|
Profile
Dr. E. O' Connor has taught psycho-educational classes in depression and anxiety for fifteen years. She has also been the director of group psychotherapy at an outpatient clinic at the University of Washington. She has been certified in two approaches to cognitive behaviour for depression, and employs these approaches in her private practice that specializes in chronic depression and anxiety disorders for adolescents, couples, and adults.
Dr. M. O’ Connor has been in the department of counsellor education at Seattle University for the past thirty years, as chair and faculty member. He has specialized in counselling theories; group and individual supervision; and spiritual dimensions of therapy.
|
When we began our clinical studies we each reviewed models and theories of depression in search of a comprehensive explanation for this complex of disorders. Haskell Bernstein (1990) spoke clearly to us about our clinical experiences with patients.
Were depression a simple, straightforward matter with a clearly defined set of manifestations and an equally clear explication of its process and course, there would be no reason to look further. But that is far from the present state of our knowledge. What is called depression appears to be a group of disorders sharing the common symptom of a depressive mood but otherwise manifesting a range of symptoms and having a variety of causes. (pp. 97-98).
Typically, these are the early warning signs of depression that patients have manifested:
1. Feelings of sadness; a black cloud hanging over them.
2. Loss of interest in things that were once enjoyable (such as pleasant activities, or
loss of sexual desire).
3. Losing or gaining weight.
4. Difficulty with sleeping and awakening; or sleeping too much.
5. Slowed down or agitated physical responses and/or verbal responses.
6. Lack of energy; feeling tired much of the time; or a sense of increased restlessness.
7. Feelings of guilt or worthlessness.
8. Thoughts of harming oneself. Suicidal thoughts.
|
|
A diagnosis of depression is often made when five or more of the symptoms listed above occur nearly every day for at least two weeks. At least one of the symptoms has to be depressed mood or loss of interest or pleasure. For children and adolescents irritability rather than sadness may be the most significant symptom. Persistence of these symptoms is another important factor. If they do not seem to be decreasing it is wise to talk to a healthcare provider. They are able to offer perspective and guidance about how to proceed.
Martin Seligman (1990) introduced the concept of Three P’s that relates to depressive thinking. Depressed patients often see events as PERMANENT. There is no light at the end of the tunnel. Further they believe that it is not just one situation that is problematic. The difficulty is widespread and is PERVASIVE. The third P stands for PERSONALIZATION. When something happens that is uncomfortable interpersonally, the explanation for the other’s behavior is usually attributed to oneself, that is, the depressed person believes that s/he is responsible, or is to blame. As he notes in his book Learned Optimism, this manner of thinking can be quite self-defeating with serious consequences.
We believe that depression is a medical illness with affective (emotional) and cognitive (thinking) symptoms (see previous list). These symptoms can change on a daily basis and can easily be interpreted by persons close to the patient as laziness; an unwillingness to move on; and an indulgence in self-pity. As with other medical conditions such as diabetes, asthma, or heart disease, depression requires treatment. Some patients receive counseling, drug therapy, or a combination of both. Research in the last decade has consistently shown that for many types of depression (particularly chronic depression) psychotherapy and drug therapy used in combination can be most helpful. As with all medical issues, however, each patient must be medically and/or psychologically evaluated in the context of his or her unique situation
Long ago Freud spoke about depression as anger turned inward. Most people have a difficult time addressing the issue of anger, and seeing themselves as angry people. Our experience suggests that people suffering from depression have become alienated from themselves, and are having difficulty connecting not only to themselves but to others in their life as well. They also may be at a loss to make new meaning out of changes in their lives. For example, some people experience depressive episodes when they encounter a life transition common to most of us (leaving home for schooling; marriage; a new job, new baby, etc.) They may seemingly welcome the transition but may also have underlying feelings that they have not addressed (fear, anger, anxiety, guilt, etc.). Or, depression may appear as one is trying to address a medical condition that is life altering. Most often depression is not a result of one situation or one factor. It may also be an accumulation of factors and variables that have been avoided for months, years or even decades.
Learning how be aware of and identify feelings is a critical element in all psychotherapies. However, therapies differ in their approaches to depression. Psychoanalytic approaches usually focus on past experiences and emphasize development of insight. Existential-humanistic approaches emphasize personal awareness, the quality of relationship with the therapist, and meaning-making regarding life issues including anxiety, death, freedom, responsibility and so forth.
Cognitive Behavioral Therapy (the focus of our forthcoming workshop) is the most widely researched psychotherapy and addresses self-defeating thought processes that in turn influence both emotions and behavior. Interpersonal Psychotherapy for Depression (an emphasis in our work) focuses on a particular area of change and as the name implies, works with interpersonal relationships that affect the well being of the patient being treated. Many therapists provide an integrated approach using Cognitive Behavioral, Narrative (a post-modern constructivist approach involving co-constructed meaning in the context of one’s social and cultural environment), and Interpersonal Therapy in their practice.
According to the American Medical Association about 2 to 4 percent of the general population currently suffers from depression. The estimated cost of depression in the United States is $43 billion per year. Only 30 percent of this cost is a result of direct medical care. Impaired productivity in the workplace and premature death account for the remaining 70 percent. These statistics suggest that depression is a significant factor affecting the emotional well being of a large country. Other studies have shown depression to be a significant factor in many countries around the world. Our own personal experience suggests that whenever we publicly discuss the topic of depression we are pulled aside by individuals who want to talk about the devastating impact that depression has had on their lives and/or the lives of their families. We tend to believe that depression is a bio-psychsocial disease. More simply put, depression has genetic components, biological repercussions, and is psychologically and socially disabling.
The most important step in overcoming depression is the patient’s willingness to get help. Next comes finding a skillful and trusted healthcare professional. A strategy for persons seeking professional help is to write down questions about the condition, contact a professional (through recommendations or personal contacts) and listen carefully for the responses provided. Patients as consumers have the right and personal responsibility to evaluate their experiences in seeking help from mental health professionals. Depression is treatable, and there are many coping skills, and new approaches (with and without medication) to dealing with depression that can be provided successfully restoring or enriching mental health.
REFERENCES
• Bernstein, H. E. (1990). Being human. NY: Gardner Press, Inc.
• Diagnostic and statistical manual-IV (1994). Washington D.C.: APA.
• Seligman, M. E. P. (1990). Learned optimism. NY: Pocket Books.
• http://www.depression.com/web_resources.html
• http://www.depression.com/depression_basics.html
DETAILS OF WORKSHOP
Dr. Elsa O’Connor Ph.D., Ed.D. (University of Washington) and Dr. Mike O’Connor Ph.D. (Seattle University) conducted a workshop titled: Integrated cognitive behaviour therapy in the treatment of depression and anxiety on invitation of the Maltese Psychological Association in April 2006.
Dr. E. O' Connor has taught psycho-educational classes in depression and anxiety for fifteen years. She has also been the director of group psychotherapy at an outpatient clinic at the University of Washington. She has been certified in two approaches to cognitive behaviour for depression, and employs these approaches in her private practice that specializes in chronic depression and anxiety disorders for adolescents, couples, and adults.
Dr. M. O’ Connor has been in the department of counsellor education at Seattle University for the past thirty years, as chair and faculty member. He has specialized in counselling theories; group and individual supervision; and spiritual dimensions of therapy.
« Back to Articles
|
