Understanding Depression and Its Impact on Relationships

1. Depression and Relationships Nathaniel R. Herr Psych 137C Summer 2004

2. What is Depression? • Depressed Mood, Loss of Interest • Also: • Sleep and Eating Problems • Concentration Difficulty • Memory Problems • Feelings of Guilt • Suicidal Thoughts • Episodic, Long-Term Disorder

3. Interpersonal Impairment • Poorer social skills • Less motivation to interact socially • More irritable • Reassurance-Seeking (Joiner, 1994) • The tendency to excessively ask others for reassurance of worth • Depressed people are not the most fun to be around!

4. Depression Interpersonal Problems Interpersonal Environment • “Transactional Nature” of Depression • Stress Generation (Hammen) • Vicious Cycle • Reassurance-Seeking Spreads Depression

5. And as if things weren’t bad enough… • Mate Selection • More depressed partners • More anxious partners • More personality disorder partners • More substance abusing partners • More abusive partners

6. Effects on Marriage • Depressed Wives: • Poorer Quality Relationships • Poorer Conflict Resolution • Lower Marital Satisfaction • Cause + Effect? • These problems obviously could make someone depressed

7. What About Men? • Little Research • Worse Marital Satisfaction • But even worse if wife is depressed instead • Wives: • Marital Satisfaction  Depression • Depression  Marital Satisfaction • Husbands: • Marital Satisfaction  Depression • Depression not related Marital Satisfaction • Why?

8. Summary • Depression causes interpersonal impairment • These problems are “transactional” in nature: • Depression causes social problems, social problems cause depression • Depressed spouses have more marital problems and lower marital satisfaction • Research has typically focused on women, but men have problems too.

9. Couple Therapy

10. Different Approaches to Therapy • Traditional Behavioral Couples Therapy • Cognitive Therapy • Integrative Behavioral Couples Therapy

11. Traditional Behavioral Couple Therapy (TBCT) • Assessment of couple’s strengths and weaknesses • Specify changes – avoid “not” behaviors • Communication Training • “I” statements • Focus on specific situations • Listening skills – paraphrase, reflection • Problem Solving Training • Define problem, acknowledge each spouse’s role • Evaluate pros and cons • Negotiation, Agreement, Experimentation

12. Problems with TCBT • Change does not always stay over time • Sometimes there is behavior change, but not a change in marital satisfaction • People don’t want to change!

13. Cognitive Therapy (CT) • Main Assumption: • Problems come from “faulty cognition” – thinking about things in the wrong way. • Attribute problems to partner (not self) • Unrealistic expectations • Have problematic assumptions (CL) • Selective Attention: Focus on negative

14. Cognitive Therapy (cont.) • Goal: Identify and change faulty cognitions • Intervention • Teach about cognitive errors • Person as “scientist” • Examine evidence for belief • “Experiments” and homework • Identify exceptions (avoid all-or-nothing thinking) • Use questioning rather than commands

15. Problems with CT • Favor more “logical” partner • Not well-suited for dealing with emotions • Can overemphasize thinking instead of doing • Focus on specifics can miss the bigger picture • Has not been shown to be more effective than TBCT

16. Integrative Behavioral Couple Therapy (IBCT; Christensen) • Emphasis on broad themes (instead of specific situations) • Emphasis on Acceptance (instead of change) • Emphasis on “contingency shaped” behavior • TBCT uses “rule-governed” behavior, where rules are imposed to promote change • “Contingency shaped” behavior is when change is elicited by introducing new ideas or situations

17. Acceptance • Focus on “receiver” not “doer” • Acceptance leads to greater intimacy • Reduces defensiveness • Leads to acknowledgement of responsibility • Acceptance can lead to change • Reduces pressure to change…which actually can help make change • Easier to change when you feel accepted • Easier to accept someone when you see change

18. Research on IBCT • Currently going on at UCLA (Christensen) • Small amount of research that exists suggests that IBCT works better than TBCT • Addresses some of the problems with TCBT: • Specifically, the emphasis on contingency shaped behavior, not rule based, leads to greater cooperation in treatment and higher marital satisfaction.

19. Being a Couples Therapist • Interacting with two or more people at once • Working both individually and together • Confidentiality • Trust • Trying not to focus on an “identified patient” • Trying not to take sides • Thinking on your feet and being creative

20. Summary • TBCT focuses on identifying and changing specific behaviors • CBT focuses on identifying and changing faulty cognitions • IBCT focuses on broad relationship patterns and acceptance of the other • Working with two different people who bring different agendas to therapy is especially difficult for couples therapists