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Depression and PTSD
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In the last section, we discussed types of adaptation reactions
to trauma. Those
were emotional numbing, trigger avoidance, and hypervigilance.
As you are well aware, the most common psychiatric problem
in the United States today is depression. Studies show that at least 50 percent of clients
who suffer from PTSD also suffer from depression. Have you ever found,
like I have, that when a client undergoes severe traumatic exposure, depression
is a common side effect?
In this section, we will discuss depression and
its various manifestations when linked to PTSD: behavioral depression,
learned helplessness, repressed anger, and loss and grief. In
this section, we will examine PTSD related to sexual abuse and combat.
4 Manifestations of Depression linked to PTSD
♦ Manifestation #1 - Behavioral
The first type of depression in relation to PTSD is behavioral depression. As
you know, behavioral theory states that depression is the natural result of
inadequate reinforcement, inadequate rewards, or inadequate recognition. This kind of depression can
also occur when clients aren’t loved or supported enough by others or
survivors, those clients most in need of both, sometimes do not get the amount
of either love or support that they require.
Many times this may be
a recurring circumstance, yet other circumstances may be a direct result
of the nature of the client’s trauma.
Luanne had been raped by
her uncle at the age of 12. When Luanne promptly reported the uncle to
police, he was convicted and sent to prison. Although the prosecutor
had sufficient DNA evidence to support Luanne’s charge, her family refused
to believe her and shunned Luanne from all activities, gatherings, and vacations.
the love and support of her loved ones, Luanne quickly slipped down into depression.
of the level of love and support your PTSD client has received. Would this be
an appropriate topic in your next session, and how can they acquire this love
and support now?
♦ Manifestation #2 - Learned Helplessness
The second type of PTSD induced depression is as you know, learned
helplessness depression. The learned helplessness theory was
developed by Martin Seligman in 1975. Seligman administered electric
shock to animal subjects from which they could not escape.
the animals fought, tried to get away, and uttered cries of pain or anger. Then
they sank into listlessness and despair. Later on, in
a second set of experiments, the same animals were shocked
again. Only this time, by pressing a certain lever or
completing some other simple task, they could stop the electric
current, but they made no effort to do so.
results, Seligman concluded that the animals had learned to
be helpless. Even when a means of relief was
provided, they had become so set in their powerlessness or
so psychologically defeated that they would not or could not
end their own suffering. After being subjected to a traumatic experience
continuously, trauma survivors can also experience this state. Those
most at risk to contract this disorder are abused women and
children, prisoners of war, concentration or refugee camp survivors, and torture
Think of your chronically traumatized client. Could
he or she be suffering from learned helplessness?
♦ Manifestation #3 - Repressed Anger
In addition to behavioral depression and learned helplessness, a third type
of depression is repressed anger. This results from
a client’s hesitation or inability to express anger. Often, clients
may be afraid of being ostracized or looked down upon if they expose their
emotions. Once a client decides to repress his or her anger, he or
she turns that anger inward on themselves.
There are two groups of
trauma survivors that most frequently suffer from this suppression
(1) The first is a group in which anger was punished or
anger was used as punishment. For example, battered
wives and children will undergo this type of depression because they feel
that anger caused their suffering.
second type of PTSD clients who suffer depression as a result of repressed
anger are those clients who have no specific individual to unload
their anger onto. Survivors of Hurricane Katrina are an excellent example
of this group of people.
Many individuals who went through this natural
disaster have no one to specifically blame for their misfortunes,
except Mother Nature and in some cases the local or national government. However,
these groups are so broad and nonspecific that
any anger thrown at them would have little or no satisfying
effect. One of my clients, William, who was subjected to Vietnamese
torture stated, "Everybody was responsible but nobody was
♦ Manifestation #4 - Loss and Grief
A fourth cause of depression is the common loss
and grief depression. Almost without exception, clients who
survive trauma go through a stage of loss and grief. Sometimes, this
may be related to the death of a loved one, but most often,
it relates to an abstract concept such as trust, security,
patriotism, or self-worth. In all these cases, the client will
most likely go through a grieving period that could result
I find that if a client is indeed going through a grieving
period that has yielded to depression, it is important to understand just what
the client is grieving for. Many times, I have found that clients do
not understand grieving for emotional losses as well as physical losses.
age 17, had been sexually abused by her father at 14. For years, Margaret
had lived with this secret until she had tried to commit suicide earlier
that year. I believed that Margaret’s depression was a result of
her inability to grieve for the losses of her childhood. Margaret
stated, "Every day, I just get these incredibly strong emotions and I
don’t know where they’re coming from. I want to scream
it’s so bad."
♦ Technique: Listing Negative Feelings
To help Margaret begin her grieving process, I asked her to
list these negative feelings as they came upon her throughout
her day. The next session, Margaret had listed, "apprehensive," "embarrassed," "insecure," and "immature." I
asked Margaret what she thought of these emotions now that
she’d seen them on paper.
Margaret said, "They’re all
related to what happened with my dad. They’re
all a result of that." I asked her, "Do
you think that they could be a result of losses you experienced after the abuse? For
instance, the emotion ‘apprehensive’ could be
a loss of security. What do you think?" Margaret stated, "I
see what you’re saying. I think the feeling "immature" could
be, like, childhood, because I never had an adolescence."
As you can
see, Margaret had begun to understand the reasons behind her
overwhelming feelings and could now move on to the next stage of her grief.
In this section, we discussed depression and its various manifestations when
linked to PTSD: behavioral depression, learned helplessness,
repressed anger, and loss and grief.
In the next section, we will examine ways for a client to better
understand his or her emotions related to feeling awareness, thoughts
vs. feelings, and writing out the trauma.
Peer-Reviewed Journal Article References:
Chang, C., Kaczkurkin, A. N., McLean, C. P., & Foa, E. B. (2018). Emotion regulation is associated with PTSD and depression among female adolescent survivors of childhood sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 319–326.
Choi, K. W., Batchelder, A. W., Ehlinger, P. P., Safren, S. A., & O'Cleirigh, C. (2017). Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD, and sexual risk in sexual minority men with trauma histories. Journal of Consulting and Clinical Psychology, 85(12), 1158–1170.
DeCou, C. R., Mahoney, C. T., Kaplan, S. P., & Lynch, S. M. (2019). Coping self-efficacy and trauma-related shame mediate the association between negative social reactions to sexual assault and PTSD symptoms. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 51–54.
Khayyat-Abuaita, U., Paivio, S., Pascual-Leone, A., & Harrington, S. (2019). Emotional processing of trauma narratives is a predictor of outcome in emotion-focused therapy for complex trauma. Psychotherapy, 56(4), 526–536.
Keller, S. M., Feeny, N. C., & Zoellner, L. A. (2014). Depression sudden gains and transient depression spikes during treatment for PTSD. Journal of Consulting and Clinical Psychology, 82(1), 102–111.
What are three manifestations of depression in conjunction with PTSD?
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