What is Positive Disintegration?

Introduction

The theory of positive disintegration (TPD) is an idea of personality development developed by Polish psychologist Kazimierz Dąbrowski.

Unlike mainstream psychology, the theory views psychological tension and anxiety as necessary for personal growth. These “disintegrative” processes are “positive”, whereas people who fail to go through positive disintegration may stop at “primary integration”, possessing individuality but nevertheless lacking an autonomous personality and remaining impressionable. Entering into disintegration and subsequent higher processes of development occurs through developmental potential, including over-excitability and hypersensitivity.

Unlike other theories of development such as Erikson’s stages of psychosocial development, it is not assumed that even a majority of people progress through all levels. TPD is not a theory of stages, and levels do not correlate with age, nor do tension and anxiety correlate to maturity.

Origins

Dąbrowski’s worldview was likely influenced by his life experiences. As a teenager in World War I, he witnessed a major battle near his village. He walked among the bodies of the dead soldiers and later recalled that the looks on their faces were wildly different—some expressed fear, some horror, while some looked calm and peaceful.

During World War II, he was imprisoned by the Nazi police several times and his wife paid ransom for his release; when Stalin seized Poland, Dąbrowski and his wife were imprisoned for 18 months. Dąbrowski said he wrote his theory to encapsulate the lowest human behaviours he had observed during the war, as well as the highest acts of self-sacrifice. He said that no other psychological theory had captured this wide range of human behaviour. After his release, his behaviour was closely monitored by the Polish authorities until at least the early 60s. In 1965 he established a base in Edmonton, Alberta, and spent the rest of his life alternating between Canada and Poland.

Dąbrowski’s Theory

The development of the theory of positive disintegration began in Dąbrowski’s earliest Polish works, as reflected in his 1929 doctoral thesis. His first work in English also contained seeds of the theory. His next major English work was his 1964 book Positive Disintegration. He proposed that the key to mental growth was having strong “developmental potential”: a constellation of psychological factors often leading to the disintegration of existing psychological structures. These disintegrations allow the individual to voluntarily reorganize their priorities and values, leading to psychological growth.

Dąbrowski’s theory of personality development emphasizes several major features, including that having a unique personality is not a universal trait: it must be created and shaped by the individual to reflect their own unique character. Personality develops as a result of developmental potential (DP), including overexcitability and the autonomous (third) factor; not everyone displays sufficient DP to move through the process of mental growth via positive disintegration.

Dąbrowski used a multilevel approach to describe the continuum of developmental levels seen in the population. In his theory, developmental potential creates crises characterised by strong anxieties and depressions (which he called psychoneurosis) that precipitate disintegrations. For personality to develop, initial integrations based on instinct and socialisation must disintegrate through a process Dąbrowski called positive disintegration. He said that the development of a hierarchy of individual values and emotional reactions was a critical component in developing one’s personality and autonomy; thus, in contrast to most psychological theories, emotions play a major role.

Emotional reactions guide the individual in creating their individual “personality ideal”, an autonomous standard that acts as the goal of individual development. Individuals must examine their essence and develop their own unique personality ideal. Only then can they make existential choices that emphasize the aspects of self that are higher and “more myself”, and inhibit those aspects that are lower or “less myself”, based upon their ideal personality; thus shaping their personality and creating an authentic self based upon the fundamental essence of the individual. Critical components of individual development include: self-education, subject-object, personality ideal, self-perfection, and autopsychotherapy.

Factors in Personality Development

Dąbrowski observed that most people live their lives in a state of “primary or primitive integration” largely guided by biological impulses (“first factor”), by uncritical endorsement and adherence to social conventions (“second factor”), or by both at once. He called this initial integration Level I. Dąbrowski observed that at this level, there is no true individual expression of the autonomous human self; the individual has no autonomous personality, and rather, they exhibit Nietzsche’s idea of the herd personality. Individual expression at Level I is influenced and constrained by the first and second factors.

The first factor directs energy and talents toward self-serving goals that reflect the “lower instincts” and biological needs, as its primary focus is on survival and self-advancement. The second factor, the social environment (milieu) and peer pressure, constrains individual expression and creativity by encouraging mob mentality and discouraging individual thought and expression. The second factor externalises values and morals, thereby externalising conscience; social forces shape behaviour. Behaviour, talents and creativity are funnelled into forms that follow and support the existing social milieu. As conscience is derived from an external social context, so long as social standards are ethical, people influenced by the second factor will behave ethically. However, if a society becomes corrupt, people strongly influenced by the second factor will not dissent. Socialisation without individual examination leads to a rote and robotic existence (the “robopath” described by Ludwig von Bertalanffy). Individual reactions are not unique, as reactions are based on the social context. According to Dąbrowski, people primarily motivated by the second factor represent a significant majority of the general population.

Dąbrowski felt that society was largely influenced by these two factors and could be characterised as operating at Level I, where the external value system absolves the individual of actual responsibility. He also described groups of people who display a different developmental course—an individualised developmental pathway. Such people break away from an automatic, rote, socialised view of life (which Dąbrowski called negative adjustment) and move into, and through, a series of personal disintegrations. Dąbrowski saw these disintegrations as a key element in the overall developmental process. Crises challenge the status quo and cause people to review the self, their ideas, values, thoughts, ideals, etc.

If development continues, one goes on to develop an individualized, conscious and critically evaluated hierarchical value structure (called positive adjustment). This hierarchy of values acts as a benchmark by which all things are now seen, and behaviour is directed by these internal values, rather than by external social mores. At these higher levels, individual values characterize an eventual second integration reflecting individual autonomy and the arrival of the individual’s true personality; each person develops their own vision of how life ought to be and lives according to that vision. This is associated with strongly individualised approaches to problem solving and creativity. One’s talents and creativity are applied in the service of these higher individual values and visions of how life could, and should, be. The person expresses their “new” autonomous personality energetically through action, art, social change, and so on.

Development Potential

Advanced development is often seen in people who exhibit strong developmental potential. Developmental potential represents a constellation of features: it may be positive or negative, it may be strong or weak. If it is strong, the input of the environment is minimal. If it is weak, the environment will play a critical role. Many factors are incorporated into developmental potential but three major aspects are overexcitability, one’s specific abilities and talents, and a strong drive toward autonomous growth (a feature Dąbrowski called the “third factor”).

Overexcitability

The most evident aspect of developmental potential is overexcitability (OE), a heightened physiological experience of stimuli resulting from increased neuronal sensitivities. The greater the OE, the more intense the day-to-day experiences of life. Dąbrowski outlined five forms of OE: psychomotor, sensual, imaginational, intellectual, and emotional. These overexcitabilities, especially the last three, often cause a person to experience daily life more intensely and to feel the joys and sorrows of life more profoundly. Dąbrowski studied human exemplars and found that heightened overexcitability was a key part of their developmental and life experience. These people are steered and driven by their values and their experiences of emotional OE. Combined with imaginational and intellectual OE, these people have an intense and multilevel perception of the world.

Although based in the nervous system, overexcitabilities are expressed psychologically through the development of structures that reflect the emerging autonomous self. The most important of these are “dynamisms”—the biological or mental forces that control behaviour and development. As used by Dąbrowski, dynamisms are instincts, drives, and intellectual processes combined with emotions. With advanced development, dynamisms increasingly reflect movement toward personal autonomy.

