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A Discussion of Psycho-immunity to Depression in relation to Reinforcement and Cognitive-Behavior Therapy

June 2nd, 2009 by Robert DePaolo | Posted in Psychotherapy | No Comments » | 3,294 views | Send article | Print this Article |


Abstract

Neurotransmission anomalies and reinforcement depletion are discussed as interchangeable antecedent mechanisms in depression. A possible augmentation to Cognitive-Behavior Therapy is presented in the form of an experience-extenuating life style resulting from a process of continued learning and self actualization

Neurotransmission anomalies and reinforcement depletion are discussed as interchangeable antecedent mechanisms in depression. A possible augmentation to Cognitive-Behavior Therapy is presented in the form of an experience-extenuating life style resulting from a process of continued learning and self actualization

Martin Seligman was among the first to discuss learned helplessness, which he believed was a crucial factor in the onset of depression (1965). He proposed that a historical disconnect between overt or covert behavior and reinforcement could lead to an enduring proneness to response suppression and his thesis was supported by subsequent research (Roth, 1980) He considered response suppression to be the operant correlate of depression and came to believe that a kind of psycho-inoculation against depression could be provided by affording young children clear and voluminous correlations between behavior and reinforcement at crucial phases of development (Seligman 1990).

This was one of the few attempts to advocate for preventative clinical psychology, but is is arguably a notion that, despite the subsequent efforts of wellness proponents such as MacCoun, (1998) and  Tobias (1984) has not yet come to fruition. Perhaps one reason is that medications have come along to provide a less costly and more immediate treatment for depression.

While the idea of reinforcing desired behavior has virtually inundated modern society, in the areas of sports, politics, child rearing and education, the argument has been made that its use as a comprehensive treatment method, and the implication that overt behavior is the source and essence of psychopathology, is on the wane (Kazdin 1980), (Dahlbom 1984), (Hawkins & Forsyth 1997).

Each school of thought has its day in the sun and the cognitive-behavioral approach is now in vogue. As with medication treatments, it tends to be brief, fairly effective and logical enough in its premises to court favor with agencies outside the mental health field. In many respects it is also easier to implement than, say, psychoanalysis, since its entails a dialectic (syllogistic) exchange with the client via a very streamlined and functional approach (Cohen, 1992). Much of the counselor’s focus revolves around the question of whether the client’s behaviors and suppositions work or don’t work.

Yet, cognitive-behavioral therapy argues implicitly for the importance of reinforcement, particularly with regard to depression. For example one sought-after therapeutic outcome is the adoption of successful behaviors by the client. Indeed, despite the language-based insights and cognitive restructuring that can derive from this method, that might be one of its most potent therapeutic features, (Ghafoon & Tracz 2001). The reason for his assertion is based on isomorphic neuro-chemical and behavioral factors that appear to be involved in certain types of depression.

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A Bridge Between Brain and Counseling

In some ways the neural and psychological foundations of depression are quite similar. The neurochemical model holds that neurotransmitters such as dopamine do not                                                                                                                                        pass fluidly through chemical receptors. In neuro-chemical terms, that leads to uptake, and in psychological terms, prevents the extenuation of experience in the brain. That ostensibly prevents psycho-emotional correlates of that extenuation (such as resilience, hope and perspective) from enabling the client to rise above his depressed mood. In other words, depression might be viewed as an attenuation of experience under duress (Dickens et. al 2003) that not only prevents hope from overriding despair but also, by virtue of its necessarily narrow focus and lack of neuro-experiential breadth, over-focuses on the client’s sadness and impoverished sense of self. It is a neuropsychological stoppage at a bad time and point in the client’s life.

Reinforcement provides a facilitative effect and neuro-conductive benefit similar to that of anti-depressive medications. For example, it has been established that when a behavior is followed by a reinforcer (or some feedback signifying a correct response) the learning and memory mechanisms resulting from that are represented in the brain by extenuation of nerve fibers and added neuro-chemical connections.(Yang & Wang, 2007), (Toni et al 2002), Greenenough et al (1993), Banich (1997). This suggests that learning in and of itself, particularly if if reflects personal growth and accomplishment, might provide a potential for perspective, hope and psychological resilience.

On the other hand if that were all there was to it, one might expect depression to subside whenever a client completes any task, provided behavior was followed by relevant reinforcement. That was one premise behind Seligman’s thesis and some research has shown that new learning per se can have a positive emotional effect on  mood. (Grieve et al 1994)

On the other hand it must be pointed out that while experience per se invariably alters neural interactions, the most significant neural extensions and chemical innervations typically occur with new learning. There would be no point in the brain wasting space and energy by establishing new pathway configurations for a task already learned, stored in memory and retrievable by the individual. In simpler terms, the growth and extension of brain cells will tend to have a reciprocal relationship to the growth and extension of the individual.

In that context, it is possible that a generative, anti-depressive effect on the brain, enhancing neuro-chemical transmission extenuating experience could result from implementation of a broad learning/personal expansion program revolving around changes in life style.

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Tweaking the Method

If extenuation could be facilitated by meaningful, personalized learning, then it is conceivable that the scope of cognitive-behavioral therapy could be to broadened to include not only logical and resolution but also resistance, psycho-immunity, wellness, prevention, and ultimately a curative life style.

It could be implemented by adding a growth component to therapy; for example by emphasizing to the client that logical conclusions about the sources of his emotional conflict and/or unsuccessful behavior and schemata might not be enough; that “cure” is bimodal and refers to both current resolution and future immunity to the disorder. In that context, clients could be prompted to explore new ideas and subject matter, test themselves, learn new tasks and skills, ponder esoteric or tantalizing ideas, write, explore, find new and challenging social outlets and immerse themselves in subject matter they find fascinating.

Such a combination of resolution/inoculation would make cognitive-behavioral therapy integrative, by combining the ideas of early and current proponents such as Albert Ellis, Max Maultsby and Arthur Freeman with the preventative concepts inherent in the work of Freud, Erikson, Rogers Adler and Seligman – all of whom believed that therapy which merely addresses present symptoms and attitudes might, absent a process of growth and self actualization, be in some cases insufficient.

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By Robert DePaolo
MS Clinical Psychology
Licensed School Psychologist
Licensed Clinical Mental Health Counselor

603 485 7566
robertde [at] surfglobal [dot] net

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