Cognitive and Psychoanalytical Approaches to Treat Depression - Essay Example

Depression A Critical Evaluation On the Cognitive and Psychoanalytical Approaches To Understanding and Treating Depression. Order No. 164118 No. of pages – 10 Writer – 6530 • “Depression is the common cold of psychopathology at once familiar and mysterious. (Seligman, 1970). At some point in time each and every one of us experience “feeling down in the dumps” or relatively depression and all of us know that it gives us a very uncomfortable feeling. Sometimes it is minor and for a very short period of time, but at other times it could be devastating for an individual who suffers from deep depression. Depression is described by many in different ways, but all said and done depression is something ominous that creeps upon a person when they least expect it. All of us experience depression now and then but this kind of depression is not “Clinical” in nature as it soon passes. But on the other hand, a clinically depressed patient would be one who has immersed himself either in grief, self pity, worthlessness, anger, helplessness and even very low self esteem. In such “over the top” cases great care and understanding should be shown to a person suffering from such depression as this may lead to a “suicide attempt”. Depression not only affects our mental state of health but it also affects our physical state. In fact it affects every aspect of our lives – from the way we eat or sleep to the way we interact with everybody around us. It is not possible for a clinically depressed person to “pull themselves together” or “snap out” of their situation. They definitely need professional assistance. Significance of Depression: Different sign posts hold different significance for depression. The World Health Organization recently stated that in 20 years time depression will be the 2nd biggest cause of death. Depression is more than a feeling of “down” or low” – it affects our thinking, working, our behavior, our emotions and physical health. “Clinical depression” is a whole body disorder resulting from a great loss or trauma and as such has to be treated diligently. Dysthymia is a type of depression that is a lot worse than a major depressive disorder and takes a longer time to cure, usually around a year. Dysthymia is characterized if a person has many of the symptoms of major depressive disorders but these symptoms may not be so severe. Many of the professionals feel that a person having Dysthymia disorder is very likely to get into a major depressive disorder. Signs of Depression: A person going through depression could be easily recognized by the following symptoms – Generally they lose their zest for life and show lack of interest and enthusiasm and enjoyment for their day to day activities. Some of them exhibit a loss of appetite while others eat excessively and put on lot of weight suddenly. Anxiety seems their key word and they have a total lack of concentration. In other words they seem to be lost in no man’s land. They suddenly complain of chronic pain and loss of memory. A depressed person shows a lapse in personal hygiene and has uncomfortable sleep patterns ranging from very poor sleep to no sleep at all.(insomnia). Causes for Depression: Getting into depression is not a “one way track”. It is caused by relevant depressing episodes that take place in a person’s life which they are unable to bear or manage. The risk factors for depression include isolation, long term illness which sometimes includes disability, chronic pain and bereavement. Some of the other causes are stated below- A depressed person’s life is stress filled and hence emotionally relies on those around most of the time. Some of them are abusers of alcohol, nicotine and drugs and therefore find it very difficult to adjust themselves in a social environment. They are emotionally imbalanced and suffer from poor self esteem and harbor a feeling of worthlessness. This is the reason they have poor family and marital relationships. Poor peer relationships and sexual abuse in childhood also contribute to depression. A person may suffer from this illness if there are hormonal changes taking place in the body or if they have a family history of depression. Unipolar Disorder: A Unipolar disorder is not as dangerous as a Bipolar disorder. It is a milder form of Depression. But for it to take on a Clinical aspect, specific features have to be present for a given length of time. These symptoms should not only be experienced by the patient but it should also be observed clearly by others around them. In order for there to be a major unipolar disorder the DSM IV suggests that any five of the following symptoms should be present for at least two weeks. These symptoms are – Low mood and sadness for most of the day, nearly every day. Disturbed sleep patterns – sleeping very late and waking very early on a regular basis. At times the person sleeps most of the time. Difference in the level of activity – either too lethargic or too agitated. Indifference to the pleasures of life and normal activities. Significant weight loss or weight gain. Negative concept of self – like worthlessness, low self esteem, guilt etc… Poor concentration and indecisiveness. Recurrent suicidal thoughts. Diagnosis: Diagnosis is based on different sub- classifications