Interpersonal theory of depression

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Interpersonal theory of depression

depression is a common and debilitating mental disorder that affects millions of people worldwide. One of the most influential frameworks for understanding the interpersonal aspects of depression is the interpersonal theory of depression, which was proposed by Coyne (1976). According to this theory, depressed individuals tend to engage in excessive reassurance-seeking (ERS), which is defined as repetitively asking for assurances from close others about one’s lovability and worth. ERS is a maladaptive coping strategy that reflects low self-esteem and doubts about the stability and predictability of relationships. ERS can elicit negative reactions from others, such as annoyance, frustration, and rejection, which can further worsen the depressed person’s mood and interpersonal problems. In this article, we will review the main concepts, empirical evidence, and benefits and challenges of the interpersonal theory of depression.

What is the interpersonal theory of depression?

The interpersonal theory of depression is a psychological framework that explains how depression can arise from disruptions in social relationships and interactions. According to this theory, depression is influenced by four main factors: interpersonal loss, interpersonal role dispute, interpersonal role transition, and interpersonal deficits. Interpersonal loss refers to the experience of losing a significant person or a source of social support, such as through death, divorce, or relocation. Interpersonal role dispute occurs when there is a conflict or mismatch between the expectations and behaviours of two or more people in a relationship, such as a spouse, a friend, or a coworker. Interpersonal role transition involves the difficulty of adapting to a change in one’s social role or status, such as becoming a parent, retiring, or starting a new job. interpersonal deficits refer to the lack of social skills or resources that hinder one’s ability to form and maintain satisfying relationships with others. These factors can trigger or worsen depressive symptoms by affecting one’s self-esteem, mood, motivation, and coping strategies.

How does it explain the causes and maintenance of depression?

The interpersonal theory of depression is a psychological framework that explains how depression is influenced by the quality and nature of one’s social interactions. According to this theory, depressed individuals tend to engage in excessive reassurance-seeking (ERS), which means that they repeatedly ask for validation and support from others about their self-worth and lovability. However, this behaviour often leads to rejection and frustration from others, who may perceive the depressed person as needy, insecure, or demanding. This in turn worsens the depressed person’s mood and self-esteem, creating a vicious cycle of depression and interpersonal problems.

The interpersonal theory of depression also suggests that depression can be triggered or maintained by negative life events that affect one’s social relationships, such as loss, conflict, role transition, or isolation. These events can disrupt one’s sense of belonging, attachment, and intimacy with others, and may also challenge one’s identity and expectations. The theory proposes that by addressing these interpersonal issues and improving one’s communication and coping skills, one can reduce depressive symptoms and enhance social support.

What are the main assumptions and components of the theory?

According to the theory, depressed people tend to seek excessive reassurance from others about their worth and lovability, but they also doubt the sincerity of the feedback they receive. This leads to a cycle of rejection and isolation that worsens their depression. The interpersonal theory of depression also identifies four main types of interpersonal problems that can trigger or maintain depression: grief, role disputes, role transitions, and interpersonal deficits. The theory suggests that by addressing these interpersonal issues, depression can be alleviated or prevented.

How do interpersonal relationships affect mood and well-being?

Interpersonal relationships are the connections and interactions we have with other people in our lives. They can be positive or negative, supportive or stressful, fulfilling or frustrating. Interpersonal relationships can have a significant impact on our mood and wellbeing, as they influence our emotions, thoughts, behaviours, and health.

One way that interpersonal relationships affect mood and well-being is through social support. Social support is the perception or reality that we have people who care about us, listen to us, help us, and provide us with a sense of belonging. Social support can buffer us from the effects of stress, enhance our self-esteem, and promote positive emotions such as happiness, gratitude, and optimism. It can also help us cope with challenges, such as illness, loss, or trauma.

Another way that interpersonal relationships affect mood and wellbeing is through social comparison. Social comparison is the process of evaluating ourselves in relation to others, based on attributes such as appearance, abilities, achievements, or status. It can be upward or downward, meaning that we compare ourselves to people who are better or worse than us in some aspect. Social comparison can have positive or negative effects on our mood and wellbeing, depending on how we interpret and respond to the comparison. For example, upward social comparison can inspire us to improve ourselves or make us feel inadequate and envious. Downward social comparison can boost our self-esteem or make us feel guilty and complacent.

A third way that interpersonal relationships affect mood and well-being is through social influence. This is the change in our attitudes, beliefs, or behaviours that results from the presence or actions of others. Social influence can be direct or indirect, conscious or unconscious, intentional or unintentional. Social influence can have beneficial or detrimental effects on our mood and wellbeing, depending on the source and nature of the influence. For instance, social influence can motivate us to adopt healthy habits or pressure us to conform to unhealthy norms.

