"Sad is How I Am!" Treating Dysthymia in Children and Adults

As you are aware, the title of this home study course is "Sad is How I Am! Treating Dysthymia in Children and Adults." On this track, we will discuss the difference between sadness and depression, Thought Distortions, and Handcuffed Depression.

According to the DSM, a dysthymic disorder is a type of depression that is not severe enough to be called a Major Depressive Episode. A Dysthymic Disorder lasts much longer than Major Depressive Disorder, and there are no high phases. For purposes of brevity of terminology in this home study course, however, I will use the terms dysthymia and depression interchangeably.

To make sure we are on the same page, so to speak, a dysthymic disorder is characterized by sadness, pessimism, dysomnia (dis-som-nee-a) or sleep disorder, poor appetite or overeating, and so on. Symptoms occur most of each day, most days for an extended period of time.

3 Differences Between Sadness and Depression
What do you feel is the difference between sadness and depression? Here are my ideas; see how they compare with yours.

--First, I feel sadness is a normal emotion created by perceptions of a situation. With sadness, your client describes an event involving loss or disappointment in usually an undistorted way. Thus, I feel, sadness oftentimes comes without distortion, for example it comes without catastrophic thinking.
-- Second, sadness involves a flow of feeling, and therefore, it is time limited.
-- Third, sadness does not involve a lessening of self-esteem.

Do you agree with these three ideas concerning the differences between sadness versus depression? If not, turn the CD player off and derive criteria that is more meaningful to you.

Regarding depression, just to make sure we're on the same page, I define depression as an illness that results from thoughts that are distorted in some way. According to the National Institute of Health, major depression is the leading cause of disability in the United States. Depression affects almost 10% of the population, or 18 to 19 million Americans in a given year.

Thought Distortions
An example of a thought distortion that differentiates depression from sadness would be your client uses all or nothing thinking and states, "I'll never be happy again." This concept of distorted thinking that accompanies depression brings me to the title of this home study course, "Sad is How I Am." Think about this phrase, "Sad is How I Am." Now think about a client you are treating or have treated with a Dysthymic Disorder or perhaps a Major Depressive Episode. Do you agree that to your client, their depression seems frozen? By frozen I mean it tends to persist or reoccur indefinitely. Also, unlike sadness, depression involves loss of self esteem.

Handcuffed Depression
One aspect of being frozen in depression is, as you know, difficulty in making decisions. I like to think of this difficulty in making decisions as Handcuffed Depression. Perhaps you have heard this term before. Think of a depressed client you are treating who feels constantly faced with decisions they cannot resolve. Do they feel confused? Overwhelmed? Do they repeatedly vacillate between choices?

Freud's 3 Kinds of Ambivalence:
-- One type of ambivalence was emotional oscillation between love and hate.
-- The second type of ambivalence was voluntary inability to decide on an action.
-- The third type of ambivalence was an intellectual belief in contradictory propositions.

So what does all this mean to the depressed client you are currently treating? I like to boil all of this down into the concept I mentioned earlier, the concept of Handcuffed Depression. I like the term Handcuffed Depression, because it creates a visualization which describes the depressed client's inability to make decisions.

As I describe three interventions on the next track regarding handcuffed depression, think of a client you are treating who feels frozen or handcuffed into depression because, as the title of this course states "Sad is How I Am" or rather "sad is how they are." Sadness appears to your client as being a state or condition that is beyond their control.

Thus, as you will see on track two with Alison her depression held her captive and frozen in indecision.

Peer-Reviewed Journal Article References:
Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31(1), 52–72. 

Keen, E. (2011). Emotional narratives: Depression as sadness—Anxiety as fear. The Humanistic Psychologist, 39(1), 66–70.

Rutter, M. (1982). Review of Loss: Sadness and depression—Attachment and loss, Vol. 3 [Review of the book Loss: Sadness and depression—attachment and loss, vol. Iii, by J. Bowlby]. American Journal of Orthopsychiatry, 52(1), 176–177.

Online Continuing Education QUESTION 1
What are Freud's three states of ambivalence? To select and enter your answer go to CEU Test.