Anxiety Depression

A Case Study (Part 4): Treating Comorbid Post-traumatic stress disorder, Generalized anxiety disorder and Depression, an Integrative Approach

As previously discussed, the development of major depressive disorder will resemble that of an anxiety disorder, in that there will be self-talk that will reinforce negative core beliefs and assumptions, there will be a behavioral component that will also reinforce depression, and a biological component that also plays a significant role (Beck, 1976; Bourne, 2005; Burns, 1999; Leahy & Holland, 2000; Sadock & Sadock, 2007).


Core beliefs generate the typical patterns of self-talk (The victim) and underlying assumptions associated to depression (Bourne, 2005; Leahy & Holland, 2000). The victim: promotes depression by making you feel helpless or hopeless; tells you that you’re not progressing; believes there is something defective about you; perceives insurmountable obstacles to your success; believes nothing will ever change (Bourne, 2005). Behaviourally, depressed individuals may start victimizing through complaints which at first rewards them with reassurance from others, though eventually, others may begin to reject them due to continued complaints. This may result in the depressed individuals isolating themselves thus further reinforcing their negative core beliefs and ultimately their depression (Leahy & Holland, 2000).



Some cognitive symptoms associated to depression are: feelings of hopelessness, helplessness, guilt, anger and worthlessness, also common to PTSD (Leahy & Holland, 2000). Some affective symptoms associated to depression are: depressed mood, anhedonia, and low motivation (Leahy & Holland, 2000). Some vegetative symptoms which are characteristic of depression are: low energy, fatigue, and psychomotor agitation or retardation (Leahy & Holland, 2000). Diminished interest in usual activities, sleeping difficulty (vegetative symptoms), restricted affect, irritable mood (affective symptoms), memory impairment and Difficulty concentrating (cognitive symptoms), are depressive symptoms that are also common to PTSD (Hansen et al., 2010). Some of the key behavioral factors associated to depression are: social isolation, inactivity, and lack of self-reward (Leahy & Holland, 2000). Some key behavioral deficits typical of depression are: lack of social skills, lack of assertiveness, and lack of rewards form others (Leahy & Holland, 2000). Some key behavioral excesses of depression are: complaining, negative or punitive behavior towards others, and self-criticism (Leahy & Holland, 2000). Also, suicidal ideation or thoughts about death are key features of depression and must always be assessed for (Leahy & Holland, 2000).

Stay tuned for Part 5 !

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