in the company of safe, trusting people) bridges the isolation and shame that feeds upon itself and keeps people locked away inside their silent prisons (Brown, 2010).  Dr. Brown acknowledges that there are no easy answers or quick fixes, and instead explains the daily grind and commitment to yourself by quoting E.E. Cummings: “To be nobody-but-yourself in a world which is doing its best, night and day, to make you everybody but yourself—means to fight the hardest battle which any human being can fight—and never stop fighting” (as cited in Brown, 2010, p. 51).  I hope her research on shame and vulnerability will continue to gain traction and attention from mental health professionals and laymen alike, as it can enlighten and empower us all.

References

Brown, C. B. (2010). The gifts of imperfection: Let go of who you think you’re supposed to be and embrace who you are. Center City, Minn: Hazelden.

Sapolsky, R. (2004). Why zebras don’t get ulcers: The acclaimed guide to stress, stress-related diseases, and coping. New York, NY: St. Martin’s Press.

Schneider, F. W., Gruman, J. A., & Coutts, L. M. (2012). Applied Social Psychology: Understanding and Addressing Social and Practical Problems. Thousand Oaks, CA: Sage Publications, Inc.

TED. (2010, June). Brené Brown: The power of vulnerability. Retrieved from http://www.ted.com/talks/brene_brown_on_vulnerability?language=en


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