Social Cognition and Depression 4/4: Synthesis

Abstract:

The goal of this article is to summarize the past three blogs focused around depression and social cognition as well as include some of my critical insight on how we as a society could make things better for individuals suffering. Through exploring the theories, risk factors, and treatments associated with this mental disorder, I will attempt to determine potential relationships by creating a dialogue between the authors presented and my point of view. I will also be highlighting some of the possible treatments I want to see in the future, including some of the things I believe the fields of science could work towards on because of my personal experience and stakes in the issue. This topic is something I’ve become increasingly interested in, and feel strongly that with the collaboration of individuals from a multitude of backgrounds, we will be able to come up with a treatment schema that caters to the individuals specific needs, whatever mental disorder it may be, and treat an individual’s symptoms based on what works for them (environmentally and genetically).

A General Understanding:

A statement from one of the articles I posted in a previous blog looked at the effect of the severity of depression on social cognitive performance. It concluded that “Patients with major depressive disorder appear to interpret social, cognitive, and emotional stimuli differently compared to healthy controls: depressed individuals may interpret emotion through a mood-congruent bias and have difficulty with cognitive theory of mind tasks requiring interpretation of complex mental states. Social cognitive performance appears to be inversely associated with severity of depression, whilst the bias toward negative emotions persists even in remission. Some deficits may normalize following effective pharmacotherapy. These features seem to persist even in remission, although some may respond to intervention. Further research is required in this area to better understand the functional impact of these findings and the way in which targeted therapy could aid depressed individuals with social interactions” (Weightman et. Al, 2014).

If there is research that is suggesting that remission is a biological possibility with depression, how come the fluidity of treatment is not readily an option? With the advancement of technology and the apparent ubiquitous addiction we already have to our phones, how is there not a greater presence of real time counselors, psychiatrists, or even scholars that could aid us in in real time access to different aids as the symptoms show up? I cannot discredit the fact that in Alberta, our government has set up a hotline to give individuals access to nurses as well as a suicide hotline. But the way that society has already stigmatized mental health I feel like potential treatments are being severely overlooked.

Many, if not all individuals experiencing a form of depression would have engaged in a type of pharmacotherapy or are still currently taking a combination of antidepressants. And in out society, it seems like the balance has shifted away from one’s environment and focuses solely on biology. Speaking from experience, my doctor was very quick to medicate when I finally made the painful decision to talk to her about my experience with depression. She only took a brief history (from my account) and took no further tests to see if there were underlying issues or if it was something else. She also gave me a number for a counselling service to get in touch with (no specific individual) and sent me to the pharmacy. After a few awful months I chose to pull of myself off the meds and decided that other means was necessary if I was going to survive. I’m in no way saying that my case sets the precedence for all others. But, what I am trying to do is highlight that I don’t think my case is textbook (if there is such a thing) and believe that an individual’s environment needs to be considered when developing a strategy to tailor to their needs.

Finding Root Issues:

With there being so many contributing factors for depression, it’s sometimes hard to determine which variables are more important, but that very thought process that we look to for answers could be undermining our attempts all together. I feel like now, comorbidity is becoming common language when considering a treatment for a patient, but how we treat them hasn’t changed. Once again the fluidity of the disorder is recognized but not the treatment.

What I am trying to explain is that maybe we don’t need to change the specifics of the treatments, but how and when we administer them is what’s going to be the game changer when trying to figure out how to help people suffering. Even with the DSM being updated constantly, I think the main issue psychologists are missing is that they are literally trying to code an individual for an illness. Even if I have an identical twin, research shows that environment can have an impact on our genome, therefore making it different than anyone else in the rest of the world. How can we expect to treat individuals by putting them in categories when the very basis of our makeup determines that everything is circumstantial or variable!? I understand that it seems impossible to treat everyone specifically and it would be easier to bell curve or generalize treatments but by looking at the root causes of these issues we can find the answer.

A New Way To Look At Individuals With Disorders:

Through the continuing education and experience I’ve gained so far, I have come up with something I would like to see done when approaching mental illness in the future. An individual must be interested in a task if they want to accomplish it, and by getting a patient genuinely invested I believe we could see better outcomes of treatments presented in current research. To come up with this schema, I took an adaption of the models of learning (Huitt, 2003) and hypothesized that through the adaption of one’s behavioral, information processing, personal development, and social interaction systems, and gave potential treatments someone would want to engage in to cover each root issue an individual may be suffering with the overall idea of recognizing that the environment and biological makeup is imperative when considering treatments.

Behavioral Systems/Information Processing:

Theorists have proposed that depression is associated with abnormalities in the behavioral activation (BAS) and behavioral inhibition (BIS) systems. In particular, depressed individuals are hypothesized to exhibit deficient BAS and overactive BIS functioning. Self-reported levels of BAS and BIS were examined in 62 depressed participants and 27 non-depressed controls. Clinical functioning was assessed at intake and at 8-month follow-up. Relative to non-depressed controls, depressed participants reported lower BAS levels and higher BIS levels. Within the depressed group, lower BAS levels were associated with greater concurrent depression severity and predicted a worse 8-month outcome. Levels of both BIS and BAS showed considerable stability over time and clinical state. Overall, results suggested that BAS dysregulation exacerbates the presentation and course of depressive illness (Sutton & Davidson, 1997).

The general theme encompassing this article is that behavioral systems are altered by a potential mental illness and by treating the information processing centers, it could correct the negative cognitive behavioral thinking.

