According to DSM V characteristic features of a depressive episode include depression of mood, anhedonia, reduced attention and concentration, ideas of guilt and worthlessness, lowered self esteem, and reduced energy which in turn leads to tiredness and reduced activity. This progresses to hopelessness and a belief that life is not worth living, which can provoke suicidal thoughts. Biological symptoms such as weight loss, reduced appetite, constipation, sleep disturbance, loss of libido frequently occur.
The National Comorbidity Survey reported a lifetime prevalence of major depressive episode of 17.1%; a life time prevalence of 14.9% for major depression; and a 6.4% prevalence rate for dysthymia.
Figures show a higher prevalence of depression in females across numerous national and international studies. Rates of depression in men and women are highest in 25 to 44 year olds; for both men and women rates decrease over age 65. In the US, prevalence rates for major depression appear unrelated to ethnicity, education, income or marital status.
REBT conceptualisation of reactive depression
The following conceptualisation of depression refers to non organic depression i.e. reactive depression. The treatment of organic depression often calls for medical intervention coupled with cognitive behaviour therapy.
According to Paul Hauck, American Psychologist who has authored numerous books on REBT suggests that we can depress ourselves three ways:
- Self Denigration
- Self Pity
- Other Pity
Self Denigration depression is triggered by holding rigid beliefs about autonomy independence, success and freedom. For example, ‘I absolutely should able to look after myself. I absolutely have to be independent. I should always succeed, the fact that I am not succeeding proves I am a total failure and worthless.’
Self damning or denigration beliefs may also be related to holding rigid beliefs about acceptance or rejection by someone significant or by your community. For example, “I should not have been rejected. The fact that I have been proves I am bad, worthless”, and so on.
Self Pity depression is based on thinking “Why Me?”, “Poor me”, “I don’t deserve this”. Self pity depression usually occurs after a loss, such losing a loved one, job, relationship.
It is triggered by holding unhealthy demands that life must be comfortable, easy and hassle free.
Other Pity depression occurs when a person disturbs himself about people’s plight, pain and suffering and misfortune, creating demands such as “Injustice absolutely should not happen people must not suffer so badly, it’s awful that they do”.
Conceptualising depression in the above way offers many benefits with respect to the treatment of reactive depression. First, it is not complex. People can also easily understand it and as a consequence be more actively involved in their therapy. Secondly, it offers the therapist a clear way for making a clinical assessment by identifying the specific factors that apply to that client. This in turn leads to choosing the most appropriate interventions in CBT.
REBT: Pioneered by Albert Ellis in the 1950’s, Rational Emotive Behaviour Therapy is one of the main schools of Cognitive Behaviour Therapy. It is philosophical, evidence based and supported by clinical research. Unlike some other forms of CBT, which require practitioners to have a wide knowledge of specialist protocols, REBT looks at the person as a whole rather than as a symptom and teaches a model that can be successfully applied to a wide range of different emotional issues. It offers a therapeutic structure which helps the client to achieve long lasting emotional and behavioural change, a universal model they can continue to apply to all areas of their lives which they may find challenging.
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