Abilities and Talents

The second aspect of developmental potential—specific abilities, and talents—tends to conform to the developmental level. At lower levels people use talents to support egocentric goals or to climb the social and corporate ladders. At higher levels, specific talents and abilities become an important force as the person uses their hierarchy of values to express, and achieve, their vision of their ideal personality and their view of how the world should be.

The Third Factor

According to Dąbrowski, the third factor of developmental potential (DP) is a drive toward individual growth and autonomy. He saw this as a critical factor in applying one’s talents and creativity toward autonomous expression, and in providing motivation to strive for more and to try to imagine (and achieve) goals currently beyond one’s grasp. Dąbrowski was clear to differentiate this third factor from free will. He felt that free will did not go far enough in capturing the motivating aspects that he attributed to this third factor, for example, an individual can exercise free will and show little motivation to grow or change as an individual. The third factor specifically describes motivation—a motivation to become one’s own true self. This motivation is often so strong that a person can find that they must develop themself, despite putting themself in danger by doing so. This feeling of “I’ve gotta be me”, especially when it is “at any cost”, and is expressed as a strong motivator for self-growth, is beyond the usual conceptualisation free will.

Dąbrowski’s theory says that a person whose DP is high enough will generally undergo disintegration, despite any external social or family efforts to prevent it; whereas person whose DP is very low will generally not undergo disintegration (or positive personality growth) even in a conducive environment. Dąbrowski’s notion of overexcitability appears to have been developed independently of Elaine Aron’s highly sensitive person, as her approach is substantially different.

Developmental Obstacles

Dąbrowski called overexcitability “a tragic gift” to reflect that the road of the person with strong OE is not a smooth or easy one. Potentials to experience great highs are also potentials to experience great lows. Similarly, potentials to express great creativity come with the potential of experiencing a great deal of personal conflict and stress. This stress drives development and is a result of conflict—both socially and within oneself. Suicide is a significant risk in the acute phases of this stress, and the isolation often experienced at this stage may also heighten the risk of self-harm.

Dąbrowski advocated autopsychotherapy, educating the person about his theory and the disintegrative process to give them a context within which to understand their intense feelings and needs. Dąbrowski suggested giving people support in their efforts to develop and find their own self-expression. According to Dąbrowski, both children and adults with high DP (and OE) have to find and walk their own path, often at the expense of fitting in with their social peers and even with their families. At the core of autopsychotherapy is the awareness that no one can show anyone else the “right” path—everyone has to find their own path for themselves. Alluding to the knights on the Grail Quest, the Jungian analyst, Joseph Campbell allegedly said: “If a path exists in the forest, don’t follow it, for though it took someone else to the Grail, it will not take you there, because it is not your path.”

Levels

The first and fifth levels of Dąbrowski’s theory of Positive Disintegration are characterized by psychological integration, harmony, and little inner conflict. There is little internal conflict at Level I because at this level one can almost always justify their behaviour – it is either for their own good and is therefore “right”, or society endorses it and it is therefore “right”. In either case, the individual confidently acts as they think anyone else would and does what everyone is “supposed to do”. Dąbrowski compared this to Level V, where there is no internal conflict because what a person does is in harmony with their own internal sense of values. Regardless of internal conflict, external conflict can, and does, still occur.

Dąbrowski used Levels II, III, and IV to describe various degrees and types of disintegration. He was very clear that the levels he presents “represent a heuristic device”. Accordingly, in the process of developing the structures, two or even three contiguous levels may exist side by side, although they exist in conflict. The conflict is resolved when one of the structures is eliminated, or comes under complete control of another structure.

Level I: Primary Integration

The first level is called primitive or primary integration. People at this level are often influenced primarily by either the first factor (heredity/impulse), the second factor (social environment), or both. The majority of people at Level I are integrated at the environmental or social level (Dąbrowski called them average people). Dąbrowski distinguished the two subgroups of Level I by degree: “the state of primary integration is a state contrary to mental health. A fairly high degree of primary integration is present in the average person; a very high degree of primary integration is present in the psychopath.” Marked by selfishness and egocentrism (both covert and explicit), those at level one generally seek self-fulfilment above all else, justifying their pursuits through a sort of “it’s all about me” thinking. They adhere strongly to the phrase “the ends justifies the means”, and may disregard the severity of the “means”. Many people who are considered “leaders” fall into this category.

The vast majority of people do not break down their primitive integration at all, and those who do after a relatively short period of disintegration, usually during adolescence and early youth, either reintegrate at level one, or partially integrate of some of the functions of higher levels, but do not experience a transformation of their whole mental structure. Dąbrowski thought that primary integration in the average person could be of value as it is stable and predictable, and, when accompanied by kindness and good-will, could represent those who can provide support and stability to people experiencing disintegration.

Level II: Unilevel Disintegration

The prominent feature of this level is an initial, brief, and often intense crisis, or series of crises. Crises are spontaneous and occur on only one level—though they may appear to be different choices, they are ultimately on the same, horizontal, level.

Unilevel disintegration occurs during developmental crises such as puberty or menopause, in periods of difficulty handling an external stressful event, or under psychological conditions such as nervousness and psychoneurosis. Unilevel disintegration occurs on a single structural and emotional level; there is a prevalence of automatic dynamisms with only slight self-consciousness and self-control.

Horizontal conflicts produce ambitendencies and ambivalences: one is equally attracted by different but equivalent choices (ambitendencies) and is not able to decide what to do as they have no real preference between the choices (ambivalences). Ultimately, if developmental forces are strong enough, the person is thrust into an existential crisis as their social rationales no longer account for their experiences and there is no alternative explanation. During this phase, existential despair is the predominant emotion. The resolution of this phase begins as individually chosen values start to replace rote, ingrained, social mores and are integrated into a new hierarchy of personal values. These new values often conflict with the person’s previous social values. Many of the status quo explanations for the “way things are”, learned through education and society, collapse under this scrutiny. This causes additional conflicts focused on the person’s analysis of their reactions to the world at large and the behaviour of themself and others. Common behaviours, and the ethics of the prevailing social norm, come to be seen as inadequate, wrong or hypocritical; positive maladjustment prevails. For Dąbrowski, these crises represent a strong potential for development toward personal growth and mental health. Using a positive definition, mental health reflects more than social conformity: it involves a careful, personal examination of the world and of one’s values, leading to the development of an individual personality.

Level II is a transitional period. Dąbrowski said a person will either fall back (reintegration on a lower level), move ahead to Level III, or the crises will end negatively, in suicide or psychosis. The transition from Level II to Level III involves a fundamental shift that requires a phenomenal amount of energy. This period is the crossroads of development, from here one must either progress or regress. The struggle between Dąbrowski’s three factors reflects this transitional crisis: “Do I follow my instincts (first factor), my teachings (second factor) or my heart (third factor)?” The developmental answer is to transform one’s lower instincts (automatic reactions like anger) into positive motivation, to resist rote and social answers, and to listen to one’s inner sense of what one ought to do.

