Depression: Social interventions

Behavioral Activation (BA) practitioners respond to difficulties in treating depression by focusing on mechanisms that reinforce depression, a process they describe as quite painful (Dimidjian, 2006).  Other difficult forms of CBT therapy tend to elicit a high dropout rate (Zayfert, 2005).  In addition, there are other barriers to successful therapy, ranging from low medication adherence (Prukkanone, 2010) to high relapse rates and the often high cost of therapy (Paykel, 2007). 

An alternative to medication and CBT is to attempt to reinforce social supports.  Depressed individuals may see themselves as outcasts, but even recalling a pleasurable group activity may help lift their spirits; this implies that feeling they have an important social role may reverse factors that reinforce depression (Scheff, 2009).  Social belonging can also reduce suicidal ideation (McLaren & Challis, 2009).  While social conflict increases depression, conflict resolution can reduce it (Vranceanu, 2009); when depressed individuals engage in dysfunctional social behaviors, it is often the result of misinterpreting social events (Steger, 2009). 

Social interventions may be most beneficial for clients with high social functioning, as pregnant women with depression benefited the most from a perception of social importance when they rated high on social functioning (O'Mahen, 2010).

An example of a reaction the difficulties in treating depression has been the development of Behavioral Activation (BA), which hones CBT  by focusing on the mechanisms that reinforce depression in way that even BA practitioners describe as painful (Dimidjian, 2006). 

This further shows the difficulty of depression treatment, as difficult forms of CBT therapy elicit a high dropout rate (Zayfert, 2005).  There are many other barriers to both medication and talk therapies: medication adherence is often low (Prukkanone, 2010), replase can be high, and a significant barrier is therapist cost (Paykel, 2007).

An alternative to medication and CBT is to attempt to reinforce social supports.  The depressed may see themselves as social outcasts, and even a memory of group activity can lift their spirits implying that a perception of importance in society can reverse depression reinforcers (Scheff, 2009).  A sense of belonging can reduce suicidal ideation (McLaren & Challis, 2009).  Social conflict increases depression, and hence a resolution of conflict can reduce it (Vranceanu, 2009), and dysfunctional social behavior that comorbid with depression is often the result of the misinterpretation of social events (Steger, 2009).

For pregnant women with depression, a perception of social importance benefited those who where high in social function.  So, perhaps these social effects apply most to the high social functioning clients.

References

DeMarco, C. (1998, June). On the impossibility of placebo effects in psychotherapy. Philosophical Psychology, p. 207. Retrieved from Academic Search Premier database.

Dimidjian, S., Hollon, S., Dobson, K., Schmaling, K., Kohlenberg, R., Addis, M., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658-670. doi:10.1037/0022-006X.74.4.658.

Hougaard, E. (2010). Placebo and antidepressant treatment for major depression: Is there a lesson to be learned for psychotherapy?. Nordic Psychology, 62(2), 7-26. doi:10.1027/1901-2276/a000008.

O'Mahen, H., Flynn, H., & Nolen-Hoeksema, S. (2010). Rumination and interpersonal functioning in perinatal depression. Journal of Social & Clinical Psychology, 29(6), 646-667. Retrieved from Academic Search Premier database.

Paykel, E. (2007) Cognitive therapy in relapse prevention in depression. International Journal of Neuropsychoparmacology 10(1), 131-6.

Prukkanone, B., Vos, T., Burgess, P., Chaiyakunapruk, N., & Bertram, M. (2010). Adherence to antidepressant therapy for major depressive patients in a psychiatric hospital in Thailand. BMC Psychiatry, 1064-68. doi:10.1186/1471-244X-10-64.

Scheff, T. (2009). A Social theory and treatment of depression. Ethical Human Psychology & Psychiatry, 11(1), 37-49. doi:10.1891/1559-4343.11.1.37.

Vranceanu, A., Gallo, L., & Bogart, L. (2009). Depressive symptoms and momentary affect: the role of social interaction variables. Depression & Anxiety (1091-4269), 26(5), 464-470. doi:10.1002/da.20384.

Zayfert, C., DeViva, J., Becker, C., Pike, J., Gillock, K., & Hayes, S. (2005). Exposure Utilization and Completion of Cognitive Behavioral Therapy for PTSD in a “Real World” Clinical Practice. Journal of Traumatic Stress, 18(6), 637-645. doi:10.1002/jts.20072.