Cognitive Behavioral and Psychodynamic Theories of Depression and Anxiety

We’ve seen now that these disorders have a root in our biology. How these factors can make us more prone to anxiety and depression. Our thoughts and behaviors can exacerbate, or even trigger these predispositions. To understand how this happens, we need to take a look at Behavioral Psychology. First, let’s look at Classical Conditioning.

Classical conditioning occurs when a person (for our purposes) experiences a neutral stimulus (no intention behind it) which elicits an autonomic response. This first stimulus will then be paired with a second stimulus and the person will be repeatedly exposed to both until the second stimulus can also produce the same autonomic response as the first stimulus. This SciShow Psych episode explains how initial fears are formed through classical conditioning (and other cognitive functions)

Second, let’s look at Operant Conditioning.

Operant conditioning occurs when a person does something willingly and then is either punished or rewarded for that action. Punishment and reward alike can have positive (something is given) or negative (something is removed) aspects. Operant conditioning follows through a number of brain regions like the hippocampus, amygdala, and the dopamine reward pathways.

Most learned behaviors will arise through operant conditioning.

In anxious people, it is theorized that they did not adequately learn how to handle stressors in their lives, and as such turned to maladaptive coping mechanisms such as avoidance coping. Avoidance behaviors such as not speaking in front of others, denying that something has occurred in thought or speech, performing rituals, or fantasizing, all play into operant conditioning. A stimulus occurs and is recognized as a stressor. The anxious person then attempts to “escape” the stressor by doing something that provides a feeling of relief and safety. This does two things: First, it tells your previously activated SNS that the stimulus is, in fact, something dangerous and possibly even lethal. (Even if it’s absolutely not.) This, in turn, will increase the sensitivity of the SNS to the stimuli, making you more afraid of it next time. Cuz you gotta stay “safe”. The second thing that occurs is that this escape behavior is now a part of a reward chain. The reward system is designed to activate when you do something that ensures your survival, and then inclines you to pursue the actions (or consumed items) that trigger it to further guarantee your survival. Both of these mechanisms can snowball until a debilitating disorder such as Agoraphobia, OCD, or addictions emerges. Escape behaviors can form into addictions, even if not of a chemical nature. Even if a debilitating disorder does not arise, this conditioning still contributes to the arising and matinence of Anxiety disorders.

In depressed patients, there are a few theories, in part because Depression arises somewhat uniquely to the individual.

One theory states that throughout childhood, (or other stages of life) one regularly receives a steady income of positive reward until something changes. This could be graduating and moving out or far away, the loss of those close to them, the loss of a job, a debilitating injury or so forth. The person is no longer able to receive the same amount or kind of positive reward they had come to rely on and also lack the skills to seek out new sources of reward. These could be making new friends, learning new skills and forming new hobbies, or succeeding in finding a new job.

The newly depressed person then withdraws, limiting their access to rewarding experiences even further, forming a self-perpetuating cycle.

Some depressed people suffer from a lack of problem-solving skills, and when are faced with nuanced problems, find themselves feeling helpless. Sometimes this helplessness is learned through conditioning, either on the part of the depressed person or through false beliefs they hear and believe.

What I believe to be the most tricky and complicated part is sympathy.

Yes, sympathy can be very terrible for those who’s behavior plays into their mood disorders.

It’s because sympathy feels very good. It’s nice- and very validating.

If your conditioning is out of whack, this is a disaster. This is because in a way, the disorder becomes a way to gain rewards. (Fun fact, there is a disorder called Facticious Disorder where people will fake an illness, possibly to receive some manner of aid and comfort. It’s more commonly known as Munchausen Syndrome. #it’scomplicated)

Lets say your depressive symptoms have hit you hard one day, and you simply don’t want to do any of your chores. You feel so tired already, and you imagine any effort will tire you further- if that’s even possible. Your partner, or roommate, feels sorry for you, and tells you to go lie down, they’ll take care of it today, and promises your favorite food for dinner to cheer you up.

Sounds lovely and kind, right? Indeed it does, but your learning centers just made the connection that if you behave a certain way, you get nice things. Maybe you don’t even have to feel that way to get the nice things! So perhaps you start spending more time in bed, sleeping more and doing less in general. Your life falls out of it’s cycle and this aggravates your condition- making the depression deeper.

The same can happen with anxiety. Very often after anxious episodes or full on panic attacks, those in our support network try to alleviate our distress by offering up sympathies, hugs, treats, activities they know we can enjoy stress free. Once again we are being rewarded for our disorder.

Not to say any of it is malicious- or that all of us do it consciously. (I do have my belief that it is conscious at least some of the time, and even when it is unconscious, I do believe we all have some inkling as to what’s happening- we just need to pay attention to ourselves.) But the lack of consciousness about the conditioning we take on can he dangerous. These conditioning loops can become as strong as certain addictions and are just as tough to break.

The best cure for behavioral problems lies in taking responsibility, and realizing that in this way, we create our own hells. It’s scary, and uncomfortable for sure. Some conversations with ourselves and others will need to be had. We may even need to request that our support people stop playing into the sympathy loops. Many of the dysfunctional behaviors we use play into short term reward and instant gratification. The uncomfortable cure is retraining our minds and bodies for the long term- the rest of the day, weeks, years, and our lives. Changing our daily habits so that instead of taking that nap and letting someone else take on the burden be our reward, finishing the project and having the satisfaction of doing the difficult thing be the reward. (And it wouldn’t hurt to make yourself your favorite food as another reward after finishing that project! I say food, but it could be anything you really love.)

On a more “thought centered” end, there are a few other theories surrounding the formation and matinence of mood disorders. Sigmund Freud theorized that children developed depression upon becoming angry with their parents, but the power differential prevented them from expressing their anger, so it turned inward, and they became angry with themselves instead. This resulted in the moodiness and lack of self worth, ability to care for themselves and feel pleasure. They were punishing themselves instead of their parents. While this certainly could be true for some depressed people, its certainly unlikely that it’s perfectly true for all patients.

Many people with mood disorders have been found to have missteps in their cognitive functioning. These can be faulty heuristics, leading to cognitive biases, and many fall prey to cognitive distortions. Summed up basically there is an issue with perception of the self and the world. Those with these disorders have a significant negative bias in their perceptual filters.

Many with reoccurring episodes of depression and anxiety have have faulty heuristics known as schemas. Dr. Jeff Young identified multiple faulty schemas (most often formed in childhood) in his repeat clients and formed what is now known as Schema Therapy to combat it.

I hope this post has been informative! Next time we’ll talk a bit more about cognitive behavioral therapies and bargaining with yourself to get the hard things done and hijack your conditioning to work for you in recovering from your disorder!

‘I wish I had known all this before,’ said Pippin. ‘I had no notion of what I was doing.’

‘Oh yes, you had,’ said Gandalf. ‘You knew you were behaving wrongly and foolishly;
and you told yourself so, though you did not listen.’

J. R. R. Tolkien, The Lord Of The Rings, The Two Towers

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