Level III: Spontaneous Multilevel Disintegration

Level III describes a new type of conflict—a vertical conflict between two alternatives that are not simply different, but that exist on different levels; one is genuinely higher and the other lower. These vertical conflicts initially arise from involuntary perceptions of higher versus lower choices in life. In the words of G.K. Chesterton: “You just look at something, maybe for the 1000th time, and it strikes you—you see this one thing differently and once you do, it changes things. You can no longer ‘go back and see it the way you did before.'” Dąbrowski called this vertical dimension multilevelness, and saw it as a gradual realization of the “possibility of the higher” (a phrase Dąbrowski used frequently), and of the contrasts between the higher and the lower in life. These vertical comparisons often contrast the lower, actual, behaviour of a person with the higher, imagined ideals, and to alternative idealised choices. Dąbrowski believed that the authentic individual would choose the higher path as the clear and obvious one to follow, erasing the ambivalences and ambitendencies of unilevel conflicts. If the person’s actual behaviour subsequently falls short of the ideal, internal disharmony and a drive to review and reconstruct one’s life will often follow. Multilevelness thus represents a new and powerful type of conflict that drives development.

Vertical conflicts are critical in leading to autonomy and advanced personality growth. If the person is to achieve higher levels, the shift to multilevelness must occur. If a person does not have the developmental potential to move into a multilevel view, then they will fall back from the crises of Level II to reintegrate at Level I. In the shift to multilevelness, the horizontal (unilevel) stimulus-response model of life is replaced by a vertical and hierarchical analysis. This vertical view becomes anchored by the individual’s emerging value structure, and all events are now seen in relation to their ideal values and how they want to live their life. As events in life are seen in relation to this multilevel, vertical view, it becomes impossible to support positions that favour a lower course of action when higher goals can be imagined and identified.

Level IV: Directed Multilevel Disintegration

In Level IV the person takes full control of their development. The involuntary spontaneous development of Level III is replaced by a deliberate, conscious, self-directed review of life from the multilevel perspective. This level marks the emergence of the third factor, described by Dąbrowski as an autonomous factor “of conscious choice (valuation) by which one affirms or rejects certain qualities in oneself and in one’s environment.” The person consciously reviews their existing belief system and tries to replace lower, automatic views and reactions with carefully thought out, examined and chosen ideals. These new values will increasingly be reflected in the person’s behaviour. Behaviour becomes less reactive, less automatic and more deliberate as choices increasingly fall under the influence of the person’s higher, chosen, ideals.

Social mores are reviewed and may be consciously re-accepted and internalised, or rejected and replaced by a self-determined alternative value system. One’s social views come to reflect a deep responsibility based on both intellectual and emotional factors. At the highest levels, “individuals of this kind feel responsible for the realization of justice and for the protection of others against harm and injustice. Their feelings of responsibility extend almost to everything.” This perspective results from seeing life in relation to one’s hierarchy of values (the multilevel view) and the subsequent appreciation of the potential of how life could, and ought to, be lived. Disagreements with a world operating at a lower level are expressed compassionately by doing what one can to help achieve the “ought”.

Given their genuine, authentic, prosocial outlook, people achieving higher developmental levels also raise the level of their society; prosocial, as used here, is not just support of the existing social order. If the social order is lower and you are adjusted to it, then you also reflect the lower (negative adjustment in Dąbrowski’s terms, a Level I feature). Here, prosocial means a genuine cultivation of social interactions based on higher values. These positions often conflict with the status quo of a lower society (positive maladjustment). In other words, to be maladjusted in a low-level society is a positive feature.

Level V: Secondary Integration

The fifth level displays an integrated and harmonious character, but one vastly different from that at the first level. At this highest level, one’s behaviour is guided by conscious, carefully weighed decisions based on an individualised and chosen hierarchy of personal values. Behaviour conforms to the person’s inner standard of how life ought to be lived, and thus little inner conflict arises.

Level V is often marked by creative expression. Especially at Level V, problem solving and art represent the highest and most noble features of human life. Art captures the innermost emotional states and is based on a deep empathy and understanding of the subject, often human suffering and sacrifice are the subjects of these works. Truly visionary works, works that are unique and novel, are created by people expressing a vision unrestrained by convention. Advances in society, through politics, philosophy and religion, are therefore commonly associated with strong individual creativity and personal accomplishments.

Applications in Therapy

The theory of positive disintegration has an extremely broad scope with many implications. One central application applies to psychological and psychiatric diagnosis and treatment. Dąbrowski advocated a comprehensive, multidimensional diagnosis of the person’s situation, symptoms and developmental potential. Accordingly, if the disintegration appears to fit into a developmental context, then the person is educated in the theory and encouraged to take a developmental view of their situation and experiences. Rather than being eliminated, symptoms are reframed to yield insight and understanding into life and the person’s unique situation.

The Importance of Narratives

Dąbrowski illustrated his theory through autobiographies of and biographies about those who have experienced positive disintegration. The gifted child, the suicidal teen, or the troubled artist is often experiencing the features of TPD, and if they accept and understand the meaning of their intense feelings and crises, they can move ahead, not fall apart. The completion of an extensive autobiography to help the individual gain perspective on their past and present is an important component in the autopsychotherapy process. In this process, the therapist plays a very small role and acts more as an initial stimulus than an ongoing therapist. Dąbrowski asked clients to read his books and to see how his ideas might relate to their lives.

Autopsychotherapy

For Dąbrowski, the goal of therapy is to eliminate the therapist by providing a context within which a person can understand and help themself – an approach to therapy that he called autopsychotherapy. The client is encouraged to embark on a journey of self-discovery, with an emphasis on looking for the contrast between what is higher versus what is lower within their personality and value structure. They are encouraged to further explore their value structure, especially as it relates to the rationale and justification of their positions; discrepancies between values and behaviour are highlighted. The approach is called autopsychotherapy to emphasize the important role that the individual must play in their own therapy process and in the larger process of personality development. The individual must come to see themselves as being in charge of determining or creating their own unique personality ideal and value structure. This includes a critical review of the social mores and values they have learned.

Dąbrowski was very concerned about what he called one-sided development, in which people display significant advanced development in only one aspect of life, usually intellectual. He believed that it is crucial to balance one’s development.

Overexcitability

In describing overexcitability (OE), Dąbrowski emphasized two main aspects: higher-than-average sensitivity, and higher-than-average responsiveness, of the nerves to stimuli. Dąbrowski explained, “The prefix ‘over’ attached to ‘excitability’ serves to indicate that the reactions of excitation are over and above average in intensity, duration and frequency.” If someone has strong OE, they will need less stimuli to cause a reaction and the reaction will be stronger than an individual who does not demonstrate overexcitability.

Dąbrowski reminded clients that without internal unease there is little stimulus for change or growth. Rather than trying to rapidly ameliorate symptoms, this approach encourages individuals to fully experience their feelings and to try to maintain a positive and developmental outlook regarding what they may perceive as strong depression or anxiety. An emphasis is placed on the client becoming aware that they can consciously control the direction of their life and apply what Dabrowski called autopsychotherapy.