In conclusion, interpersonal relationships are an important factor in shaping our mood and well-being. They can provide us with social support, social comparison, and social influence, which can have positive or negative consequences for our psychological and physical health. Therefore, it is essential to cultivate and maintain healthy interpersonal relationships that enhance our well-being and happiness.

What are the four interpersonal problem areas that can trigger or maintain depression?

According to IPT, there are four main interpersonal problem areas that can trigger or maintain depression. They are:

• Grief or complicated bereavement: This occurs when a person experiences a loss of a loved one and has trouble adjusting to the change. It can involve feelings of sadness, anger, guilt, loneliness and hopelessness.
• role dispute: This occurs when a person has conflicting expectations or demands with someone close to them, such as a spouse, parent, friend or coworker. It can involve feelings of resentment, frustration, disappointment and dissatisfaction.
• role transition: This occurs when a person faces a major change in their life role, such as becoming a parent, getting married, retiring, moving or losing a job. It can involve feelings of anxiety, uncertainty, insecurity and loss of identity.
• interpersonal deficits: This occurs when a person has chronic problems in forming and maintaining satisfying relationships with others. It can involve feelings of isolation, alienation, rejection and low self-esteem.

IPT helps patients identify which problem area is most relevant to their depression and work on resolving it through specific strategies such as expressing emotions, communicating needs, negotiating conflicts, adjusting to changes and enhancing social skills. IPT also helps patients understand how their depression affects their relationships and vice versa, and how they can break the vicious cycle of interpersonal distress and depressive symptoms.

How do interpersonal factors interact with biological and psychological factors in depression?

Interpersonal factors can interact with biological and psychological factors in depression in several ways. For example, interpersonal factors can trigger or worsen depression by causing stress, conflict, isolation, rejection, abuse or loss. Interpersonal factors can also buffer or protect against depression by providing support, comfort, validation, belonging or meaning. Interpersonal factors can also influence the treatment and recovery of depression by affecting the availability and quality of professional help, social support and self-care.

Biological and psychological factors can also interact with interpersonal factors in depression in several ways. For example, biological factors can affect how a person perceives and responds to interpersonal situations by modulating their mood, energy, motivation and cognition. Biological factors can also be influenced by interpersonal situations by altering their gene expression, hormone levels, inflammation and neuroplasticity. Psychological factors can affect how a person interprets and copes with interpersonal situations by shaping their self-esteem, attribution style, coping skills and resilience. Psychological factors can also be influenced by interpersonal situations by changing their schemas, expectations, appraisals and emotions.

What is interpersonal psychotherapy (IPT)?

Interpersonal psychotherapy (IPT) is a form of psychotherapy that focuses on improving the quality of a person’s relationships and social functioning. IPT is based on the idea that interpersonal problems can trigger or worsen psychological distress, such as depression and anxiety. It aims to help people identify and resolve these problems, and to develop more adaptive ways of relating to others. IPT typically involves 12 to 16 weekly sessions, in which the therapist and the client work together to explore the client’s interpersonal issues, such as grief, role transitions, interpersonal disputes, or social isolation. The therapist helps the client to understand how these issues affect their mood and behaviour, and to develop strategies to cope with them more effectively. IPT can be used as a standalone treatment or with medication or other forms of therapy.

How does IPT help depressed patients improve their interpersonal functioning and mood?

Some of the common interpersonal problems that IPT targets are:

• Adjustment difficulties: coping with stressful life changes, such as moving, job loss, divorce, or illness.
• role transition: adapting to new roles or expectations, such as becoming a parent, getting married, retiring, or starting a new career.
• role dispute: managing conflicts or disagreements with significant others, such as spouses, partners, friends, or co-workers.
• interpersonal deficit: overcoming social isolation or loneliness, developing new relationships, or improving existing ones.

IPT has been shown to be an effective treatment for depression in various settings and populations. Several studies have found that IPT is as effective as antidepressant medication or cognitive-behavioural therapy (CBT) for mild to moderate forms of depression. IPT can also be combined with medication for more severe cases of depression or for patients who do not respond well to either treatment alone. IPT has also been adapted for different groups of people who may have specific needs or issues related to their depression, such as adolescents, older adults, pregnant women, or people with chronic illnesses.

What is the evidence for the effectiveness of IPT?

Interpersonal psychotherapy (IPT) is a time-limited, evidence-based treatment that focuses on improving interpersonal functioning and reducing psychological distress. IPT has been shown to be effective for a range of mental health conditions, such as depression, anxiety, eating disorders, and post-traumatic stress disorder. The evidence for the effectiveness of IPT comes from various sources, such as randomized controlled trials, meta-analyses, systematic reviews, and clinical guidelines. Some of the main findings from these sources are:

