A cognitive science perspective on kindling and episode sensitization in recurrent affective disorder

Abstract

SynopsisA cognitive science analysis of the interaction between psychosocial stress and the neurobiology of affective illness highlights a number of mechanisms relevant to the study of recurrence in major depressive disorder. It builds on observations previously offered by Post (1992) regarding the importance of kindling and sensitization effects in determining activation of neural structures, and proposes a model of knowledge structure activation that follows similar parameters. Vulnerability to depressive relapse/recurrence is determined by the increased risk of particular negative patterns of information processing being activated in depressed states. As is found in studies of kindling and behavioural sensitization, the likelihood of cognitive patterns being activated is dependent on the frequency of past usage, and increased reliance on these patterns of processing makes it easier for their future activation to be achieved on the basis of increasingly minimal cues. This model suggests that the processes related to relapse/recurrence and episode onset may not be isomorphic and, as such, treatments that emphasize relapse prevention strategies should take this distinction into account.

Depression and sensitization to stressors among young women as a function of childhood adversity.

“…Cognitive theorists have long hypothesized-although rarely tested-a model of cognitive vulnerability to depression through the acquisition of maladaptive schemas that arise in childhood and are presumably based on adverse experiences in the family (e.g., Beck, Rush, Shaw, & Emery, 1979;Nolen-Hoeksema, Girgus, & Seligman, 1992). Segal, Williams, Teasdale, and Gemar (1996) speculated about a possible cognitive sensitization effect in which increasing accessibility of negative schemas results from repetition and frequent usage. By extension, long-practiced negative ways of viewing the self and the world may be triggered by minor events, resulting in depressive reactions due to negative information processing.…”

Life stress and the long-term treatment course of recurrent depression: III. Nonsevere life events predict recurrence for medicated patients over 3 years.

“…As less severe forms of stress are assessed, however, there will be more events that affect primarily others (e.g., spouse, friend, relative, child, neighbor) in the subject's social sphere. It follows that such events may be of less central psychological relevance to the person (i.e., not subject focused), and thereby less likely to trigger the cognitive and biological mechanisms via which stress may bring about recurrence (Post, 1992;Segal, Williams, Teasdale, & Gemar, 1995). 12 However, as we have outlined previously (see Monroe & Harkness, 2005), there is good reason to suspect that, if less severe events become capable of triggering recurrence, these less severe events will become more frequent precipitants of recurrence relative to severe events.…”

Mindfulness-Based Cognitive Therapy: Primary Care Patients’ Experiences of Outcomes in Everyday Life and Relapse Prevention

“…This then intensifies the negative affect, preventing effective problem-solving and leading to further depressive thoughts. Thus a self-destructive cycle is created, in which normal transient mood oscillation escalates into more serious depressive symptoms (Segal et al, 1996;Teasdale et al, 1995). Group participation in MBCT has been shown to reduce the risk of relapse by 50% (Segal et al, 2002).…”