Identity Structure Analyses of Individuals with Clinical Depression & Anxiety

1. Identity Structure Analyses of Individuals with Clinical Depression & Anxiety Presented by Alison McKenna BSc (Hons)

2. Identity, Depression & Anxiety • Joiner, Coyne, & Blalock, 1999:3 By ignoring “the intricacies of depressed persons’ involvement with other people” one may “attribute to depressed persons characteristics they do not possess” and “leave significant aspects of their experience unexplained.” • ISA: self/identity distinction.

3. Depression & Anxiety • Prolonged, unresolved periods of anxiety often precede depressive episodes (Wolpe, 1971; Bittner et al, 2004). • Sloman, Farvolden, Gilbert, & Price, 2006:98 “…[they] have complex and important co-regulating influences on each other that may explain [their] high comorbidity…”

4. Postulates Examined • Participants’ biographical experiences within their social milieu are likely to be reflected by ISA through their modulation of identity indices with significant others. • The psychological processes underlying comorbidity of depression and anxiety will be elucidated through examination of participants’ identifications with others across depressed and anxious selves.

5. Method • Participants all had depressive disorder and anxiety disorder. • Semi-structured interview with each participant. • Customization of ISA Identity Instrument. - Approx. 20 entities. - Inclusion Criteria: Participant’s testimony. Investigation of a priori theoretically derived postulates.

6. Entity List Excerpt

7. Method ctd. - Same 20 constructs for each participant. - Constructs included for the examination of a priori theoretically derived postulates. - Terminology influenced by testimony given in interviews.

8. Construct List Excerpt

9. Method ctd. • Participants were asked to complete both their Identity Instrument as well as the Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995).

10. Results “Philip” – Biographical Factors • Mixed anxiety & depressive disorder (F41.2). • He had endured numerous prejudicial attacks. • Nevertheless, he held strong aspirations towards positive social relationships (SP=99.69). • Depression likened to loss – related to loss of relationships due to prejudicial encounters.

11. Results ctd. “Philip” – Biographical Factors ctd. • Idealized his “well” self states, thus inducing the retaliations of others and amplifying their prejudicial appraisals of him.

12. Results ctd. “Philip” - Comorbidity • Anxiety was revealed to involve engagement with the social world in spite of problematic conflicted identifications with others and high diffusion… • …where conflicted idn refers to the multiplicative function of one’s empathetic idn with another and one’s contra-idn with that other…

13. Results ctd. “Philip” – Comorbidity ctd. • …and diffusion refers to the overall dispersion and magnitude of one’s conflicted idns with others. • Depression, on the other hand, was entered as he endeavored to resolve his conflicted idns with others through social withdrawal.

14. Results ctd. “Philip” – Comorbidity ctd. • Vicious Cycle Maintaining Comorbidity: Once in depression, attempts to relieve it through re-engagement socially reinstates problematic conflicted idns, high diffusion and implicit anxiety. • Thus, a vicious cycle ensues whereby anxiety is traded off against depression and vice versa.

15. Results ctd. “Gordon” - Biographical Factors • Recurrent Depressive Disorder (Current Episode Moderate) (F33.1) with prominent anxiety symptoms. • He had separated from his wife and had lost a friend through suicide in recent years, and had lost his job immediately prior to his participation in the study.

16. Results ctd. “Gordon” - Biographical Factors • Strong aspirations towards feeling safe and secure and having positive social relationships. • Defensively identified with his parents when appraising his childhood self and, more recently, with his wife.

17. Results ctd. “Gordon” – Comorbidity • The same psychological dynamic where anxiety and depression inter-relate within the person that was in evidence for “Philip” resulted in “Gordon’s” case.

18. Results ctd. Contrasting case – “Nancy” • Negative evaluations of others generally enabled her to feel closer to them through illness. • This tendency related to her early negative experiences in the family context, where her appraisals indicated a problematic relationship with her then depressed parents which had infiltrated her current idns with them. • Her results showed a coalescence of the anxious and depressive states in her mind, where on the affective level they had merged into an unitary state.

19. Conclusion • ISA revealed diverse and complex biographical and social factors feature in the aetiology of clinical depression and anxiety… • …confirming the importance of examining the intricacies of depressed persons’ social involvement.

20. Conclusion ctd. • Furthermore, ISA enabled the discovery of a dynamic whereby anxiety and depression inter-relate and co-regulate one another. • Anxiety is experienced through social interaction in spite of problematic conflicted idns with others and high diffusion, and depression enables partial resolution thereof, via social withdrawal. • A cyclical process ensues where the two may be entered interchangeably.