Key Ideas

Dąbrowski based his theory on certain key ideas:

  • Lower animal instincts (first factor) must be inhibited and transformed into “higher” forces for people to be truly human as this ability to transform instincts is what separates people from other animals.
  • The common initial personality integration, based upon socialization (second factor), does not reflect true personality.
  • At the initial level of integration, there is little internal conflict as when one “goes along with the group”, there is little sense of individual wrongdoing. External conflicts often relate to the blockage of social goals—career frustrations for example. The social mores and values prevail with little question or conscious examination.
  • True personality must be based upon a system of values that are consciously and volitionally chosen by the person to reflect their own individual sense of “how life ought to be” and their “personality ideal” – the ideal person they feel they “ought to be”.
  • The lower animal instincts, the forces of peer groups, and socialisation are inferior to the autonomous self (personality) consciously constructed by the person.
  • To break down the initial integration, crises and disintegrations are needed, usually provided by life experience.
  • These disintegrations are positive if the person can achieve positive and developmental solutions to the situation.
  • “Unilevel crises” are not developmental as the person can only choose between equal alternatives, such as whether to go left or right.
  • A new type of perception involves “multilevelness”, a vertical view of life that compares lower versus higher alternatives and now allows the individual to choose a higher resolution to a crisis over other available, but lower, alternatives—the developmental solution.
  • “Positive disintegration” is a vital developmental process.
  • Developmental potential describes the forces needed to achieve autonomous personality development.
  • Developmental potential includes several factors including innate abilities and talents, “overexcitability” and the “third factor”.
  • Overexcitability is a measure of an individual’s nervous system’s level of response.
  • Overexcitability, or an overly sensitive nervous system, makes one prone to angst, depression and anxiety. Dąbrowski’s calls these psychoneuroses—a very positive and developmental feature.
  • The third factor is a measure of an individual’s drive toward autonomy.
  • When multilevel and autonomous development is achieved, a secondary integration is seen reflecting one’s mature personality. The individual has no inner conflict; they are in internal harmony as their actions reflect their deeply felt hierarchy of values.

Dąbrowski’s approach is of interest philosophically as it is Platonic, reflecting the bias of Plato toward seeing an individual’s essence as a critical determinant of their developmental course in life. However, Dąbrowski also added a major existential aspect as well, one that depends upon the anxieties a person feels and on how they resolve the day-to-day challenges they face. According to Dąbrowski’s theory, essence must be realised through an existential and experiential process of development. The characterisation advanced by Kierkegaard of “Knights of faith” may be compared to Dąbrowski’s autonomous individual.

Dąbrowski also reviewed the role of logic and reasoning in personal development and concluded that intellect alone does not fully help people know what to do in life. His theory incorporates Jean Piaget’s views of development into a broader scheme guided by emotion, as the emotions one feels about something are the more accurate guide to life’s major decisions.

Secondary Integration versus Self-Actualisation

People[example needed] have often equated Maslow’s concept of self-actualisation with Dąbrowski’s idea of secondary integration, despite there being some major differences between the two ideas. Dąbrowski, a personal friend and correspondent of Maslow, rejected Abraham Maslow’s description of self-actualisation. Actualisation of an undifferentiated self is not a developmental outcome in Dąbrowski’s theory, whereas Maslow described self-actualisation as a process where the self is accepted “as is”, with both higher and lower aspects of the self being actualised. For Maslow, self-actualisation involved “being all that one can be and accepting one’s deeper self in all its aspects”.

Dąbrowski instead applied a multilevel (vertical) approach to self. He spoke of the need to become aware of and inhibit and reject the lower instinctual aspects of the intrinsic human self, and to actively choose and assemble higher elements into a new unique self. Dąbrowski would have people differentiate the initial self into higher and lower aspects, and reject the lower and actualise the higher aspects to create their unique personality; Maslow would have people “embrace without guilt” all aspects.

Dąbrowski introduces the notion that although the lower aspects may initially be intrinsic to the self, people can develop a self-awareness of their lower nature and discover how they feel about these low levels. If they feel badly about behaving in these ways, they can cognitively and volitionally decide to inhibit and eliminate these behaviours; Dąbrowski called this personality shaping. In this way, the higher aspects of the self are actualised while the lower aspects are inhibited. For Dąbrowski, this inhibition is the unique aspect of humans sets people apart from other animals – no other animal is able to differentiate their lower instincts and inhibit their animalistic impulses, an idea also expressed in Plessner’s eccentricity.

Dąbrowski and the Gifted Individual

An appendix to Dąbrowski (1967) reports the results of investigations done in 1962 where “a group of [Polish] gifted children and young people aged 8 to 23” were examined.  Of the 80 youth studied, 30 were “intellectually gifted” and 50 were from “drama, ballet, and plastic art schools”. 

Dąbrowski found that every one of the children displayed overexcitability

Which constituted the foundation for the emergence of neurotic and psychoneurotic sets. Moreover it turned out that these children also showed sets of nervousness, neurosis, and psychoneurosis of various kinds and intensities, from light vegetative symptoms, or anxiety symptoms, to distinctly and highly intensive psychasthenic or hysterical sets.

Dąbrowski asked why these children would display such “states of nervousness or psychoneurosis” and suggested that it was due to the presence of OE. 

Probably the cause is more than average sensitivity which not only permits one to achieve outstanding results in learning and work, but at the same time increases the number of points sensitive to all experiences that may accelerate anomalous reactions revealing themselves in psychoneurotic sets.

The association between OE and giftedness has been the topic of extensive research done by Michael Piechowski and colleagues Lysy and Miller. It appears that intellectual OE is a marker of potential for giftedness/creativity, and that other types of OE may be as well. Dąbrowski’s thesis is that the gifted will disproportionately display this process of positive disintegration and personality growth.

Criticism

For the last 40 years, efforts to measure Dabrowskian constructs have been limited to looking at overexcitability. The most widely known instrument is the Overexcitability Questionnaire-Two.

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What is the Six-Factor Model of Psychological Wellbeing?

Introduction

The six-factor model of psychological well-being is a theory developed by Carol Ryff which determines six factors which contribute to an individual’s psychological well-being, contentment, and happiness.

Psychological well-being consists of self-acceptance, positive relationships with others, autonomy, environmental mastery, a feeling of purpose and meaning in life, and personal growth and development. Psychological well-being is attained by achieving a state of balance affected by both challenging and rewarding life events.

Measurement

The Ryff Scale of Measurement is a psychometric inventory consisting of two forms (either 54 or 84 items) in which respondents rate statements on a scale of 1 to 6, where 1 indicates strong disagreement and 6 indicates strong agreement. Ryff’s model is not based on merely feeling happy, but is based on Aristotle’s Nicomachean Ethics, “where the goal of life isn’t feeling good, but is instead about living virtuously”.

The Ryff Scale is based on six factors: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Higher total scores indicate higher psychological well-being. Following are explanations of each criterion, and an example statement from the Ryff Inventory to measure each criterion.

