Depression

Discuss the typical symptoms and causes of clinical depression and with clear reference to any one specific counselling model – show how counselling can be used to identify and help to alleviate the problem in a client. “ The sad one is present at the first opening of your eyes, the first conscious thought, that all pervading presence that you know will fill your day.” ( John F. Mc Carthy) Introduction The innocuous sounding word ‘depression’ refers to a potentially disabling illness that affects many but is understood by few. During any one year, one in ten people experience the sluggishness of mind, body and spirit, know as depression. Females are twice as likely to become depressed as males (Ainsworth, 2000 p.2). The following essay will examine the symptoms of clinical depression and thereafter discuss the factors that are believed to contribute to the onset of the disorder. According to Carlson et al (2000) there are two principal treatments for clinical depression, Cognitive Therapy and antidepressant medication (p.637). This essay will explore the counselling model – Cognitive Behavioural Therapy (CBT), which is viewed as the most effective psychosocial treatment for depression (Gotlib & Hammen, p.384). In concluding a final comment on the enduring effects of CBT and its place in clinical practice is explored. This essay will begin with a definition of clinical depression. Definition The term ‘depression’ means different things to different people, and most of us would claim that we have experienced it at one time or another in our lives. This type of depression is know as ‘normal depression’ and may be experienced as a ‘blue mood’ a drop in self-esteem, feelings of wanting to give up, or a pessimistic outlook about the future (Austin et al, 2002, p.1). According to Feltham & Horton (2005) once depression has struck, there is a high chance of relapse (p.448). Generally speaking the term ‘clinical depression’ refers to any depression that requires some form of treatment. It is considered normal for people to feel depressed after the death of someone close to them, however when the condition persists for months on end, it is then classified as clinical depression. (Aware, 2007). Discussion According to Feltham & Horton (2005) depression affects about one in five people and women are over twice as likely to suffer an episode as men (p.228). Depression is a condition that can take many forms, from short termed sadness, right up to more severe depressive disorder such as Bi Polar or Manic Depression which require more intense treatment. It is thought that over 400,000 people in Ireland suffer from this condition, with one in four men and one in two women suffering from the condition at one time or another in their lives (Aware, 2007). Symptoms of Depression According to Ainsworth (2000) depressed people describe their mood as sad, anxious or flat. They speak of the additional feelings of emptiness, hopelessness, uselessness, profound apathy and unreasonable guilt. Loss of interest in activities previously enjoyed is common (anhedonia) and is usually accompanied by an inability to feel pleasure, even in sexual activity (p.7). Feltham and Horton (2005) describe the symptoms of depression as loss of pleasure and positive effect. Negative emotions such as anger, shame guilt and anxiety are increased (p.449). Carr (2001) suggests that while these features may be the result of a death or loss of some kind, depressed people tend to perceive the world as if further losses were imminent (p.82). Causes of depression In (2000) Feltham & Horton state that depression results from a variety of complex interacting factors, including biological vulnerability, relationship issues and early life history (p.317). According to Cognitive Theory people who are prone to depression are unduly negative in their perceptions of themselves, their worlds and their futures (Gotlib & Hammen, 2002, p384). Beck (1976) states that the depressed individual ‘regards himself as lacking some element or attribute that he considers essential for his happiness.’ He says that the depressed person exhibits specific distortions and has a negative view of his world, a negative concept of himself and a negative view of the future. Beck collectively referred to these elements as the cognitive triad (p.105). Individuals who experienced loss or adversity in childhood, develop negative schemata, concerning loss, failure or abandonment. These schemata become reactivated when the individual later experiences a life event that is similar to the previous trauma. The reactivated schemata take the form of; ‘excessively rigid and inappropriate beliefs or attitudes about the self and the world, as well as unrealisitic, perfectionistic standards by which the self is judged.’ Field et al (2000, p118). According to Feltham & Horton (2005) Beck also sees other precipitating factors such as physical disease, external stress and chronic stress as being responsible for activating the unhealthy cognitive processes. Problems are believed to be managed by cognitive distortions. Once unhealthy schema become activated the individual continues to behave in a way that maintains this activation. As a result, the maintenance of unhealthy cognitions leads to a continuation of the emotional difficulties in the individual (p.317). Cognitive Behavioural Therapy Cognitive Behavioural Therapy is a form of psychodynamic therapy and is based on emotional and mental responses to external events. The system was developed by Aaron T Beck and Ellis in the 1970’s and is now in use throughout Europe for the treatment of depression and associated disorders ( Solomon, 2001 p,107). According to Carlson et al (2002) CBT begins by arguing that the negative beliefs held by depressed individuals are conclusions based on a faulty logic (p.635). Beck contends that by correcting negative reasoning one can achieve better mental health. CBT teaches objectivity. The client learns why he finds certain events depressing and is able to free himself of inappropriate responses. (Solomon 2001, p.107) In (2002) Gotlib and Hammen state how cognitive therapy and the related cognitive-behavioural interventions have emerged as the most effective psychological treatments for depression. These approaches have shown to be effective in the reduction of acute distress and show an enduring effect that protects patients against subsequent relapse after treatment. Cognitive behaviour therapies may also prevent the initial onset of symptoms in persons at risk that as yet have never been depressed (p.384). Feltham & Horton (2005) state that cognitive therapists employ an active-directive counselling style and develop a good therapeutic alliance with their client. (p.318) Beck (1995) states that it is essential that the therapist have a solid understanding of the clients current symptoms and functioning, presenting problems and history before starting therapy. (p.297). Therapy begins with the therapist and client working together and forming an agenda for that session. Working together in this manner allows both client and therapist to prioritise matters of importance and note specific issues that need to be addressed within the session or at a later time (Gotlib and Hammen, 2002, p.384). Having set the agenda in the initial session, the Therapist does a brief mood check. An objective self-report questionnaire such as the Beck Depression Inventory allows both client and therapist to maintain an objective track on the progress of the client. (Beck 1995, p.29). Cognitive therapy according to Gotlib and Hammen (2002) is predicated on the notion that teaching patients to recognise their negative beliefs can produce relief from their distress and enable them to cope more effectively with life’s challenges (p.384). According to Beck (1995) the cognitive model proposes that distorted or dysfunctional thinking (which influence a person’s mood and behaviour) is common to all psychological disturbances (p.1). Gotlib and Hammen (2002) describe how exploration, examination, and experimentation are all components designed to help the depressed individual replace maladaptive negative thoughts with more adaptive concepts. The first component is a thorough exploration of the client’s personal meaning system or dysfunctional beliefs. A careful examination of that belief system is the second stage and finally the active experimentation part is designed to test the validity of the maladaptive belief system (p.385). According to Beck (1995) the therapist does not impose his own belief system on the client but rather tries to modify and restore the mind to a more functional state. This process of interpreting maladaptive thoughts and the underlying core beliefs behind them is a technique known as ‘socratic questioning’.(p.150). Gotlib and Hammen (2002) describe this process as a series of gentle and thoughtful questions that help to bring the persons dysfunctional thoughts and beliefs to light. This way of working is essential to successful cognitive therapy, as it avoids confrontations and allows the therapist to understand the thought processes of his clients (p.385). Beck (1995) contends that the cognitive therapist is interested in the level of thinking that operates simultaneously with the more obvious, surface level of thinking (p.14). In 1976, Beck described these as ‘automatic thoughts’ as they arise by reflex, and without any prior reflection or reasoning (p.237). Beck 1995 states that when dysfunctional thoughts are subjected to rational reflection, the emotions tend to change (p.15). Gotlib and Hammen state that cognitive therapy emphasizes the links between mood, thought and behaviour, as a result effective behavioural techniques may be used in the service of testing specific automatic negative thoughts (p.385). Beck (1976) states that the client can frequently be taught how to terminate