• IPT is as effective as cognitive-behavioural therapy (CBT) and other psychological treatments for depression, and may have some advantages over CBT in terms of relapse prevention and interpersonal outcomes (Cuijpers et al., 2016; de Mello et al., 2005; Lemmens et al., 2019).
• IPT is effective for treating anxiety disorders, such as social anxiety disorder, panic disorder, and generalized anxiety disorder, and may be superior to CBT for some subgroups of patients (Cuijpers et al., 2014; Markowitz et al., 2014; Milrod et al., 2015).
• It is effective for treating eating disorders, such as bulimia nervosa and binge-eating disorder, and may be more acceptable and feasible than CBT for some patients (Fairburn et al., 2009; Hilbert et al., 2014; Wilson et al., 2007).
• IPT is effective for treating post-traumatic stress disorder (PTSD), especially when combined with trauma-focused interventions, such as prolonged exposure or eye movement desensitization and reprocessing (EMDR) (Bisson et al., 2013; Markowitz et al., 2015; Schnurr et al., 2007).

These findings suggest that IPT is a versatile and efficacious treatment that can be applied to various mental health problems and populations. IPT is also compatible with other interventions, such as pharmacotherapy, and can be delivered in different formats, such as individual, group, or online therapy. It is based on a solid theoretical framework that emphasizes the role of interpersonal relationships in psychological wellbeing and distress. It also aims to help patients identify and resolve interpersonal difficulties that may contribute to or maintain their symptoms, such as role transitions, interpersonal disputes, grief, or social isolation. IPT also helps patients develop interpersonal skills and strategies to cope with stressors and enhance their social support network. By doing so, IPT fosters positive changes in patients’ interpersonal functioning and psychological state.

How can interpersonal theory and therapy be adapted to different populations and settings?

Interpersonal theory and therapy are based on the premise that human relationships are the primary source of psychological well-being and distress. According to this approach, interpersonal problems can be understood and resolved by identifying and modifying the maladaptive patterns of relating to others that stem from early attachment experiences, personality traits, and situational factors. Interpersonal theory and therapy can be adapted to different populations and settings by considering the specific needs, preferences, and cultural backgrounds of the clients, as well as the goals and resources of the service providers. Some examples of adaptations are:

• Using culturally sensitive assessment tools and interventions that respect the values, beliefs, and norms of the clients and their communities.
• Incorporating elements of other evidence-based therapies that target specific symptoms or disorders, such as cognitive-behavioural therapy for depression or anxiety, dialectical behaviour therapy for borderline personality disorder, or trauma-focused therapy for post-traumatic stress disorder.
• Modifying the frequency, duration, and format of the sessions according to the availability and accessibility of the clients and the therapists. For instance, some clients may benefit from more intensive or longer-term therapy, while others may prefer shorter or less frequent sessions. Some clients may prefer individual therapy, while others may benefit from group or family therapy. Some clients may prefer face-to-face sessions, while others may opt for online or phone sessions.
  – Collaborating with other professionals and agencies that provide complementary services to the clients, such as psychiatrists, social workers, case managers, or community organizations. This can help to coordinate care, enhance support, and address the multiple needs of the clients.

What are some of the limitations and challenges of interpersonal theory and therapy?

Interpersonal theory and therapy are based on the premise that human well-being and mental health are influenced by the quality of one’s relationships and social interactions. However, this approach also faces some limitations and challenges, such as:

• It may not be suitable for clients who have severe cognitive impairments, psychotic symptoms, or personality disorders that hinder their ability to form and maintain meaningful connections with others.
• It may not address the underlying causes of some mood disorders, such as biological factors, genetic predispositions, or traumatic experiences that are not related to interpersonal issues.
• Furthermore, it may not be effective for clients who are reluctant to change their interpersonal patterns or who have unrealistic expectations about their relationships.
• It may require more training and supervision for therapists to master the skills and techniques of IPT, such as conducting interpersonal inventories, identifying problem areas, and providing feedback and guidance.
• It may not be widely available or accessible for clients who live in remote areas, have limited resources, or face cultural or linguistic barriers.

These limitations and challenges suggest that interpersonal theory and therapy are not a panacea for all mental health problems, but rather a useful and evidence-based option that can benefit many clients who struggle with depression and other mood disorders.

Further reading

If you are interested in learning more about the interpersonal theory of depression, here are some weblinks for further reading:

Interpersonal Theory of Depression – an overview | ScienceDirect Topics
https://www.sciencedirect.com/topics/psychology/interpersonal-theory-of-depression

Interpersonal Psychotherapy for depression – American Psychological Association
https://www.apa.org/PTSD-guideline/treatments/interpersonal-psychotherapy

Interpersonal and Social Rhythm Therapy for Bipolar Disorder – Verywell Mind
https://www.verywellmind.com/interpersonal-and-social-rhythm-therapy-for-bipolar-disorder-380313

The Interpersonal Theory of Suicide – The Jed Foundation
https://www.jedfoundation.org/the-interpersonal-theory-of-suicide/

Interpersonal Psychotherapy: An overview – MJA
https://www.mja.com.au/journal/2007/187/7/interpersonal-psychotherapy-overview