Influence Of Psychotherapy And Gender On Depression

2.0. THEORETICAL REVIEW
Depression is a common and important cause of mobility and mortality worldwide. Although effective pharmacological interventions are available, much depression remains inadequately treated. Compliance with antidepressant treatment is often poor: studies have shown that between 20% and 59% of patients in primary care stop taking antidepressants within three weeks of the drugs being prescribed. The effect of exercise on depression has been the subject of research for several decades, and the literature on the subject is growing. In the past decade “exercise on prescription” schemes have become popular in primary care in the United Kingdom, many of which include depression as a referral criterion.
Several plausible mechanisms for how exercise affects depression have been proposed. In the developed world taking regular exercise is seen as a virtue; the depressed patient who takes regular exercise may, as a result, get positive feedback from other people and an increased sense of self worth. Exercise may act as a diversion from negative thoughts, and the mastery of a new skill may be important. Social contact may be an important mechanism, and physical activity may have physiological effects such as changes in endorphin and monoamine concentrations. 

Exercise has been shown too improve mood and to reduce anxiety in healthy people. These findings have led to a growing interest in the effects of physical activity in patients with affective disorders. However, although exercise is often used as an additional treatment for depression, scientific evidence about the effects of this intervention is lacking. Although two meta-analyses suggested that exercise may be as effective as psychotherapy as and more effective than other behavioural interventions for the treating depression, a meta-analysis could not determine the effects of exercise on depression because of a lack of good-quality research on clinical populations.
A growing body of evidence shows that regular physical activity results in functional and morphemically adaptations in the brain. Exercise increases the expression of growth factors (insulin like growth factor-1, nerve growth factor and brain-derived neurotrophic factor), which trigger the production of proteins of signal transduction cascades associated with memory processes. Indeed, research in synaptic connections and the development of new neurons.
These processes may result in a higher efficiency, plasticity and adaptability of the brain. Several randomized controlled trials have shown that physical activity improves the mood of patients with mild to moderate depression after several weeks. However, experiments in animals indicate that even a single exercise bout generates considerable changes in the brain concentration of neurotransmitters involved in the pathophysiology of depression. We have previously reported that exercise may improve the mood of patients undergoing bone marrow transplantation or with therapy-resistant depression in a short time. The results of a trial suggest that even a single exercise both may improve the mood of patients with clinical depression.

Further, two randomized controlled trials showed an association between exercise amount and duration, and reduction of symptoms in patients with depression. Finally, a recent study provided evidence for exercise as a possible for patients with poor response to antidepressant drugs. These findings could be of clinical relevance, as about 30% of patients do not respond to conventional pharmacotherapy, and antidepressants require 1-4 weeks before they show any therapeutic effect. The introduction of exercise programmes in the early treatment of depression could help reduce the duration of therapeutic latency. However, there is a lack of information about the possibilities and mechanisms of action of diverse exercise programmes in patients with depression in different settings. In the present study, we evaluated the effect of a short-time exercise programme as adjuvant treatment on patient with major depression undergoing standard clinical antidepressant drug treatment.
Defining self-talk, self-concepts and self-esteem  Burnet (1996) noted that confusion exists in the literature as to what terminology should be used to describe the self-talk phenomena and how it should be defined. Synonymous terms used in the literature include self-statements, inner speech, private speech, inner dialogue, internal dialogue, positive self-referent, verbal statements, verbal self-regulation, speech-to-self, self directed speech, destructive dialogue, self-cognition, private self talk, adaptive self-talk, positive self-talk and negative self-talk. Self talk is defined as what people say to themselves with particular

emphasis on the words used to express thoughts and beliefs about oneself and the world to oneself. Self-talk can be positive, indicating a positive self-enhancing disposition or negative, indicating a critical self-defeating outlook. Some definitional confusion also surrounds the use of self-concept and self-esteem despite the huge amount of research that has been undertaken using these constructs. Burnet (1993) investigated the definitional issues associated with the two constructs and found little empirical support for the traditional definition of self-concept in descriptive terms and self esteem in evaluative terms. However, empirical support for an alternative conceptualization was found (Burnett 1994) and formed the basis for the following definition used in this study. Self-concept was defined as the descriptive and evaluative beliefs that a person holds about multidimensional characteristics of the self, while self esteem is believed to be synonymous with global or general self concept and is defined as the thought and feelings that a person has about him or herself as a person.

Statement by Other Significant and Self-Perceptions Four sources of significant others have been identified by Harter (1985) as being parents, teacher, classmates and close friends. Juhasz (1989) examined the importance of the type of significant other, using self-report to open questions and found that 5th and 6th graders rank order of importance was mother, father, siblings, and friends. However in the 7th and 8th grade, friends become more important and for university freshmen, teachers were high with friends and parents equal. There is evidence that indicates that verbal abuse (negative statements by significant others) adversely affects self-esteem and self-concept (Campbell, 1989) often resulting in the victim’s self degradation and blame (Elgin, 1980). Joubert (1991) investigated self-esteem and mother and father treatment of self when younger and found that men with high self-esteem tended to have fair mothers, who were interested in their activities and less likely to engage in verbal abuse, while high self-esteem in women correlated with parental praise, interest, and less verbal put-downs. Verbal abuse was the only parental category influencing self-esteem for men and women, indicating the influence of positive and negative statements by significant others.The effect of negative statements on self-perceptions is illustrated in the Goodman and Ritini (1991) study of the self-esteem of 8-10 year old children whose mothers were diagnosed with depression. They classified the mother’s descriptions of their child with regards to school, peer relations, family relations, and sports using a positive/negative/neutral response format. Negative descriptions were classified as being critical/hostile, maternal over-involvement, self-blaming, or negative other statement. The results showed that the depressed mothers gave more negative emotional statements overall (specifically more critical/hostile and self-blame) and had children with lower self-esteem.  Blake and Slate (1993) developed the Verbal Interaction Questionnaire (VIQ) in response to lack of studies investigating the effects of parental verbal interaction on adolescents. They described 4 areas of verbal abuse: belittling or berating; non-support; non communication; and rejection and hostility.
The results of this study showed that perceived parental verbal interaction was related to adolescent self-esteem (r=.65, p<.01) so that the greater the perceived parental verbal abuse, the lower the self-esteem of the adolescent. More recently, Burnett (1996) investigated the relationship between children’s’ self-reported perceptions of statements made by significant others and self-concept and self esteem. The results suggested that positive statements correlated positively with self-esteem and non-academic self-concepts, while negative statements correlated negatively with reading self-concept and with relations with mother and father self-concepts.

Interestingly, positive statements were more highly related to self esteem suggesting that their presence or absence appeared to have a stronger influence on self-esteem when compared to negative statements.