  1. Autonomy: High scores indicate that the respondent is independent and regulates his or her behaviour independent of social pressures. An example statement for this criterion is “I have confidence in my opinions, even if they are contrary to the general consensus”.
  2. Environmental Mastery: High scores indicate that the respondent makes effective use of opportunities and has a sense of mastery in managing environmental factors and activities, including managing everyday affairs and creating situations to benefit personal needs. An example statement for this criterion is “In general, I feel I am in charge of the situation in which I live”.
  3. Personal Growth: High scores indicate that the respondent continues to develop, is welcoming to new experiences, and recognises improvement in behaviour and self over time. An example statement for this criterion is “I think it is important to have new experiences that challenge how you think about yourself and the world”.
  4. Positive Relations with Others: High scores reflect the respondent’s engagement in meaningful relationships with others that include reciprocal empathy, intimacy, and affection. An example statement for this criterion is “People would describe me as a giving person, willing to share my time with others”.
  5. Purpose in Life: High scores reflect the respondent’s strong goal orientation and conviction that life holds meaning. An example statement for this criterion is “Some people wander aimlessly through life, but I am not one of them”.
  6. Self-Acceptance: High scores reflect the respondent’s positive attitude about his or her self. An example statement for this criterion is “I like most aspects of my personality”

Applications and Research Findings

Contributing Factors

Positive Contributing Factors

Positive psychological well-being may emerge from numerous sources. A happy marriage is contributive, for example, as is a satisfying job or a meaningful relationship with another person. When marriages include forgiveness, optimistic expectations, positive thoughts about one’s spouse, and kindness, a marriage significantly improves psychological well-being. A propensity to unrealistic optimism and over-exaggerated self-evaluations can be useful. These positive illusions are especially important when an individual receives threatening negative feedback, as the illusions allow for adaptation in these circumstances to protect psychological well-being and self-confidence. Optimism also can help an individual cope with stresses to their well-being.

Negative Contributing Factors

Psychological well-being can also be affected negatively, as is the case with a degrading and unrewarding work environment, unfulfilling obligations and unsatisfying relationships. Social interaction has a strong effect on well-being as negative social outcomes are more strongly related to well-being than are positive social outcomes. Childhood traumatic experiences diminish psychological well-being throughout adult life, and can damage psychological resilience in children, adolescents, and adults. Perceived stigma also diminished psychological well-being, particularly stigma in relation to obesity and other physical ailments or disabilities.

Extrinsic and Intrinsic Psychological Needs

A study conducted in the early 1990s exploring the relationship between well-being and those aspects of positive functioning that were put forth in Ryff’s model indicates that persons who aspired more for financial success relative to affiliation with others or their community scored lower on various measures of well-being.

Individuals that strive for a life defined by affiliation, intimacy, and contributing to one’s community can be described as aspiring to fulfil their intrinsic psychological needs. In contrast, those individuals who aspire for wealth and material, social recognition, fame, image, or attractiveness can be described as aiming to fulfil their extrinsic psychological needs. The strength of an individual’s intrinsic (relative to extrinsic) aspirations as indicated by rankings of importance correlates with an array of psychological outcomes. Positive correlations have been found with indications of psychological well-being: positive affect, vitality, and self-actualization. Negative correlations have been found with indicators of psychological ill-being: negative affect, depression, and anxiety.

Relations with Others

A more recent study confirming Ryff’s notion of maintaining positive relations with others as a way of leading a meaningful life involved comparing levels of self-reported life satisfaction and subjective well-being (positive/negative affect). Results suggested that individuals whose actions had underlying eudaimonic tendencies as indicated by their self-reports (e.g. “I seek out situations that challenge my skills and abilities”) were found to possess higher subjective well-being and life satisfaction scores compared to participants who did not. Individuals were grouped according to their chosen paths/strategies to happiness as identified by their answers on an Orientation to Happiness Questionnaire. The questionnaire describes and differentiates individuals on the basis of three orientations to happiness which can be pursued, though some individuals do not pursue any.

The “pleasure” orientation describes a path to happiness that is associated with adopting hedonistic life goals to satisfy only one’s extrinsic needs. Engagement and meaning orientations describe a pursuit of happiness that integrates two positive psychology constructs “flow/engagement” and “eudaimonia/meaning”. Both of the latter orientations are also associated with aspiring to meet intrinsic needs for affiliation and community and were amalgamated by Anić and Tončić into a single “eudaimonic” path to happiness that elicited high scores on all measures of well-being and life satisfaction. Importantly, she also produced scales for assessing mental health. This factor structure has been debated, but has generated much research in wellbeing, health, and successful ageing.

Personality

Meta-analytic research shows that psychological well-being scales correlate strongly with all of the Big Five personality traits. Neuroticism is the strongest Big Five predictor of psychological well-being, correlating negatively with psychological well-being. In particular, openness has strong connections with personal growth, agreeableness and extraversion are notably related to positive relations, and conscientiousness is notably related to environmental mastery and purpose in life.

Heritability

Individual differences in both overall Eudaimonia, identified loosely with self-control and in the facets of eudaimonia are heritable. Evidence from one study supports 5 independent genetic mechanisms underlying the Ryff facets of this trait, leading to a genetic construct of eudaimonia in terms of general self-control, and four subsidiary biological mechanisms enabling the psychological capabilities of purpose, agency, growth, and positive social relations.

Wellbeing Therapy

According to Seligman, positive interventions to attain positive human experience should not be at the expense of disregarding human suffering, weakness, and disorder. A therapy based on Ryff’s six elements was developed by Fava and others in these regards.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Six-factor_model_of_psychological_well-being >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Self-Determination Theory?

Introduction

Self-determination theory (SDT) is a macro theory of human motivation and personality that concerns people’s innate growth tendencies and innate psychological needs. It pertains to the motivation behind people’s choices in the absence of external influences and distractions. SDT focuses on the degree to which human behaviour is self-motivated and self-determined.

In the 1970s, research on SDT evolved from studies comparing intrinsic and extrinsic motives, and from growing understanding of the dominant role that intrinsic motivation played in individual behaviour. It was not until the mid-1980s, when Edward L. Deci and Richard Ryan wrote a book titled Intrinsic Motivation and Self-Determination in Human Behaviour, that SDT was formally introduced and accepted as a sound empirical theory. Since the 2000s, research into practical applications of SDT has increased significantly.

The key research that led to the emergence of SDT included research on intrinsic motivation. Intrinsic motivation refers to initiating an activity because it is interesting and satisfying in itself to do so, as opposed to doing an activity for the purpose of obtaining an external goal (extrinsic motivation). A taxonomy of motivations has been described based on the degree to which they are internalised. Internalisation refers to the active attempt to transform an extrinsic motive into personally endorsed values and thus assimilate behavioural regulations that were originally external.

Edward Deci and Richard Ryan later expanded on the early work differentiating between intrinsic and extrinsic motivation and proposed three main intrinsic needs involved in self-determination. According to Deci and Ryan, three basic psychological needs motivate self-initiated behaviour and specify essential nutrients for individual psychological health and well-being. These needs are said to be the universal and innate need for autonomy, competence, and relatedness.

Self-Determination Theory

Humanistic psychology has been influential in the creation of SDT. Humanistic psychology is interested in looking at a person’s psyche and personal achievement for self-efficacy and self-actualisation. Whether or not an individual’s self-efficacy and self-actualisation are fulfilled can affect their motivation.

