KEvents presents Keys to Unlocking Depression

1. KEvents presentsKeys to Unlocking Depression A Webinar with Michael D. Yapko, Ph.D.

2. Part 2 Individual and interpersonal risk factors, and self-help

3. Key Risk Factors I’ll Identify Today and Their Implications • Ambiguity • Negative attributions • Social isolation • Unrealistic expectations • Depressed parent(s) • Global cognition • Poor decision making strategies • Absence of foresight

4. Ambiguity is a Risk Factor • People strive to understand and make “meaning” • Ambiguity raises, while certainty lowers, anxiety; projection as a coping device • Cognitive distortions represent efforts to reduce, eliminate ambiguity • A therapeutic goal is to learn to both RECOGNIZE and TOLERATE ambiguity

5. The Projective Hypothesis When you encounter an ambiguousstimulus, you project meaning onto it using your own frame-of-reference

7. Attributional Style Patterns to Identify • Internal or external (“It’s me/ It’s them.”) • Stable or unstable (“It will always be this way/ It will change.”) • Global or specific (“It affects everything/ It affects only this.”)

8. The first task in treatment is to shift the person from a stable to unstable attributional style Co-create Vision of What is Possible: Realistic Hopefulness is Crucial!

9. The Negative AttributionalStyle of Depression The generalized tendency to attribute negative events to internal, stable and global causes.

10. Families and Attributional Style Formation • Modeling • Attachment • Trauma and loss • Contingent self-worth • Conflict and abuse • “Risky” parents

11. The quality of your relationships is a significant predictor of your risk for depression What about social skills training as a preventive opportunity?

12. Social Isolation and Comparative Health Risks • In a study published July, 2010, in the open-access journal PLoS Medicine, psychologist Dr. Julianne Holt-Lunstad and her team at Brigham Young University conducted a meta-analysis of studies that examine social relationships and their effects on health. They looked at 148 studies that covered more than 308,000 people…

13. Social Isolation and Comparative Health Risks • People with strong social relationships were 50% less likely to die early than people without such support • A lack of social relationships was equivalent to 15 cigarettes a day • Having low levels of social interaction was equivalent to being an alcoholic, more harmful than not exercising, and twice as harmful as obesity

14. Social Isolation and Comparative Health Risks • Over the last 20 years there has been a three-fold increase in the number of Americans who report having no confidant • Trends reveal reduced intergenerational living, greater social mobility, delayed marriage, dual-career families, increased single-resident households and increased age-related disabilities

15. Social Isolation and Comparative Health Risks • “Despite increases in technology and globalization that would presumably foster social connections, people are becoming more socially isolated.” • Holt-Lunstad, J., Smith, T., and Layton J. (July 27, 2010). “Social Relationships and Mortality Risk: A Meta-Analytic Review.”, PLoS Medicine7(7): e1000316.

16. Maladaptive Mate Selection • The choice of a mate is a strong determinant of stress level and overall family adjustment • Poor self-concept and perceived limited choices • Similarity and familiarity with “damaged” partners • Family “re-enactment” • Complementarity in seeking “excitement”

17. Interpersonal Patterns That Maintain Depression • Negative feedback seeking (seeking out information that confirms their already low self-concepts) • Excessive reassurance seeking (desiring and repeatedly asking for reassurances as to their worth while rejecting positive input) • Interpersonal conflict avoidance

18. Expectations and Marital Satisfaction How well your partner lives up to your expectations determines your degree of marital satisfaction. What happens if the expectations aren’t realistic?

19. How much of the anger, hurt, and disappointment people experience in their relationships is a product of their own unrealistic expectations? Especially when combined with low frustration tolerance, poor impulse control, and an external attributional style

20. Children and Media • According to the Kaiser Family Foundation’s 2010 report, American children and teens average 7.5 hours a day watching TV, playing video games, or surfing the internet. This does not include the 1.5 hour average time spent texting and the .5 hour spent talking on cell phones. • When you add in multitasking, kids are spending about 11 hours a day with technology. Small, G. (2008). iBrain: Surviving the technological alteration of the modern mind. New York: Collins Living.

21. Children and Media • The Kaiser study found that nearly half the heaviest 8-18 year old users (averaging 16 hours a day) had: • School grades of mostly C’s or lower • More frequent reports of sadness or boredom • Greater dissatisfaction with school • Higher incidences of getting into trouble at home and school • More psychological difficulties Page et al.,(October, 11, 2010). “Children’s screen viewing is related related to psychological difficulties irrespective of physical activity.” Pediatrics, 126, 5, e1011-e1017.