this kind of thinking, however in severe cases, i.e. psychosis, the administration of drugs may be required in order to stop the reoccurrence of the maladaptive thoughts (p.237). As therapy continues new techniques are introduced in order to access the negative expectations and interpretations of the client. (Gotlib and Hamen, 2002, p.385). e.g., T: When you notice your mood changing or getting worse in the week, will you stop and ask yourself, “What is going through my mind right now'” C: Yeah. T: Maybe you could jot down a few of these thoughts on a piece of paper' C: Sure. (J.S. Beck 1995) According to Gotlib and Hammen, (2002) use of the various techniques depend on the patient’s goals and symptoms. The Dysfunctional Thought Record is a formalized way for the client to identify and evaluate their response to an automatic thought in a written format. This method is introduced early in therapy and is used for the duration. Techniques such as the use of ‘flash cards’ and role-plays are also used, in order to work through real life situations as well as teach problem solving skills. (p386) According to Payne (1991) a major difficulty with the cognitive behavioural methods is their technical character and jargon type terminology can appear non-human in their approach (p.122). Gotlib and Hammen on the other hand see the cognitive behavioural interventions as clearly effective in the treatment of depression and may have enduring effects. They appear to work by teaching patients to identify and test their negative belief systems and provide a set of strategies that clients may use to relieve their distress. Recent studies in this area seem to suggest that simpler and more concrete interventions may prove to be more effective for people who suffer with depression, including those who suffer with chronic depression. If this is proved to be correct, then it may facilitate the spread of these approaches to the clinical practice community, which increasingly has to rely on poorly trained practitioners and shorter treatment intervals (p.387). Conclusion Depression and Anxiety are common problems for many who seek counselling. It is estimated that one in twenty people suffer with depression, with three times as many women suffering as men. (Hough 2006, p14). The symptoms of depression are described by Feltham and Horton (2005) as; Sleep disturbance, flattened mood effect, anhedonia, apathy, hopelessness and loss of appetite (p.449). In the 1960’s Beck and Ellis formulated a structured short term present orientated psychotherapy for depression. Cognitive Behavioural Therapy, aims to solve current problems and modify dysfunctional thinking and behaviour (Beck 1995, p.1). Mendels (1970) states that depressed people have abnormal thinking patterns (p.58). Gotlib & Hammen (2002) see the primary role of the therapist is to educate their clients in the use of various techniques that may alleviate their symptoms over a period of time.(p.384). Controversy surrounds this approach in that it can appear to be laden down with jargon and for some practitioners it can appear too clinical in its approach (Payne 1997, p 131). However, Gotlib and Hammen see this approach as being clearly effective in the treatment of depression as it serves to teach the client how to manage their own behaviour, using techniques that may prevent a reoccurrence of the disorder.(p.384). “We must never forget that we may also find meaning in life even when confronted with a hopeless situation, when facing a fate that cannot be changed. For what then matters is to bear witness to the uniquely human potential at its best, which is to transform a personal tragedy into a triumph.” Viktor E. Frankl, 2004 Bibliography 1. Ainsworth, P. (2002) Understanding Depression, {on-line}. Available at: www.questia.com (assessed on the 24th April, 2007). 2. Aware; Helping to Defeat Depression {on-line} Available at: www.aware.ie (assessed on the 12th April, 2007) 3. Austin, M.P. (2002) Dealing with Depression, {on-line}. Available at: www.questia.com. {Accessed on the 25th April, 2007). 4. Beck, A.T. (1976) Cognitive Theory and the Emotional Disorders, New York: Penguin Books. 5. Beck, J.S. (1995) Cognitive Theory, Basics and Beyond. New York: The Guilford Press. 6. Carlson, N.R., Buskist, W, Martin, G.N. (2000), Psychology, The Science of Behaviour. England: Pearson Ed. Ltd. 7. Carr, A. (2001), Abnormal Psychology {on-line}. Available at: www.questia.com (Assessed on the 30th April, 2007). 8. Field, T.M. (2000), Stress, Coping and Depression. {on-line}. Available at: www .questia.com. (Assessed on the 30th April, 2007). 9. Frankl, V. (2004) Man’s Search for Meaning. London: Ryder. 10. Gotlib, I.H, Hammen, C.L. (2002) Handbook of Depression. New York: The Guilford Press. 11. Mendels, J. (1970). Concepts of Depression. U.S.A: John Wiley & Sons Ltd. 12. Payne, M.S. (1997). Modern Social Work Theory. London: Mac Millan Press Ltd. Conclusion Bibliography