Depression: Psychosocial Theories

Psychosocial Theories

Psychoanalytic theory as postulated by both Freud and Abraham emphasized the connection between mourning and melancholia. wherein the melancholic patient experiences a loss of self-esteem with associated helplessness, prominent guilt and self-denigration. According to the theory, this results from internally directed anger which or aggression turned against the self, lead-ing to a depressive experience. Self-psychologists have described the effects of loss and trauma on the development of a coherent sense of self. Bowlby’s work on attachment elucidates the impact of very early loss and trauma with a resultant predisposition to depression among other things.

Behavioral theory holds that depression is an overgeneral-ized response to loss of social support. Indeed, the lack of social support appears to be one of the strongest factors in promoting vulnerability to depression. The experience of depression may also elicit negative responses from others which reinforces nega-tively held personal beliefs.

The cognitive-behavioral perspective emphasizes a set of dysfunctional attitudes, cognitions and images associated with depressive symptomatology. This theory is the most empirically examined psychosocial theory in relation to the management and treatment of the depressed patient, and emphasizes how cogni-tive distortions and negative self-image cause depression and are associated with maintenance of the disorder.

The cognitive perspective as well as contributions from the helplessness–hopelessness models formed an empirical basis for CBT. In CBT, education, behavioral assignments and cogni-tive retraining form the active components of the psychotherapy.

This cognitive therapy has been demonstrated to be an effective short-term psychotherapy for depression. Another current ther-apy called interpersonal therapy derives from a focus on diffi-culties in current interpersonal functioning. The relationship be-tween psychological health and one’s interpersonal environment has received substantial attention.

The current iteration of the interpersonal approach is re-flected in the development of a specific treatment for depression termed interpersonal psychotherapy of depression (IPT). IPT in-volves a formal diagnostic assessment, inventory of important current and past relationships, and definition of the current prob-lem area. In IPT, four areas of focus that could relate to depres-sive symptoms are: 1) grief, 2) interpersonal role disputes, 3) role transitions, and 4) interpersonal deficits.

The loss of “social zeitgebers” has been proposed as a link between biological and psychosocial formulations. The social zeitgebers theory suggests that social relationships, interpersonal continuity and work tasks entrain biological rhythms. Disrup-tions of social rhythms due to loss of relationships interfere with biological rhythms that maintain homeostasis. This disruption leads to changes in neurobiological processes including altera-tions in neurotransmitter functions, neuroendocrine regulation, and neurophysiologic control of sleep/wake cycle and other nor-mal circadian oscillations.