A Neuropsychotherapy View of Depression

This short piece is intended to be a primer on the neurobiological underpinnings of depression and to give a neuropsychotherapeutic perspective on the disorder. Later on in this series we will go into more depth and detail on each of these brain regions, but for now here is a brief overview.There are four main brain areas that have been studies in relationship to depressive disorders and we will look at each of these and what part they play in depression.

 

1. PFC – The prefrontal cortex
2. ACC – The anterior cingulate cortex
3. The hippocampus
4. The amygdala

The Role of the Prefrontal Cortex in Depression

The prefrontal cortex (PFC) plays a vital role in the planning and pursuit of long-term goals and can maintain a focus and volition toward goals despite transient and/or short-term stimuli that may compete with such long-term goals. If we have a damaged PFC we may not have the ability to orient our behavior toward valued goals and can be left a victim of automatically responding to whatever is the current stimuli. Damasio (2000) describes Phineas Gage, who suffered major traumatic damage to his PFC at the age of 25, as one who not only had a major personality change, but as one who was unable to pursue goals or behave according to his own wishes.

The two halves of the PFC play different roles in guiding our behaviour based on our goals and values. The left PFC (lPFC) tends to operate along the lines of positive goals and emotions, whereas the right PFC (rPFC) has a bias toward negative emotions and avoidance goals (for a detailed study of the lateralization of the hemispheres, see McGilchrist, 2012). Some people have a tendency to be more lPFC activated and others more rPFC activated, thus manifesting a personality difference in pursuit of positive goals and generating positive emotions. Generally people will respond to stimuli and their circumstances with a bias to the right or left hemisphere depending on the context of the situation. A stable personality will be horizontally well integrated between the two hemispheres when dealing with life and pursuing goals.

In the case of a depressed individual the lPFC is underactive in an overall sense and in comparison to the rPFC. This lateral asymmetry is well documented (see Grawe, 2007, p.130) and accounts for the negative feelings and low volition for positive goal attainment in the depressed individual. Responsiveness to rewards, as opposed to punishment, is a function of the left medial region of the PFC, and with the lPFC underactive, there is less motivation for rewards. There have been studies showing depressed individuals responding to punishment but not to rewards (Henriques & Davidson, 2000), thus demonstrating the ineffectiveness of trying to establish positive goal attainment with the depressed client.

It has also been found that rPFC hyperactivity is linked to avoidance behaviors and negative emotions, and that this hyperactivity can be a global right-sided activation often associated with increased anxiety.

The depressed individual with an under activated PFC can have a reduced volume of PFC gray matter, likely due to underuse of the area. Both neurons and glia have been found to be less dense in the depressed PFC and suggest a lack of PFC structural requirements to perform the rational, motivating, positive goal pursuing tasks attributed to a healthy PFC (see Grawe, 2007. P.131 for statistics of PFC volume reduction). It would be unfair to expect a client to feel joy, and motivate themselves, if the neural underpinnings for such activity is severely degraded. There is something more fundamental that needs to be addressed, and restored in the capacity of the lPFC, before the depressed client can be expected to embrace positive motivations.

The Role of the Anterior Cingulate Cortex in Depression

The Anterior Cingulate Cortex (ACC) is consistently implicated in depressive disorders. The ACC can broadly be divided into two functional regions: 1) the rostral and ventral division involved with affect and autonomic function and connected with the hippocampus, amygdala, orbital prefrontal cortex, anterior insula, and nucleus accumbens; 2) a caudal division involved with cognitive processing and connected with the dorsal regions of the PFC, secondary motor cortex, and posterior cingulate cortex (Kandel, et al., 2012, p.1406).

The ACC is vital in monitoring inconsistency and conflict and mobilizes resources to attend to the conflict (like the executive functions of working memory and volitional effort). When a situation is encountered that is contrary to one’s wishes (including pain) then the ACC will recruit brain areas such as the PFC to resolve the situation and maintain desired goals.

In the case of depression the ACC is under-activated and the mobilization of volitional effort, for example, to change a situation from an undesirable direction is dampened. There is a typical resignation to circumstances and a passiveness and inability to cope with the demands of life.

Davidson et al. (2002b) proposes two subtypes of depression based on what we have discussed so far about the PFC and ACC:

1) ACC Subtype of Depression: Individuals with an underactive ACC and have resigned and lost the will to change.
2) PFC Subtype of Depression: Individuals who do experience a discrepancy between their state and the demands of the environment, but are unable to activate positive goal-oriented behaviour to effect change.

