PSYCHOTHERAPY TRENDS

Transcription

1 PSYCHOTHERAPY TRENDS The current trends in clinical research faithfully communicated in everyday language FREE ISSUE 2015 DEPRESSION Editor s Remarks: What s inside this issue: This particular issue focused primarily upon Depression. Whenever possible we like to organize each issue around a particular topic, but our first goal is to attempt to cover as many clinically relevant scholarly research articles as possible in a given year. These were selected because we felt they had some direct bearing on clinical practice. Dr. Clifford Moore Depression and Attributional Style Revisited Facebook and Depression: Understanding Envy and Depression Self-Compassion and Depression Can Smiles Cure? Zinc as a Depression cure?

2 Depression and Attributional Style Revisited Zhang and Yang published a meta analysis in the Journal of Social and Clinical Psychology. They reviewed 86 studies, totaling 51,407 participants over the past 20 years. The meta analysis examined attributional style and depression. They drew their hypothesis from famous and established models regarding learned helplessness and hopelessness. These models demonstrate a vulnerability to depression based upon particular styles of attribution. This style is considered to be a cognitive dimension of one s personality that reflects how an individual interprets events. The three categories of attribution are as follows: Internal vs. external- whether responsibility for the event was within the control of the individual or not o Ex. I failed the test because I didn t study or the professor was unreasonable Stable vs unstable- whether the causes persist throughout time or are attributed to one event o Ex. I didn t get the job because I m a terrible interviewer or had a bad interview Global vs specific- will the attribution affect a single event or generalize to many events o Ex. Failing the test means I will fail most tests and interviews as opposed to seeing it as a reflection of only that one event. Several instruments were designed to assess for attributional style and basic configurations that left people vulnerable for depression, namely having internal, stable, and global attributions for events. In that case, one would blame themselves, expect the bad outcome to continue, and expect it to continue in multiple areas of their lives. The alternative might be to see it as bad luck, a onetime occurrence, and confined to the one event (external, unstable, specific). The meta analysis supported these conclusions finding that internal, stable, and global attribution styles were correlated with depression, but they also discovered that age and gender play a statistically significant role. Their findings suggest that only adults exhibit a connection between global attribution and depression and that women have a stronger correlation between attributional style and depression. (Hu, T., Zhang, D., & Yang, Z. (2015). The relationship between attributional style for negative outcomes and depression: a meta-analysis. Journal of Social and Clinical Psychology, 34(4), ) PSYCHOTHERAPY TRENDS FREE ISSUE psychotherapytrends.com 2

3 Facebook and Depression: Understanding Envy and Depression Summary of Study Published in the Journal of Social and Clinical Psychology, Appel, Crusius, and Gerlach sought to understand the nature of envy and depression using facebook usage as a way to demonstrate and understand the phenomenon. They note the link between envy and depression hypothesizing that those experiencing the effects of low self worth will compare themselves to others. The study took two groups, depressed and not depressed, had them rate their self-esteem and then had envious, inferior, bitter, and disadvantaged they felt when seeing the profile, and to what extent they wanted to change roles with, wished to be like, and felt inspired by the profile owner. Results The results indicated that depression was associated with higher levels of envy. Moreover, social comparison seems to play a crucial role in this phenomenon. As predicted, not only did the depressed group As predicted, not only did the depressed group report more feelings of inferiority in the social comparison, but inferiority also predicted envy substantially. them compare themselves to various facebook profiles. Finally, they were then asked to rate their feelings of inferiority and envy. The sample size was 89 individuals 44 depressed and 45 non depressed, based upon Beck s Depression Inventory. Attractiveness was measured by the subjects themselves, rating the profile on a 7 point scale. Then they were asked to rate how happy they thought the profile owner was and how happy they were in comparison to themselves. Participants indicated how report more feelings of inferiority in the social comparison, but inferiority also predicted envy substantially. Furthermore, envy was correlated with depressive symptoms and, negatively, with self-esteem. The study demonstrates that depressiveness affects how individuals process envy-relevant stimuli. It is then likely that low self-esteem and comparison bias contribute to envy, making those who experience depression at a higher risk for envy and Online Social Networking (OSN) may be very... Continued PSYCHOTHERAPY TRENDS FREE ISSUE psychotherapytrends.com 3