To this day, it may be difficult for a parent, coach, mentor, and teacher to motivate and help others complete specific tasks and goals. SDT acknowledges the importance of the interconnection of intrinsic and extrinsic motivations as a means of motivation to achieve a goal. With the acknowledgment of interconnection of motivations, SDT forms the belief that extrinsic motivations and the motivations of others, such as a therapist, may be beneficial. However, it is more important for people to find the “why” behind the desired goal within themselves. According to Sheldon et al., “Therapists who fully endorse self-determination principles acknowledge the limits of their responsibilities because they fully acknowledge that ultimately people must make their own choices” (2003, p.125). One needs to determine their reasons for being motivated and reaching their goal.

SDT comprises The Organismic Dialectic approach, which is a meta-theory, and a formal theory containing mini-theories focusing on the connection between extrinsic and intrinsic motivations within society and an individual. SDT is continually being developed as individuals incorporate the findings of more recent research. As SDT has developed, more mini-theories have been added to what was originally proposed by Deci and Ryan in 1985. Generally, SDT is described as having either five or six mini-theories. The main five mini-theories are cognitive evaluation theory, organismic integration theory, causality orientations theory, basic needs theory, and goal contents theory. The sixth mini-theory that some sources include in SDT is called Relational Motivation Theory.

SDT centres around the belief that human nature shows persistent positive features, with people repeatedly showing effort, agency, and commitment in their lives that the theory calls inherent growth tendencies. “Self-determination also has a more personal and psychology-relevant meaning today: the ability or process of making one’s own choices and controlling one’s own life.” The use of one’s personal agency to determine behaviour and mindset will help an individual’s choices.

Summary of SDT Mini-Theories

Mini-TheoryOutline
Cognitive Evaluation Theory (CET)1. This explains the relationship between internal motivation and external rewards.
2. According to CET, when external rewards are controlling, when they pressure individuals to act a certain way, they diminish internal motivation.
3. On the other hand, when external motivations are informational and provide feedback about behaviours, they increase internal motivation.
Organismic Integration Theory (OIT)1. This suggests different types of extrinsic motivations and how they contribute to the socialization of the individual.
2. This mini-theory suggests that people willingly participate in activities and behaviours that they do not find interesting or enjoyable because they are influenced by external motivators.
3. The four types of extrinsic motivations proposed in this theory are external regulation, introjected regulation, identified regulation, and integrated regulation.
Causality Orientations Theory (COT)1. This explores individual differences in the way people motivate themselves in regards to their personality.
2. COT suggests three orientations toward decision making which are determined by identifying the motivational forces behind an individual’s decisions.
3. Individuals can have an autonomy orientation and make choices according to their own interests and values, they may have a control orientation and make decisions based on the different pressures that they experience from internal and external demands, or they may have an impersonal orientation where they are overcome with feelings of helplessness which are accompanied by a belief that their decisions will not make a difference on the outcome of their lives.
Basic Needs Theory (BNT)1. This considers three psychological needs that are related to intrinsic motivation, effective functioning, high quality engagement, and psychological well-being.
2. The first psychological need is autonomy or the belief that one can choose their own behaviours and actions.
3. The second psychological need is competence.
4. In this sense, competence is when one is able to work effectively as they master their capacity to interact with the environment.
5. The third psychological need proposed in basic needs theory is relatedness, or the need to form strong relationships or bonds with people who are around an individual.
Goal Contents Theory (GCT)1. This compares the benefits of intrinsic goals to the negative outcomes of external goals in terms of psychological well-being.
2. Key to this mini-theory is understanding what reasoning lies behind an individual’s goals.
3. Individuals who pursue goals as a way to satisfy their needs have intrinsic goals and over time experience need satisfaction while those who pursue goals in search of validation have external goals and do not experience need satisfaction.
Relationship Motivation Theory (RMT)1. This examines the importance of relationships.
2. This theory posits that high quality relationships satisfy all three psychological needs described in BNT.
3. Of the three needs, relatedness is impacted the most by high quality relationships but autonomy and competence are satisfied as well.
4. This is because high quality relationships are able to provide individuals with a bond to another person while simultaneously reinforcing their needs for autonomy and competence.

The Organismic Dialectical Perspective

The organismic dialectical perspective sees all humans as active organisms interacting with their environment. People are actively growing, striving to overcome challenges, and creating new experiences. While endeavouring to become unified from within, individuals also become part of social structures. SDT also suggests that people have innate psychological needs that are the basis for self-motivation and personality integration. Through further explanation, people search for fulfilment in their ‘meaning of life’. Discovering the meaning of life constitutes a distinctive desire someone has to find purpose and aim in their lives, which enhances their perception of themselves and their surroundings. Not only does SDT tend to focus on innate psychological needs, it also focuses on the pursuit of goals, the effects of the success in their goals, and the outcome of goals.

Basic Psychological Needs

One mini-theory of SDT includes basic psychological needs theory which proposes three basic psychological needs that must be satisfied to foster well-being and health. These three psychological needs of autonomy, competence, and relatedness are generally universal (i.e. apply across individuals and situations). However, some needs may be more salient than others at certain times and be expressed differently based on time, culture, or experience. SDT identifies three innate needs that, if satisfied, allow optimal function and growth:

  • Autonomy;
  • Competence; and
  • Relatedness.

Autonomy

Desire to be causal agents of one’s own life and act in harmony with one’s integrated self; however, note this does not mean to be independent of others, but rather constitutes a feeling of overall psychological liberty and freedom of internal will. When a person is autonomously motivated their performance, wellness, and engagement is heightened rather than if a person is told what to do (a.k.a. control motivation).

Deci found that offering people extrinsic rewards for behaviour that is intrinsically motivated undermined the intrinsic motivation as they grow less interested in it. Initially intrinsically motivated behaviour becomes controlled by external rewards, which undermines their autonomy. In further research by Amabile, DeJong and Lepper, other external factors also appear to cause a decline in such motivation. For example, it is shown that deadlines restrict and control an individual which decreases their intrinsic motivation in the process.

Situations that give autonomy as opposed to taking it away also have a similar link to motivation. Studies looking at choice have found that increasing a participant’s options and choices increases their intrinsic motivation. Direct evidence for the innate need comes from Lübbecke and Schnedler who find that people are willing to pay money to have caused an outcome themselves. Additionally, satisfaction or frustration of autonomy impacts not only an individual’s motivation, but also their growth. This satisfaction or frustration further affects behaviour, leading to optimal well-being, or unfortunate ill-being.

Competence

Seek to control the outcome and experience mastery.

Deci found that giving people unexpected positive feedback on a task increases their intrinsic motivation to do it, meaning that this was because positive feedback fulfilled people’s need for competence. Additionally, SDT influences the fulfilment of meaning-making, well-being, and finding value within internal growth and motivation. Giving positive feedback on a task served only to increase people’s intrinsic motivation and decreased extrinsic motivation for the task.

Vallerand and Reid found negative feedback has the opposite effect (i.e. decreasing intrinsic motivation by taking away from people’s need for competence). In a study conducted by Felnhofer et al., the level of competence and view of attributing competence is judged in regards to the scope of age differences, gender, and attitude variances of an individual within a given society. The effect of the different variances between individuals subsidise the negative influence that may lead to decreasing intrinsic motivation.

Relatedness

Will to interact with, be connected to, and experience caring for others.

