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

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

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!

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

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

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

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

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.

Couple Therapy

Different Approaches to Therapy Traditional Behavioral Couples Therapy Cognitive Therapy Integrative Behavioral Couples Therapy

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

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!

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

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

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

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

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

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.

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

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