22. Depression Intensifies From One Generation to the Next The first such study following 3 generations of high-risk families and has taken more than 2 decades to complete showed most of the prepubescent grandchildren with a 2 generation history of depression developed anxiety disorders that developed into depression as they aged into adolescence. Weissman et. al, Archives of General Psychiatry, January, 2005

23. Why are children the fastest growing group of depression sufferers? You have a generation of people who wanted children… they just didn’t want to be parents

25. Mother-Infant Interactionsand Neurological Risks “Severe neglect, neglectful and/or emotionless parenting appears to have specific and long lasting biochemical and behavioral consequences…Early exposure to stressful stimuli in the environment can impact the monoaminergic neurotransmitter systems, the structural development of the brain, and alter gene expression.” Konyecsni & Rogeness, Sem in Clin Neuropsychiatry

26. Problem Parents, Problem Children “… less than 3% of the families with no risk factors had a multi-problem child. Among families with a depressed parent, the prevalence of multi-problem children rose to 26%.” Holahan, Moos & Bonin, The Interactional Nature of Depression, 1999

27. Children at Risk • Having a depressed parent • Loss of mother • Low level depressive symptoms • Living in family distress • Divorce • Absentee fathers • Alcohol and drug abuse

28. “When Parents Are Depressed… Children can be deprived of basic needs in subtle ways that do not constitute serious neglect or abuse…These parents are far less able than others to provide their children with almost all of the ingredients of growth.” Richard Weissbourd The Vulnerable Child

29. If you want to help children… …help their parents to function as parents, a major preventive opportunity

31. Global thinking is what makes issues seem so big that they can’t be handled; it’s what leads people to feel overwhelmed and paralyzed into inaction One step at a time…

32. “Overgenerality Bias” and the Global Cognitive Style in Depression Depressed individuals suffer from an overgenerality bias in retrieving personal memories of past emotional experiences as well as in imagining possible future experiences. For instance, when asked to recall experiences of anger, depressed individuals tend to report overgeneral events (e.g., “When I am with my girlfriend”) rather than a specific event (e.g., “last Sunday, I had an argument with my neighbor whose dog was endlessly barking”). (p. 560) Philippot et al., Emotion, Nov., 2006, Vol. 6, No. 4, 560-571.

33. Criteria of Distinction Your criteria of distinction determine what, out of a wide range of possibilities, you will focus on and respond to Most of the problems we treat come about directly as a result of the client employing criteria that are ineffective and thereby give rise to their problems

35. The Merits of Concreteness Reduced concrete thinking characterizes recurrent self-related negative thinking, such as worry and rumination. Concrete thought is “distinct, situationally specific, unequivocal, clear, singular.” (p.320) Concrete thoughts evoke more imagery and more vivid imagery than abstract ones Watkins & Moulds, Emotion, September, 2005, 5(3), 319-328

36. The Stress GenerationModel of Depression “Depressed people contribute to the occurrence of their own stress, which, in turn, maintains or exacerbates vulnerability to depression.” Constance Hammen, The Interactional Nature of Depression

37. Stress Generation Patterns • The presence of depression and/or anxiety seriously compromises these individuals’ stress coping resources. Minor aggravations become major problems. • Poor problem solving skills lead to poor choices, which aggravate negative circumstances. Hammen, Journal of Abnormal Psychology, 1991 Harkness & Luther, Journal of Abnormal Psychology,2001

38. The Foundation of Prevention is the Ability to Think Ahead Emphasize the Skill of Foresight

39. People say, “The future can’t be predicted” or “Life is what happens to you when you had other plans” or “Live for today” That’s global thinking, and it’s wrong!And, worst of all, it precludes learning to think preventively

40. Ways to Think Preventively!! • Teach impulse control and cause-effect thinking (foresight) • Acknowledge individual differences with respect and empathy • Generate multiple viewpoints (flexibility) • Accepting and utilizing one’s uniqueness • Stress management • Adapting to changing circumstances

41. HIGHLY RECOMMENDED SELF-HELP RESOURCES • Keys to Unlocking Depression (Yapko) • Depression is Contagious (Yapko) • Breaking the Patterns of Depression (Yapko) • Hand-Me-Down Blues (Yapko) • Focusing on Feeling Good CD Program(Yapko) • Calm Down! CD Program (Yapko) • Emotional Intelligence (Goleman) • Mind Over Mood (2nd ed.) (Greenberger & Padesky) • Feeling Good (Burns)

42. Please visit my website (www.yapko.com) to join my electronic mail list in order to receive my monthly newsletter

43. Thank you for your kind attention! Michael D. Yapko, Ph.D. E-mail: michael@yapko.com Website: www.yapko.com Address: P.O. Box 487 Fallbrook, CA. 92088-0487 USA