such as by symptoms or by aeitology. The diagnosis depends on the factors that caused it – external factors such as – a divorce or bereavement or internal factors such as stemming from an internal process. As referral criteria for Psychological services, these sub- classifications are still used by medical practitioners for diagnosis. It is difficult pin pointing a diagnosis because of the subtle differences between patients. While some patients suffer with a few symptoms for a longer period of time, others suffer with many symptoms but for a shorter period of time. Roth and Fonagy (1996) reviewed many of the studies on prevalence, for example a study by Robins and Regier (1991) stated that during a six month period 6% of the population will have a DSM IV mood disorder. Women are said to be more prone to depression since they under go hormonal changes, childbirth and severe stress due to added responsibilities. According to (Brown and Harris, 1978). , some women are in situations where they are disempowered and are under severe economic stress, and these factors are considered as contributing to depression (Brown and Harris, 1978). BiPolar Disorder: Bipolar means two. The patient has depression accompanied with mania. A person having this condition would suddenly feel up and energetic and slowly shift to feeling low or depressed. Melancholia alternating with Mania is a classic example of Bipolar depression. The occurrence of Bipolar is less frequent than Unipolar depression. In the “fortune teller’s theory” taken from (Beck (1989);Hawton et al (1989); Woolfe & Dryden (2003); Wills & Sanders (2005).it describes how an individual who is depressed will anticipate that things will turn out badly and would assume that this is an established fact. This kind of depression is more common in the adolescent age and in older people. It usually begins with a depressing episode and recurs time and again. Sometimes it manifests itself in the over exuberance of a person, or a kind of manic condition, sleeplessness, hyperactivity and delusions. Such patients exhibit risky behavior patterns like taking drugs or alcohol, inflated sense of self and grandiose speech. They feel a lot of energy that they do not feel at normal times. It lasts for several months. The above discussion on definitions and prevalence of depression has been drawn from Lemma (1996); Roth & Fonagy (1996); Kring, Davison, Neale & Johnson (2007); Frude (2000). Since there is all likelihood of failure to detect bipolar depression, it often goes unrecognized and untreated. Therefore it resurfaces once again later on in life and manifests itself. It is very important to recognize and treat depression in time because if left unchecked, it could lead to severe problems in the future. In many cases, depression is mistaken for changes in the aging process, or illnesses like dementia. Treatment: Treatment should start immediately on identifying depression. It is commonly based on a combination of counseling, psychotherapy and a course of anti-depressant medication. The treatment is done sometimes using ECT and sometimes using drug therapy. The treatment would largely depend on the nature and severity of the depression and also taking into consideration the person’s physical health. Medication: Anti- depressants are used to help manage the rapid mood swings of the patient. A low level of Noripinephrine is responsible for the symptoms in Bi polar depression. To monitor and manage mood swings Lithium is used. Low levels of Serotonin are argued to be the cause of depression. . The main drug used currently by doctors for depression is known as a selective serotonin reuptake inhibitor (SSRI’s). These drugs are commonly prescribed in their brand name of ‘Prozac’or ‘Seroxat’. For treatment of the elderly depressed, the most modern and safest drug for them would be ““inibidoras seletivas da recaptação da serotonina”. This would process less collateral effects. Psychotherapy: So far, Pharmacological treatment is found to be the only effective treatment in preventing relapse in the long term. But due to methodological problems in research, the efficacy of this cannot be properly judged. Psychotherapy can be used to treat a patient in many different ways- Supportive Counseling – The counselor addresses hopelessness and eases the pain of depression. They speak to the patient in an understanding manner and find out about their feelings and why they feel that way. The councilor gives them mental support and may suggest that they join a support club where people share the same problems. Cognitive Therapy – Extensive research has been carried out on “Cognitive Behavioral Therapy”, and researchers are of the opinion that the therapy given depends largely on the severity of the illness and the duration of its presence. Based on this, there are two approaches to Cognitive Behavioral Theory Therapy. For a mild and moderate illness that has been present for a short time and has not been recurrent, the “Standard Cognitive Behavioral Therapy” would be best suited. Where as for chronic illness that has been persistent and recurrent for a good number of years, the best approach would be “Schema focused Cognitive Behavioral Therapy”. The Standard Cognitive Behavioral Therapy: This therapy is recognized as one of the best and most