During a study on the relationship between infants’ attachment styles, their exhibition of mastery-oriented behaviour, and their affect during play, Frodi, Bridges and Grolnick failed to find significant effects: “Perhaps somewhat surprising was the finding that the quality of attachment assessed at 12 months failed to significantly predict either mastery motivation, competence, or affect 8 months later, when other investigators have demonstrated an association between similar constructs …” Yet they note that larger sample sizes could be able to uncover such effects: “A comparison of the secure/stable and the insecure/stable groups, however, did suggest that the secure/stable group was superior to the insecure/stable groups on all mastery-related measures. Obviously, replications of all the attachment-motivation relations are needed with different and larger samples.”

Deci and Ryan claim that there are three essential elements of the theory:

  • Humans are inherently proactive with their potential and mastery of their inner forces (such as drives and emotions);
  • Humans have an inherent tendency toward growth development and integrated functioning; and
  • Optimal development and actions are inherent in humans but they do not happen automatically.

In an additional study focusing on the relatedness of adolescents, connection to other individuals’ predisposed behaviours from relatedness satisfaction or frustration. The fulfilment or dissatisfaction of relatedness either promotes necessary psychological functioning or undermines developmental growth through deprivation. Across both study examples, the essential need for nurturing from a social environment goes beyond obvious and simple interactions for adolescents and promotes the actualisation of inherent potential.

If this happens, there are positive consequences (e.g. well-being and growth) but if not, there are negative consequences (e.g. dissatisfaction and deprivation). SDT emphasizes humans’ natural growth toward positive motivation, development, and personal fulfilment. However, this prevents the SDT’s purpose if the basic needs go unfulfilled. Although thwarting of an individual’s basic needs might occur, recent studies argue that such prevention has its own influence on well-being.

Self-determination theory

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Self-determination theory (SDT) is a macro theory of human motivation and personality that concerns people’s innate growth tendencies and innate psychological needs. It pertains to the motivation behind people’s choices in the absence of external influences and distractions. SDT focuses on the degree to which human behavior is self-motivated and self-determined.[1][2][3]

In the 1970s, research on SDT evolved from studies comparing intrinsic and extrinsic motives,[4] and from growing understanding of the dominant role that intrinsic motivation played in individual behavior.[5] It was not until the mid-1980s, when Edward L. Deci and Richard Ryan wrote a book titled Intrinsic Motivation and Self-Determination in Human Behavior,[6] that SDT was formally introduced and accepted as a sound empirical theory. Since the 2000s, research into practical applications of SDT has increased significantly.[7]

The key research that led to the emergence of SDT included research on intrinsic motivation.[8] Intrinsic motivation refers to initiating an activity because it is interesting and satisfying in itself to do so, as opposed to doing an activity for the purpose of obtaining an external goal (extrinsic motivation). A taxonomy of motivations has been described based on the degree to which they are internalized. Internalization refers to the active attempt to transform an extrinsic motive into personally endorsed values and thus assimilate behavioral regulations that were originally external.[9]

Edward Deci and Richard Ryan later expanded on the early work differentiating between intrinsic and extrinsic motivation and proposed three main intrinsic needs involved in self-determination.[10][11] According to Deci and Ryan, three basic psychological needs motivate self-initiated behavior and specify essential nutrients for individual psychological health and well-being. These needs are said to be the universal and innate need for autonomy, competence, and relatedness.[1]

Self-determination theory
Humanistic psychology has been influential in the creation of SDT.[12] Humanistic psychology is interested in looking at a person’s psyche and personal achievement for self-efficacy[13] and self-actualization. Whether or not an individual’s self-efficacy and self-actualization are fulfilled can affect their motivation.[14]

To this day, it may be difficult for a parent, coach, mentor, and teacher to motivate and help others complete specific tasks and goals. SDT acknowledges the importance of the interconnection of intrinsic and extrinsic motivations as a means of motivation to achieve a goal. With the acknowledgment of interconnection of motivations, SDT forms the belief that extrinsic motivations and the motivations of others, such as a therapist, may be beneficial. However, it is more important for people to find the “why” behind the desired goal within themselves.[15] According to Sheldon et al., “Therapists who fully endorse self-determination principles acknowledge the limits of their responsibilities because they fully acknowledge that ultimately people must make their own choices” (2003, p. 125).[15] One needs to determine their reasons for being motivated and reaching their goal.

SDT comprises The Organismic Dialectic approach, which is a meta-theory, and a formal theory containing mini-theories focusing on the connection between extrinsic and intrinsic motivations within society and an individual.[16] SDT is continually being developed as individuals incorporate the findings of more recent research. As SDT has developed, more mini-theories have been added to what was originally proposed by Deci and Ryan in 1985. Generally, SDT is described as having either five or six mini-theories. The main five mini-theories are cognitive evaluation theory, organismic integration theory, causality orientations theory, basic needs theory, and goal contents theory.[17][18] The sixth mini-theory that some sources include in SDT is called Relational Motivation Theory.[16]

SDT centers around the belief that human nature shows persistent positive features, with people repeatedly showing effort, agency, and commitment in their lives that the theory calls inherent growth tendencies.[12] “Self-determination also has a more personal and psychology-relevant meaning today: the ability or process of making one’s own choices and controlling one’s own life.”[19] The use of one’s personal agency to determine behavior and mindset will help an individual’s choices.

Summary of the SDT mini-theories
Cognitive evaluation theory (CET): explains the relationship between internal motivation and external rewards. According to CET, when external rewards are controlling, when they pressure individuals to act a certain way, they diminish internal motivation. On the other hand, when external motivations are informational and provide feedback about behaviors, they increase internal motivation.[18]
Organismic integration theory (OIT): suggests different types of extrinsic motivations and how they contribute to the socialization of the individual. This mini-theory suggests that people willingly participate in activities and behaviors that they do not find interesting or enjoyable because they are influenced by external motivators.[17] The four types of extrinsic motivations proposed in this theory are external regulation, introjected regulation, identified regulation, and integrated regulation.[18]
Causality orientations theory (COT): explores individual differences in the way people motivate themselves in regards to their personality.[18] COT suggests three orientations toward decision making which are determined by identifying the motivational forces behind an individual’s decisions. Individuals can have an autonomy orientation and make choices according to their own interests and values, they may have a control orientation and make decisions based on the different pressures that they experience from internal and external demands, or they may have an impersonal orientation where they are overcome with feelings of helplessness which are accompanied by a belief that their decisions will not make a difference on the outcome of their lives.[17]
Basic needs theory (BNT): considers three psychological needs that are related to intrinsic motivation, effective functioning, high quality engagement, and psychological well-being. The first psychological need is autonomy or the belief that one can choose their own behaviors and actions. The second psychological need is competence. In this sense, competence is when one is able to work effectively as they master their capacity to interact with the environment. The third psychological need proposed in basic needs theory is relatedness, or the need to form strong relationships or bonds with people who are around an individual.[18]
Goal contents theory (GCT): compares the benefits of intrinsic goals to the negative outcomes of external goals in terms of psychological well-being.[18] Key to this mini-theory is understanding what reasoning lies behind an individual’s goals. Individuals who pursue goals as a way to satisfy their needs have intrinsic goals and over time experience need satisfaction while those who pursue goals in search of validation have external goals and do not experience need satisfaction.[17]
Relationship motivation theory (RMT): examines the importance of relationships. This theory posits that high quality relationships satisfy all three psychological needs described in BNT. Of the three needs, relatedness is impacted the most by high quality relationships but autonomy and competence are satisfied as well. This is because high quality relationships are able to provide individuals with a bond to another person while simultaneously reinforcing their needs for autonomy and competence.[16]
The organismic dialectical perspective
The organismic dialectical perspective sees all humans as active organisms interacting with their environment. People are actively growing, striving to overcome challenges, and creating new experiences. While endeavoring to become unified from within, individuals also become part of social structures.[20][21] SDT also suggests that people have innate psychological needs that are the basis for self-motivation and personality integration. Through further explanation, people search for fulfillment in their ‘meaning of life’. Discovering the meaning of life constitutes a distinctive desire someone has to find purpose and aim in their lives, which enhances their perception of themselves and their surroundings.[22] Not only does SDT tend to focus on innate psychological needs, it also focuses on the pursuit of goals, the effects of the success in their goals, and the outcome of goals.[20]

