Procedure for identifying depression-inhibitors.

Abstract

A multiplicity of anxiety-inhibitors (e.g., relaxation, assertive responses) exist for the counterconditioning of anxiety. Unfortunately, no such class of depression-inhibitors has been identified. The present case history concerned modification of a procedure for identification of anxiety-inhibitors to select possible depression-inhibitors. The subject, an outcare patient, was a 38-yr.-old divorcee, mother of three children, w~rh four prior psychiatric hospitalizations over the previous 4 yr. due to suicidal attempts or jicstures and complaints of depression. Her previous diagnoses were depressive neurosls or passive-aggressive personality. She was then referred by a staff member for behav~oral therapy because of complaints of depression. In the initial interview, she complained of loneliness, helplessness, lack of self-confidence, self-pity, and worry about the future. Essentially following Wolpe's (1969) procedure, a seven-item hierarchy was established concerning her feeling lonely when by herself at night, not enjoying herself when in the company of married couples, and feeling insecure about her adequacy as a mother. Depression was evaluated by modifying the subjective units of disturbance scale which was anchored at the two e x t r e m e 4 representing the absence of depression and 100 representing the most depressive feeling. To identify depression-inhibitors, a procedure was used similar to that of Kass, Rogers, and Feldman (1973) for anxiety-inhibitors. The subject was asked if she could recall any response which had been associated with the diminution or termination of depression in any situation. Since the subject reported having no such response in her repertoire, she was then asked to describe a scene, feeling, or activity which she believed to be the opposite of the feeling of depression. She described a scene in which she was lying in bed looking at drapes which she had just made and feeling the warmth of the sun streaming into the room. Next, the potential depression-inhibitor was tested in a trial run during the initial session An Item from the middle of the hierarchy was presented followed by instructions to engage ~n the selected inhibitor when she signalled depression. Since the subject reported that rhe identified scene terminated her depressive feeling, it was used as the depression-inhlblror in the subsequent trials. The first six hierarchical items were completed in eight sessions. After the last session, she reported that she was no longer depressed. She could stay home in the evening without becoming depressed and was again enjoying social activities. For 5 mo. following the last treatment session, she continued to meet once a week with her outcare worker who reported that she experienced no significant depression. Further follow-up was not possible because she moved to a distant state; however, pteviouly her worry about her psychological problems had prevented such a move. These results suggest that the identification procedure may be useful in selecting depression-inhibitors.