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An Integrated Cognitive Theory of Depression

Lincoln Pashute

cont.

Therapeutic Implications of Self-Comparisons Analysis

Now we may consider how one's mental apparatus may be manipulated so as to prevent the flow of negative self- comparisons which the person feels helpless to improve. Self- comparisons Analysis makes clear that many sorts of influences, perhaps in combination with each other, can produce persistent sadness. From this it follows that many sorts of interventions may be of help to a depression sufferer. That is, different causes call for different therapeutic interventions. Furthermore, there may be several sorts of intervention that can help any particular depression.

The possibilities include: changing the numerator in the Mood Ratio; changing the denominator; changing the dimensions upon which one compares oneself; making no comparisons at all; reducing one's sense of helplessness about changing the situation; and using one or more of one's most cherished values as an engine to propel the person out of depression. Sometimes a powerful way to break a logjam in one's thinking is to get rid of some "oughts" and "musts", and recognize that it is not necessary to make the negative comparisons that have been causing the sadness. Each of these modes of intervention includes a wide variety of specific tactics, of course, and each is briefly described in Appendix A to this paper. (The appendix is not intended for publication with this paper because of the limitations of space, but will be made available upon request. Longer descriptions are given in book form; Pashute, 1990).

In contrast, each of the contemporary "schools", as Beck (dustjacket of Klerman et. al., 1986.) and Klerman et. al. (1986, p. 5) call them, addresses one particular part of the depression system. Therefore, depending upon the "theoretical orientation and training of the psychotherapist, a variety of responses and recommendations would be likely...there is no consensus as to how best [to] regard the causes, prevention, and treatment of mental illnesses" (pp. 4, 5). Any "school" is therefore likely to achieve best results with people whose depression derives most sharply from the element in the cognitive system which that school focuses upon, but is likely to do less well with people whose problem is mainly with some other element in the system.

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More broadly, each of the various basic approaches to human nature -- psychoanalytic, behavioral, religious, and so on-- intervenes in its characteristic manner no matter what the cause of the person's depression, on the implicit assumption that all depressions are caused in the same way. Furthermore, practitioners of each viewpoint often insist that its way is the only true therapy even though, because "depression is almost certainly caused by different factors, there is no single best treatment for depression" (Greist and Jefferson, 1984, p. 72). As a practical matter, the depression sufferer faces a baffling array of potential treatments, and the choice is too often made simply on the basis of what is readily at hand.

Self-comparisons Analysis points a depression sufferer toward the most promising tactic to banish the particular person's depression. It first inquires why a person makes negative self-comparisons. Then in that light it develops ways of preventing the negative self-comparisons, rather than focusing on merely understanding and reliving the past, or on simply changing contemporary habits.

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