Treatments I recommend: CBT, mild antidepressants (pharmacotherapy), other psychotherapies.

Personal Development:

Aspects of personal development include: self-concept/esteem, self-direction/independence, creativity and curiosity.

An article I found talked about how retrieving problem-solving information from a human expert can be a major problem when building an expert system. Methods from George Kelly’s personal construct psychology have been incorporated into a computer program, the Expertise Transfer System, which interviews experts, and helps them construct, analyze, test and refine knowledge bases. Conflicts in the problem-solving methods of the expert may be enumerated and explored, and knowledge bases from several experts may be combined into one consultation system. Fast (one to two hour) expert system prototyping is possible with the use of the system, and knowledge bases may be constructed for various expert system tools (Boose, 1985).

This piece of research doesn’t suggest that personal development directly correlates with the success of treating a mental disorder, but it does note the issue that the proper development of  a system where efficiency is essential. Affect and emotion are imperative to building a base of who we and and the re-incorporation of the GxE theory and instant intervention by invested professionals will aid in that. 

Treatments I recommend: integration of a service animal, mindfulness-based cognitive therapy (MBCT), constant communication with experts in all fields and (what I want to see in the future) an app based technology that gives you access to doctors, psychiatrists, psychologists, as well as lifestyle coaches for diet and exercise.

Social Interaction:

The last aspect I adapted from the models of learning is social interaction (Huitt, 2003), and in my opinion, the most overlooked concept when treating mental illness. Social avoidance, social anxiety, the general fear of being judged or looked at, etc. Those are all things that contribute to the inability to function in a social situation normally, and are all things I sometimes can’t control. If I had the resources to combat that at an earlier age, I don’t think I’d experience the reoccurring symptoms as badly. I found an article that brought together recent findings from developmental science and cognitive neuroscience to argue that perception-action coupling constitutes the fundamental mechanisms of motor cognition. A variety of empirical evidence suggested that observed and executed actions were coded in a common cognitive and neural framework, enabling individuals to construct shared representations of self and other actions. They reviewed work to suggest that such shared representations supported action anticipation, organization, and imitation. Those processes, along with additional computational mechanisms for determining a sense of agency and behavioral regulation, forms the fabric of social interaction. In addition, humans possess the capacity to move beyond these basic aspects of action analysis to interpret behavior at a deeper level, an ability that may be outside the scope of the mirror system. Understanding the nature of shared representations from the vantage point of developmental/cognitive science and neuroscience has the potential to inform a range of motor and social processes. This perspective also elucidates intriguing new directions and research questions and generates hypotheses’ regarding the impact of early disorders on subsequent action processing (Sommerville & Decety, 2006).

I wanted to draw on this article because it highlights the importance of proper socialization via body language and motor skills. By giving an individual the concepts and skills to navigate social settings and more importantly, the ability to co-operate with others, it opens countless opportunities for individuals to seek other treatments that worked for people like them. It also creates the environment for an individual to understand different or outside perspectives so that they can come to the realization that they are not alone, on their own.

Treatments I recommend: Group therapy, interpersonal therapy (IPT), and (what I want to see in the future) camps, retreats, and community groups specifically designed to give individuals socialization and co-operation skills at any age, and medical THC (cause you sometimes need to chill out when you’re around a bunch of people).

Conclusion:

I understand that this was a long-winded blog compared to those past, but as I’ve said before, this is something near and dear to me and is something I have become quite passionate about. The one thing I can take away from my exploration of depression within the context of social cognition is: it’s not simple. There is no one answer, but if we had some sort of template like I recommended and focus on fixing root systems like behaviour/ information processing, personal development, and social interaction I infer it could bring better efficiency to treatments that we already have access to. If we are to transcend the current treatment process of categorizing individuals that are usually a case-by-case basis, we need to better understand the theories, risk factors, and treatments associated with mental illness and bring together all the fields of science through an unbiased lens so individuals may one day be able to live a life not having to worry that when an episode arises, they will have the tools and resources available to deal with it.

References:

Boose, J. H. (1985). A knowledge acquisition program for expert systems based on personal construct psychology. International Journal of Man-Machine Studies, 23(5), 495-525. doi:https://doi.org/10.1016/S0020-7373(85)80055-9

Huitt, W. (2003). Models of teaching/instruction. Educational Psychology Interactive. Valdosta, GA: Valdosta State University. Retrieved [date], from http://www.edpsycinteractive.org/topics/instruct/instmdls.html

Sommerville, J. A., & Decety, J. (2006). Weaving the fabric of social interaction: Articulating developmental psychology and cognitive neuroscience in the domain of motor cognition. Psychonomic Bulletin & Review, 13(2), 179-200. doi:10.3758/bf03193831

Sutton, S. K., & Davidson, R. J. (1997). Prefrontal Brain Asymmetry: A Biological Substrate of the Behavioral Approach and Inhibition Systems. Psychological Science, 8(3), 204-210. doi:10.1111/j.1467-9280.1997.tb00413.x

Weightman, M. J., Air, T. M., & Baune, B. T. (2014). A Review of the Role of Social Cognition in Major Depressive Disorder. Frontiers in Psychiatry, 5, 179. http://doi.org/10.3389/fpsyt.2014.00179

(Photo) The Violet Flame. (n.d.). Retrieved March 30, 2017, from https://www.google.ca/search?as_st=y&tbm=isch&hl=en&as_q=hope %2B understanding %2B knowledge&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=isz:l#imgrc=CRckQx3hhfe0QM:&spf=198