effective forms of psychotherapy. CBT is based on the knowledge that most of our psychological problems are caused due to our helpless beliefs and assumptions not only of us but also of others. According to Beck, he argues that a person thinks of his experiences and behaves in such a way because of what he feels. The depression that follows could be enduring and self destructive. The cognitive theory not only focuses on the patients earlier negative experiences which make them form certain “core beliefs” about themselves and the world around them. These core beliefs often get registered as “dysfunctional assumptions”. The psychologist or the psychiatrist tries to understand and analyze these assumptions and interpretations that an individual has assigned to their day to day experiences. Some support groups use the “Cognitive Behavioral Therapy” where the person learns how to solve their problems using new ways and means. They teach the person to relax by doing certain calming exercises like Meditation, Yoga or Tai-chi. For severe cases medication is rendered on a regular basis and follow up visits are conducted till the doctor is sure that the person is well and out of depression completely. The Schema Focused Cognitive Behavioral Therapy: The Schema Therapy is a far more advanced and deeper form of Psychological Therapy which was developed by two of Aaron Beck’s students -Jeffrey Young, Ph.D and Janet Klosko, Ph.D. The founder of Cognitive Behavioral Therapy, Aaron Beck acknowledged the effectiveness of this therapy which was developed over the past thirty years. This therapy is specifically used in treating chronic cases of depression, difficulties in relationship and chronic anxiety. This therapy uses the cognitive, behavioral, psychoanalytical and experiential therapies, while keeping focus on the practical and problem solving aspect of cognitive therapy. The Schema Therapy enables the patient to break free from his core beliefs, build up good self esteem and strong personality and enables them to understand why they behave in the way they do. Stress Management: In many cases depression manifests itself due to the stress in their lives. Such stress is caused when they have to look after a very aged or bed ridden parent, or traveling great distances without proper food or rest to the body and other stressful events. Complimentary Medication: In recent years this kind of practice has become increasingly popular among people. Examples of such medication would be homeopathy and acupuncture. The patient is supposed to inform the doctor if he undertaking such treatment. Such treatment is quite safe for the patient and has few side effects. Conclusion: According to Clinical Hypnotherapist / Psychoanalyst David Kato PhD DHP MAPHP Cert.H, the treatment that works the best for the illness of depression is CBT and interpersonal approaches which includes psychoanalytical therapy. According to David, using hypnosis together with CBT has greater therapeutic value than drug therapy. This is termed as “brief therapy”. Clinical hypnosis with CBT adds a different dimension to the treatment of a patient’s thoughts and feelings. Some clients need a Psychoanalytical approach to treating them. This approach is also used effectively with hypnosis. Hypno-analysis tends to reveal and then treat the cause. It is also briefly summarized as the “cause” and “effect” treatment. Using hypno-analysis the clinician identifies the hidden skills and talents of the person and helps them to put them to good use. Therefore specific and positive changes take place within the individual after undergoing treatment using this therapy. Depression is quite a serious matter and as such has to be taken seriously and treated immediately otherwise it would lead to serious problems. It is not to be ignored or put off to treatment in the later stages as it has very bad effects on a person’s mental as well as physical life. People with depression should be treated always with a “handle with care” signpost or it may become worse. Finally, we could say that each person is unique and therefore have their specific problems. The course of treatment therefore should be analyzed well to suit different people. What may be good for one may not necessarily hold good for another. It becomes the responsibility of the doctor to understand his patient thoroughly before crystallizing his opinion on the course of treatment. Finally, not to say the least -“Everyone of us need a shoulder to cry on sometimes, so let us lend ours in time to save someone from the dreaded disease of depression. References: www.bbc.co.uk/health/conditions/depressionelderly1/shtml www.bjp.rcpsych.org/cgi/content/full/177/6/516 Cognitive Therapy: Transforming the Image. Wills, F., & Sanders, D. (2005). London: Sage. www.irishealth.com?level=4&con=372 National Health and Medical Research Council Commonwealth of Australia, 1997 ISBN – 0644397713 Produced by the Australian Government Publishing Service – RESCINDED www.nhmrc.gov.au/publications/synopses/cp37to41.htm www.nice.org.uk/pdf/CGO28quickrefguide.pdf www.mydr.com.au/default.asp?article=4160 www.psycom.net/depression.central.special.html The Royal College of Psychiatrists. The British Journal of Psychiatry (2000)177:516-528, 2000 www.sonolab.com.br/artigo_depresao_idoses_eng.htm Read More