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Depression is a complex disorder that has an effect on every area of our life. Depression is mainly characterized by helplessness, hopelessness, sadness and unworthiness (DSM-IV). Depression also involves lack of interest and involvement in the environment and the self, despair and hostility. Depression makes the emptiness of one’s life become self-evident. Life becomes meaningless and filled with despair. Depressive states become a disorder once they become a permanent fixture, are severe, intense and form an obstacle to normal functioning (Beckham & Leber, 1995).

The depressed are very sensitive to social threats such as rejection or criticism. Their social behaviour is very inhibited and defensive as it is mainly generated by the need to protect oneself rather than to enjoy the interaction. Interpersonal inhibitions such as shyness, withdrawal and avoidance represent a risk factor for the development and the persistence of depression (Gottlib & Hammen, 2002). The depressed have emotional as well as social deficits, which impair their ability to function well in different facets of their lives. Emotional and social deficits intertwine and interconnect. For example, a depressed man who is unable to derive pleasure from a certain activity (emotional deficit) will lose interest and start avoiding social activities of a similar nature (social deficit). Low assertiveness and avoidance of social situations reduces the availability of social support, which could help reduce the depressive state. 

The depressed have negative schemata. Cognitive schemata are like a filter that influence information which we pay attention to, our interpretation, appraisals and even our behaviour. Existing schemata focus our attention to particular stimuli that is consistent with the existing beliefs and attitudes. The negative schemata are automatically activated. The depressed cherish the schemata as true and reflective of reality without even testing them. Data that is not congruent with the schemata will create dissonance. Cognitive dissonance is basically chaos and disorganization that is created when conflicting schemata exist at the same time. The dissonance leads to discomfort, anxiety and confusion which eventually will disrupt normal level of functioning. The depressed tries to avoid dissonance at any costs even at the cost of causing her- himself more psychological pain. This implies that the depressed actually seeks negative information, feedback and criticism from the environment, which is consistent with his or her own maladaptive negative schemata. Positive information or information that contradicts own schemata are not even on the radar or get quickly dismissed. One thus tries to maintain the balance between inner beliefs and external events by adjusting the experiences of the world to the existing beliefs and by avoiding everything that contradicts these beliefs. This dangerous behaviour tendency makes the individual more vulnerable to depression. The negative vicious cycle in which one is caught will only maintain and escalate the depressive symptoms that are experienced.

The last risk factor that I want to present is interpersonal dependency.  The depressed need relationships that provide him or her with support. The problem arises when the depressed has excessive need in reassurance, approval and attention.  Extreme neediness may leave the partner feeling overwhelmed and depleted. It can invoke frustration and irritability in others, who in time will reject the depressed (Coyne & Whiffen, 1995). Sharing negative emotions with the partner can provide relief and support, but at some level it takes a toll on the relationship. This can be reflected in many fights, reported dissatisfaction, low intimacy, avoidance, loneliness, deep silences and angry exchanges (Gottlib & Hammen, 2002). Negative communication in relationships is a lavish ground for blame, hostility and increases the severity of depression. Depressed individuals who also have the tendency to externalize their anger will be even more socially isolated.

The text above mentioned a few factors that cause the development, maintenance and escalation of depression. Cognitive behavioural therapy focuses on challenging the negative schemata and on the changing of the deficient behavioural tendencies, which allow the depressed to be caught in this negative vicious cycle.  The discovery of the negative thoughts that one has of the self, others and the world, which lead to the negative mood and the challenging of these thought help pave the way into the formulation of more balanced, helpful, rational and reality reflecting thoughts. Some of the behavioural changing strategies include the increase of social interaction, activity scheduling to increase daily functioning levels as well as the sense of pleasure and mastery, the enhancement of self-esteem, the improvement of problem solving skills which also increase self-efficacy and reduces dependency on other. Additionally, according to the needs of the client, the therapy session may even include social skills training, anger management and etc.

 

Beckham, E. E., & Leber W. R. (1995). Handbook of depression.New York: TheGuilford press. 

Coyne, J. C., & Whiffen, V. E. (1995). Issues in personality as diathesis for depression: the case of sociotropy- dependency and autonomy-self criticism. Psychological Bulletin, 118, 358-378.

Gotlib, I. H., & Hammen, C. L. (2002). Handbook of depression. New York: The Guildford press.

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