4 effective at inducing envy in depressed individuals. Depressed individuals are likely to be more susceptible to envy and vulnerable to high comparison standards. Clinical Implications The authors suggest the following treatment implications: 1. Assess for high Online Social Networking with depressed individuals 2. Include educational interventions regarding OSN o Raise awareness of positive impression management in OSN o Encourage avoidance of comparison standards (Helmut Appel, Jan Crusius, and Alexander L. Gerlach, Social Comparison, Envy, and Depression on Facebook: A Study Looking at the Effects of High Comparison Standards on Depressed Individuals, Journal of Social and Clinical Psychology, Vol. 34, No. 4, 2015, pp ) PSYCHOTHERAPY TRENDS FREE ISSUE psychotherapytrends.com 4

5 Self-Compassion and Depression Podina, Jucan, and David explain in their article published in the Journal of Evidence-Based Therapies that research has demonstrated that there are underlying irrational beliefs involved in the development of depression. The study s authors set out to understand what boosts an immunity to these cognitive distortions. Their hypothesis is that self-compassion can buffer the connection between irrational beliefs and depression. 187 individuals were assessed based upon irrational beliefs, self-compassion and levels of depression. For those individuals that demonstrated a high level of self-compassion there was no correlation between depression and irrational beliefs. In particular, selfkindness moderated the irrational beliefdepression relationship. The authors cite such irrational beliefs as When people reject or dislike me, it is because I am bad or worthless. They discuss Albert Ellis formulation that an activating event triggers an irrational belief that produces a negative experience like depressed mood. They cite research indicating a positive relationship between irrational beliefs and depression. But the authors point out that not everyone with irrational beliefs develops depression. So their study was designed to examine the resiliency factors that boosts the cognitive immunity, namely self-compassion. Self-compassion was operationalized using the Self-compassion scale (Neff, 2003). It breaks down self-compassion into 3 domains: self-kindness, common humanity and mindfulness. Self- kindness I try to be loving toward myself when I m feeling emotional pain. Common Humanity When things are going badly for me, I see the difficulties as part of life that everyone goes through. Mindfulness When I fail at something important to me I try to keep things in perspective. Self-kindness showed strong statistical significance with regard to moderating the effects of depression and irrational beliefs, whereas common humanity and mindfulness did not. In other words, the study indicated that self-kindness may have the potential to protect individuals from depression. (Podina, I., Jucan, A., & David, D. (2015). Self-Compassion: A Buffer in the Pathway from Maladaptive Beliefs to Depression. an Exploratory Study. Journal of Evidence-Based Psychotherapies, 15(1), ) Further reading: (Full text available) Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology and Psychotherapy, 13(6), 353. (Free on the net) PSYCHOTHERAPY TRENDS FREE ISSUE psychotherapytrends.com 5

6 Can Smiles Cure? Authors Lin and Gong explored the idea of embodied emotions. They note research that demonstrates positive mood shifts when smiling. Their goal was to expand upon the research in order to determine if smiling could actually help people with depression. Their Rationale: 1. William James observed that we don t laugh because we are happy. We re happy because we laugh. 2. Laird and Lacasse (2014) state that bodily feedback like facial expressions have a significant role regarding emotions. 3. Lewis Bowler (2009) found that patients injected with Botox to prevent frowning experienced less anxiety and depression 4. Freitas-Magalhaes and Castro (2009) performed a study using smiles as an intervention noting an increased value of positive thoughts over negative thoughts. They reference several studies (Fredrickson & Levenson, 1998;Kraft & Pressman, 2012) indicating that simply changing ones facial expression affected cardiovascular and affective responses to stress. Methodology ERN Amplitude is an electrophysiological maker that indicates emotional change when people are making errors during tasks. It is also thought to be associated with dopamine levels in areas of the brain. Studies have indicated that manipulation of facial expressions affect the ERN. There is an indication that those with depression symptoms have higher ERN amplitudes. The researchers chose undergraduate students who were diagnosed with minor depression. Their hypothesis was that those individuals that were induced to smile would have a reduction in their ERN amplitudes as well as a positive mood shift. As each participant was asked to do a task their facial expression was manipulated in the following ways: 1. Hold a stick vertically between teeth with lip corners pulled upward activates the zygomaticus muscles and simulates a standard smile 2. Holding a stick horizontally between the teeth with cheeks raised activates the zygomaticus and orbicularis oculi muscles which simulates a Duchene smile. 3. Hold a stick vertically and keep faced relaxed which simulates a no-smile condition. Continued PSYCHOTHERAPY TRENDS FREE ISSUE psychotherapytrends.com 6