The Role of the Hippocampus in Depression

The hippocampus is part of the limbic system and is critical in consolidating short-term memory to long-term memory, contextualization, special memory and navigation. It contains a large number of glucocorticoid receptors, making it more vulnerable to long-term stress (chronically increased level of cortisol) than other brain regions.

The majorly depressed individual can have a volume reduction (between 8%-19%, see Campbell, et al., 2004; Davidson, et al., 2002a; Bidebech & Ravnkilde, 2004) of neurons and glia in the hippocampus. This hippocampal atrophy hinders the individual to place current events in context based on prior experience and thus impairs the cognitive ability to cope effectively with current challenges. The tendency to remember negative events and to interpret neutral or positive information as negative may be linked to hippocampal atrophy (see Gradin & Pomi, 2008, for an interesting neural network model).

The Role of the Amygdala in Depression

We know the amygdala as a primary center for anxiety as it performs it’s role of monitoring all incoming stimuli and evaluating that stimuli in terms of importance for the individuals motivational goals. If the stimuli are of high emotional/motivational value, then the amygdala ensures a higher level of cortical arousal and environmental monitoring.

With depressed individuals there is often increased activation of the amygdala as well as an increase in amygdala volume. It has been found that the degree of amygdala activation correlates with the severity of depression and that the amygdala may play an important role in the onset of depression. The heightened anxiety-readiness of the amygdala, particularly attuned to negative events, plays an important role in a bias toward storing negative memories and the tendency to ruminate and be preoccupied with negative thoughts.

As you can appreciate from the very brief outline above, mental disorders like depression have some serious neurobiological underpinnings that need to be addressed before the individual has the capacity to engage positive neural networks and resulting behaviour and emotions

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5 Personality Traits of Extroverts

 

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Do you love meeting new people? Does a big social event leave you feeling energized and renewed? If you can answer yes to these questions, then there is a possibility that you might just be an extrovert.

What is the origin of the term Extrovert?

It was Carl Jung who first popularized the concepts of introversion and extraversion while developing theories of human personality. The subsequent theories of personality, which basically revolve around these traits, include Cattell’s 16 personality factors, the four temperaments, the Big Five Personality traits, Eysenck’s three-factor model, Socionics, Myers Briggs Type Indicator, and Minnesota Multiphasic Personality Inventory. According to Carl Jung’s analytical psychology every person has both the traits of extroversion and introversion, the difference being that one of these personality traits may be more dominant in individuals. All the same people do not always behave according to their behavior type all the time.

What exactly is an extrovert? On the positive side, extroverts are often described as talkative, sociable, action-oriented, enthusiastic, friendly, and out-going. On the negative side, they are sometimes described as attention-seeking, easily distracted, and unable to spend time alone.

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Which Therapy is Best for Depression?

 

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Whatever the therapy happens to be called, therapy for depression must incorporate the following elements:

  1. A therapist who has an up-to-date and accurate clinical understanding of what depression is. (You can check this by learning yourself through the Depression Learning Path.
  2. A therapy which is time-limited, active and focused on learning skills, not personality change.
  3. There should be a significant improvement in symptoms within 6 sessions, and usually earlier.
  4. A therapist who you feel you can work with.

There are well over 400 different types of psychotherapy on offer for clinical depression. This can be confusing to say the least. Continue reading “Which Therapy is Best for Depression?”

Psychotherapy Guide for Generalized Anxiety Disorder

The Talking Cure”

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Psychotherapy is a popular form of treatment for generalized anxiety disorder(GAD). This type of treatment can be performed by a variety of mental health professionals. Though “talk therapies” share a number of features, different approaches are guided by differing theories and emphases.

Individuals with full-syndrome and sub-threshold GAD are likely to benefit from psychotherapy, which can be used as a standalone treatment or in conjunction withmedication.

The following is a brief description of the most popular talk therapy treatment methods for GAD.

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Why You Always Wake Up at the Same Time

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Have you ever wondered why you seem to wake up at nearly the same time every night or in the morning? Whether it is at 3 am, 4 am, 5 am, or another time—it occurs like clockwork. You might even wake up in the minute before your alarm clock is set to go off on a consistent basis. Why does this occur? Though some might ascribe this to causes that are paranormal, spiritual, or even related to shifts in the body’s energy systems, there may be more scientific explanations.

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How to Use Positive Affirmations to Manage Stress

 

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Positive affirmations are a great tool to reprogram your unconscious mind from negative thinking to positive. The idea is to take positive statements of what you would like to see manifested and repeat them enough so that they’re part of your way of thinking and seeing the world. This operates in the same way that negative self-talk does, but in a way that benefits you. To come up with your own positive affirmations, use the following guidelines:

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