Transcript Identity Structure Analyses of Individuals with Clinical

Identity Structure
Analyses of
Individuals with
Clinical Depression &
Anxiety
Presented by
Alison McKenna BSc (Hons)
Identity, Depression & Anxiety
 Joiner, Coyne, & Blalock, 1999:3
By ignoring “the intricacies of depressed
persons’ involvement with other people” one
may “attribute to depressed persons
characteristics they do not possess” and
“leave significant aspects of their experience
unexplained.”
 ISA: self/identity distinction.
Depression & Anxiety
 Prolonged, unresolved periods of anxiety
often precede depressive episodes (Wolpe,
1971; Bittner et al, 2004).
 Sloman, Farvolden, Gilbert, & Price, 2006:98
“…[they] have complex and important coregulating influences on each other that may
explain [their] high comorbidity…”
Postulates Examined
 Participants’ biographical experiences within
their social milieu are likely to be reflected by
ISA through their modulation of identity
indices with significant others.
 The psychological processes underlying
comorbidity of depression and anxiety will be
elucidated
through
examination
of
participants’ identifications with others
across depressed and anxious selves.
Method
 Participants all had depressive disorder
and anxiety disorder.
 Semi-structured interview with each
participant.
 Customization of ISA Identity Instrument.
- Approx. 20 entities.
- Inclusion Criteria:
Participant’s testimony.
Investigation of a priori theoretically
derived postulates.
Entity List Excerpt
Me when I am going through a long lasting depression…
Me when I am feeling anxious…
Me when I am without depression…
Me when I am without anxiety…
A prejudiced person…
My friend as he was before suicide…
Method ctd.
-
-
Same 20 constructs for each participant.
Constructs included for the examination
of a priori theoretically derived
postulates.
Terminology influenced by testimony
given in interviews.
Construct List Excerpt
…wishes to keep to oneself
…wishes to enter fully into
relationships with others, with
minimal boundaries
…feels that doing something
well is the best way to help
depression
…feels that care and affection
from others is the most helpful
way to remove depression
…feels the world is full of
danger, which must be protected
against
…feels depression is rather
different from the feeling one
has after a death in the family
…feels the world is generally
safe and should be welcomed
…feels depression is very similar
to the feeling one has after a
death in the family
Method ctd.
 Participants were asked to complete both
their Identity Instrument as well as the
Depression Anxiety Stress Scale (Lovibond
& Lovibond, 1995).
Results
“Philip” – Biographical Factors
 Mixed anxiety & depressive disorder (F41.2).
 He had endured numerous prejudicial attacks.
 Nevertheless, he held strong aspirations
towards
positive
social
relationships
(SP=99.69).
 Depression likened to loss – related to loss of
relationships due to prejudicial encounters.
Results ctd.
“Philip” – Biographical Factors ctd.
 Idealized his “well” self states, thus
inducing the retaliations of others and
amplifying their prejudicial appraisals of
him.
Results ctd.
“Philip” - Comorbidity
 Anxiety
was
revealed
to
involve
engagement with the social world in spite
of problematic conflicted identifications
with others and high diffusion…
 …where conflicted idn refers to the
multiplicative function of one’s empathetic
idn with another and one’s contra-idn with
that other…
Results ctd.
“Philip” – Comorbidity ctd.
 …and diffusion refers to the overall
dispersion and magnitude of one’s
conflicted idns with others.
 Depression, on the other hand, was
entered as he endeavored to resolve his
conflicted idns with others through social
withdrawal.
Results ctd.
“Philip” – Comorbidity ctd.
 Vicious Cycle Maintaining Comorbidity:
Once in depression, attempts to relieve it
through re-engagement socially reinstates
problematic conflicted idns, high diffusion
and implicit anxiety.
 Thus, a vicious cycle ensues whereby
anxiety is traded off against depression
and vice versa.
Results ctd.
“Gordon” - Biographical Factors
 Recurrent Depressive Disorder (Current
Episode
Moderate)
(F33.1)
with
prominent anxiety symptoms.
 He had separated from his wife and had
lost a friend through suicide in recent
years, and had lost his job immediately
prior to his participation in the study.
Results ctd.
“Gordon” - Biographical Factors
 Strong aspirations towards feeling safe
and secure and having positive social
relationships.
 Defensively identified with his parents
when appraising his childhood self and,
more recently, with his wife.
Results ctd.
“Gordon” – Comorbidity
 The same psychological dynamic
where anxiety and depression interrelate within the person that was in
evidence for “Philip” resulted in
“Gordon’s” case.
Results ctd.
Contrasting case – “Nancy”
 Negative evaluations of others generally enabled
her to feel closer to them through illness.
 This tendency related to her early negative
experiences in the family context, where her
appraisals indicated a problematic relationship
with her then depressed parents which had
infiltrated her current idns with them.
 Her results showed a coalescence of the anxious
and depressive states in her mind, where on the
affective level they had merged into an unitary
state.
Conclusion
 ISA revealed diverse and complex
biographical and social factors feature in
the aetiology of clinical depression and
anxiety…
 …confirming the importance of examining
the intricacies of depressed persons’ social
involvement.
Conclusion ctd.
 Furthermore, ISA enabled the discovery of a
dynamic whereby anxiety and depression interrelate and co-regulate one another.
 Anxiety is experienced through social interaction
in spite of problematic conflicted idns with
others and high diffusion, and depression
enables partial resolution thereof, via social
withdrawal.
 A cyclical process ensues where the two may be
entered interchangeably.