No abstract

This paper explores the participant's experience of what it is like to suffer depression, endured for years. Four women and three men, who each reported a minimum of four years' depression, were interviewed and themes were generated using interpretative phenomenological analysis. A first complex theme is 'depths of emptiness' which encompasses: decline of will; disconnection from others; empty future; and numbing of the self. A second theme, 'episodic despairing engulfment' describes: agonising feelings and thoughts; a sense and conviction that one's world and self are being destroyed; a growing belief that there is no escape; and sometimes ideas of suicide. The third theme, 'the struggle of unending life-problems' describes: a perceived timeline of struggle and difficulties; and terrible feelings and emotions. Five of the participants engaged in extreme negative thoughts and narrations about themselves, whilst two participants focused specifically on loss and threatening present situations. We conclude that chronic depression involves the experience of emptiness, but also a repeated experience of the destruction of self, connection to the world and deepest hopes. In chronic depression there are negative thoughts and feelings, yet crucially, it also involves alterations in motivation, in particular a process where aims, cares and concerns, that form important parts of the person's life, are repeatedly thwarted or destroyed. In extreme occurrences, the phenomenological self seems to be passing out of existence.

This study explores the phenomenological experience of rumination in a sample of 22 chronically depressed people and looks at the extent to which it is consistent with theoretical ideas. The findings indicate that, on average, depressed people ruminate about at least two different topics, and that there is wide variability in how long each episode lasts. Rumination is a complex process frequently involving imagery as well as verbal thoughts and is almost invariably associated with multiple emotions. Although there was some evidence for stop rules being involved, most individuals attributed ending a period of rumination to distraction, whether external or internally generated.

One-third of patients with chronic delusions whom we treated responded to delusion modification with a reduction in degree of belief. Change within therapy sessions predicted outcome, as did variation in the conviction during baseline. Cognitive therapy with delusions should aim at reducing distress as well as conviction.