7 The participants were NOT told that they were engaging in a smile experiment or that their actions were simulating smile conditions. They were told that they were involved in a multitasking study. This eliminates the possibility of placebo effect. Assessments 1. Emotional state was assessed using a self report instrument: 1 to 10, 1 being totally happy and 10 being totally unhappy 2. The task, referred to as the event-related potential was assessed along with an EEG and analyzed using the Brain Vision Analyzer software. The EEG results were examined as people performed the task analyzing the results as individuals performed the task correctly and incorrectly. Results 1. No smile condition scored lower on selfreported happiness state than Duschene and normal smile conditions. 2. Manipulation of smile conditions exhibited significant changes in event response, meaning that participants performed the task more correctly when engaged in a smile condition. 3. The smile condition decreased the enlarged ERN amplitude that has been associated with the participants diagnosed with minor depression. or Duchene smile conditions were noted. The authors believe that results may indicate that smile conditions may interrupt the negative rumative cycles regarding failures and mistakes. They point out that there have been many researchers who have begun to incorporate smile training in their treatment of depression. This may be very similar to the Cognitive Behavior approach of substituting an opposite emotional response than one is currently experiencing or the Gestalt concept of acting As if, or even the Alcoholics Anonymous idea of fake it till you make it. Due to studies like these we may have a better idea of why such strategies can work. In conclusion our findings added further support for the embodied emotion approach (Niedenthal et al., 2010), by demonstrating that smile manipulation can lead to better mood, more frequent correct judgments for arrow direction, and decreased ERN amplitude among people with MinD [minor depression]. (Lin, W., Hu, J., & Gong, Y. (2015). Is it helpful for individuals with minor depression to keep smiling? An event-related potentials analysis. Social Behavior and Personality: an international journal, 43(3), ) The authors speculate that the results of this study indicate that smile conditions may increase the dopamine levels as is indicated by the decreased ERN Amplitude. No significant differences between standard PSYCHOTHERAPY TRENDS FREE ISSUE psychotherapytrends.com 7

8 Zinc as a Depression cure? Authors Solati, et. al., examined a 30mg zinc therapy for Depression. They cite other studies that demonstrate a reduction in depressive symptoms along with therapy, but wanted to examine the results of zinc as a monotherapy. They examined the effects of zinc upon depressive symptoms and serum brain-derived neurotrophic factor levels. Their population was overweight or obese subjects. They recruited 50 overweight or obese individuals and assigned them to a placebo group and a group that received 30mg of zinc daily for 12 weeks. Depressive symptoms were assessed using Beck s Inventory and the Serum levels were assessed using enzyme-linked immunosorbent assay. After 12 weeks serum levels significantly increased in those taking the zinc supplement. Depressive symptoms declined in both the zinc and placebo groups, but zinc group experienced significantly greater reduction in symptoms. Their conclusion: Zinc monotherapy improves mood in overweight or obese subjects most likely through increasing BDNF levels. (Solati, Z., Jazayeri, S., Tehrani-Doost, M., Mahmoodianfard, S., & Gohari, M. R. (2015). Zinc monotherapy increases serum brain-derived neurotrophic factor (BDNF) levels and decreases depressive symptoms in overweight or obese subjects: a double-blind, randomized, placebo-controlled trial. Nutritional neuroscience, 18(4), ) About the Editor: Clifford Moore is a therapist in private practice with a doctorate in clinical psychology. In addition to his practice, he teaches graduate level classes and conducts workshops in the New Jersey Area. PSYCHOTHERAPY TRENDS FREE ISSUE psychotherapytrends.com 8