Depression: Two Types, Two Treatments

by: Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice)

We’re used to thinking about depression in terms of its symptoms: for example, depressed mood, inability to feel pleasure, sleep disruption, and loss of appetite, weight, and/or sexual desire, among others.

But, have you ever thought about there being two types of depression? 

Some mental health professionals have begun to focus not just on symptoms, but also on the everyday life experiences associated with depression: feelings of loss and of being abandoned and unloved on the one hand, and feelings of worthlessness, failure, and guilt on the other.

Based on these two different experiences related to depression, Sidney J. Blatt, a professor emeritus of psychiatry and psychology at Yale University’s Department of psychiatry, along with his colleagues, distinguished two types of depression.

One type of depression is the “relational” type, sometimes called the “anaclitic” version, from the Greek word for “to lean on.” Typically, this depression is characterized by feelings of loneliness, helplessness, and weakness, as well as intense and chronic fears of being abandoned and left unprotected and uncared for.

The other type of depression is the “self-critical” type, sometimes called the “introjective” type. Typically, it’s characterized by feelings of unworthiness, inferiority, failure, and guilt. Introjectively depressed individuals engage in harsh in scrutinizing and evaluating themselves. They have a persistent fear of criticism and of losing the approval of others.

Not only do these two types of depression reflect two different internal experiences of depression – “I’m empty, I’m hungry, I’m lonely, I need a connection” (relational) versus “I’m not good enough, I’m flawed, I’m self-indulgent, I’m evil” (self-critical) – they also indicate different therapeutic needs.

Research shows that those who are relationally depressed are more responsive to the supportive interpersonal or relationship aspects of therapy. In contrast, those who are introjectively depressed are more responsive to the interpretive or explorative elements of the treatment process. A mental health therapist who understands different types of depressive experiences can help a range of depressed individuals understand themselves better and also overcome the difficulties that come along with depression.

Psychotherapists at CFIR can support you to deal with your negative beliefs of self and other, and the relentless characteristics that might be at the root of your depression. We integrate cognitive-behavioral, mindfulness and acceptance and commitment, and psychodynamic-based approaches to help you deal with the thinking that might be contributing to your depressed moods.

Dr. Alexander Vasilovsky, C.Psych. (Supervised Practice) is a psychologist in supervised practice at the Centre for Interpersonal Relationships (CFIR) in Toronto. Dr. Vasilovksy works with adult and couple clients from an integrative therapeutic perspective, and helps them overcome difficulties related to depression and mood, anxiety and stress, trauma and PTSD, interpersonal conflict, major life transitions, and identify-related struggles.

What Kind of Role Does Emotional Intelligence Play?

 by: Dr. Meg Aston-Lebold, C.Psych

Intelligence has traditionally been defined as the ability to acquire and apply knowledge and skills. We often see it represented by an Intelligence Quotient (IQ) score. However, there is growing research indicating that emotions also play an influential role in learning. For centuries, philosophers have contemplated intelligence as more complex than cognitive capacity: 

“All learning has an emotional base.”

Plato

In response to this missing piece, the concept of Emotional Intelligence (EI) has been suggested as a complement to traditional IQ and, as such, has been affectionately dubbed EQ. While there is some controversy about how to measure EQ, it is commonly thought to describe a few key skills:

  • Emotional Awareness: the ability to recognize one’s own emotions and their impact on others.
  • Emotional Regulation: the ability to manage one’s own emotions, for example, by calming oneself down or cheering oneself up.
  • Empathy: the ability to recognize and respond to another person’s emotions.
  • Emotion Application: the ability to use one’s emotions to help guide tasks, such as thinking and problem-solving.

Well-developed emotional intelligence may lead to improved performance and satisfaction in a variety of life areas, including mood, self-confidence, and interpersonal relationships. Competence in emotional regulation allows people to remain calm and collected in stressful environments or situations and allows the brain to remain in a state conducive to effective problem-solving. 

In contrast, poorly developed emotional intelligence may lead to relationship dissatisfaction; general feelings of malaise or distress with seemingly no cause; as well as physical ailments like muscle aches, headaches and stomach/digestion discomfort that seem to have no medical basis.

While many of us may admit to the benefits of emotional intelligence in our relationships, we do not commonly value emotional intelligence in the workplace. This is a mistake. EQ competencies can help you approach an impending deadline with an organized plan, effectively respond to conflicts with co-workers or supervisors, and figure out how to get people on your side, whether that’s by motivating workers or getting buy-in from new clients. 

Without effective EQ at work, you may find yourself blaming others, lashing out, or having difficulty asserting yourself. This could potentially lead to negative consequences for yourself or others.

We are not born with EQ and, while these skills may come more naturally to some, we all must learn how to understand and respond to our own and others’ emotions. But since emotions aren’t part of the traditional school curriculum, how do we figure it out? In ideal circumstances, we learn emotional intelligence from significant adult role models in our early years. 

Unfortunately, not everyone grows up in an ideal environment where their caregivers have their own well-developed EQ. As a result, emotional intelligence often gets stunted, leaving the individual unable to articulate feelings, easily overwhelmed, unable to trust their gut, or wondering why their relationships remain shallow and unfulfilling. 

Psychotherapy can help you learn to recognize, make sense of, and respond to your emotional needs. By exploring your inner world, you can feel more competent responding to challenging interpersonal interactions, managing your stress, and obtain the healthy and satisfying relationships that you may have struggled with. These skills will help you both personally and professionally. Becoming more emotionally competent will help get you out of that rut by improving your mood and relationships, which can ultimately lead to greater productivity and success in all areas of your life.

Dr. Meg Aston-Lebold, C.Psych. is a clinical psychologist at the Centre for Interpersonal Relationships (CFIR) in Toronto. She provides psychological assessment and treatment services to adults and couples experiencing a wide range of issues related to depression, anxiety and stress, self-esteem, trauma, and relationships.

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