Basic psychological needs
One mini-theory of SDT includes basic psychological needs theory which proposes three basic psychological needs that must be satisfied to foster well-being and health.[23] These three psychological needs of autonomy, competence, and relatedness are generally universal (i.e., apply across individuals and situations). However, some needs may be more salient than others at certain times and be expressed differently based on time, culture, or experience. SDT identifies three innate needs that, if satisfied, allow optimal function and growth:

Autonomy[24][25]
Desire to be causal agents of one’s own life and act in harmony with one’s integrated self; however, note this does not mean to be independent of others, but rather constitutes a feeling of overall psychological liberty and freedom of internal will. When a person is autonomously motivated their performance, wellness, and engagement is heightened rather than if a person is told what to do (a.k.a. control motivation).[26][27]
Deci[28] found that offering people extrinsic rewards for behavior that is intrinsically motivated undermined the intrinsic motivation as they grow less interested in it. Initially intrinsically motivated behavior becomes controlled by external rewards, which undermines their autonomy. In further research by Amabile, DeJong and Lepper,[29] other external factors also appear to cause a decline in such motivation. For example, it is shown that deadlines restrict and control an individual which decreases their intrinsic motivation in the process.

Situations that give autonomy as opposed to taking it away also have a similar link to motivation. Studies looking at choice have found that increasing a participant’s options and choices increases their intrinsic motivation.[30] Direct evidence for the innate need comes from Lübbecke and Schnedler[31] who find that people are willing to pay money to have caused an outcome themselves. Additionally, satisfaction or frustration of autonomy impacts not only an individual’s motivation, but also their growth. This satisfaction or frustration further affects behavior, leading to optimal well-being, or unfortunate ill-being.[27]

Competence[32][33]
Seek to control the outcome and experience mastery.[34]
Deci[28] found that giving people unexpected positive feedback on a task increases their intrinsic motivation to do it, meaning that this was because positive feedback fulfilled people’s need for competence. Additionally, SDT influences the fulfillment of meaning-making, well-being, and finding value within internal growth and motivation.[35] Giving positive feedback on a task served only to increase people’s intrinsic motivation and decreased extrinsic motivation for the task.

Vallerand and Reid[36] found negative feedback has the opposite effect (i.e., decreasing intrinsic motivation by taking away from people’s need for competence). In a study conducted by Felnhofer et al., the level of competence and view of attributing competence is judged in regards to the scope of age differences, gender, and attitude variances of an individual within a given society. The effect of the different variances between individuals subsidize the negative influence that may lead to decreasing intrinsic motivation.[37]

Relatedness
Will to interact with, be connected to, and experience caring for others.[38]
See also: Belongingness
During a study on the relationship between infants’ attachment styles, their exhibition of mastery-oriented behaviour, and their affect during play, Frodi, Bridges and Grolnick[39] failed to find significant effects: “Perhaps somewhat surprising was the finding that the quality of attachment assessed at 12 months failed to significantly predict either mastery motivation, competence, or affect 8 months later, when other investigators have demonstrated an association between similar constructs …” Yet they note that larger sample sizes could be able to uncover such effects: “A comparison of the secure/stable and the insecure/stable groups, however, did suggest that the secure/stable group was superior to the insecure/stable groups on all mastery-related measures. Obviously, replications of all the attachment-motivation relations are needed with different and larger samples.”

Deci and Ryan claim that there are three essential elements of the theory:[26]

Humans are inherently proactive with their potential and mastery of their inner forces (such as drives and emotions)
Humans have an inherent tendency toward growth development and integrated functioning
Optimal development and actions are inherent in humans but they do not happen automatically
In an additional study focusing on the relatedness of adolescents, connection to other individuals’ predisposed behaviors from relatedness satisfaction or frustration. The fulfillment or dissatisfaction of relatedness either promotes necessary psychological functioning or undermines developmental growth through deprivation. Across both study examples, the essential need for nurturing from a social environment goes beyond obvious and simple interactions for adolescents and promotes the actualization of inherent potential.[40][26]

If this happens, there are positive consequences (e.g. well-being and growth) but if not, there are negative consequences (e.g. dissatisfaction and deprivation). SDT emphasizes humans’ natural growth toward positive motivation, development, and personal fulfillment.[41][42] However, this prevents the SDT’s purpose if the basic needs go unfulfilled. Although thwarting of an individual’s basic needs might occur, recent studies argue that such prevention has its own influence on well-being.[41]

Motivations

SDT claims to offer a different approach to motivation, considering what motivates a person at any given time, rather than viewing motivation as a single concept. SDT makes distinctions between different types of motivation and what results from them. White and deCharms proposed that the need for competence and autonomy is the basis of intrinsic motivation and behaviour. This idea is a link between people’s basic needs and their motivations.

Intrinsic Motivation

Intrinsic motivation is the natural, inherent drive to seek out challenges and new possibilities that SDT associates with cognitive and social development.

Cognitive evaluation theory (CET) is a sub-theory of SDT that specifies factors explaining intrinsic motivation and variability with it and looks at how social and environmental factors help or hinder intrinsic motivations. CET focuses on the needs of competence and autonomy. CET is offered as an explanation of the phenomenon known as motivational “crowding out”.

Claiming social context events like feedback on work or rewards lead to feelings of competence and so enhance intrinsic motivations. Deci found positive feedback enhanced intrinsic motivations and negative feedback diminished it. Vallerand and Reid went further and found that these effects were being mediated by perceived control.

Autonomy, however, must accompany competence for people to see their behaviours as self determined by intrinsic motivation. There must be immediate contextual support for both needs or inner resources based on prior development for this to happen.

CET and intrinsic motivation are also linked to relatedness through the hypothesis that intrinsic motivation flourishes if linked with a sense of security and relatedness. Grolnick and Ryan found lower intrinsic motivation in children who believed their teachers to be uncaring or cold and so not fulfilling their relatedness needs.

There is an interesting correlation between intrinsic motivation and educational performance according to Augustyniak, et al. They studied intrinsic motivation in second year medical students and discovered that students with lower intrinsic motivation had lower test scores and overall grades. They also noted these students lacked interest and enjoyment in their studies. They suggest that it may be beneficial to find out if a student lacks intrinsic motivation when they are younger and it may be possible to develop as they grow up.

Extrinsic Motivation

Extrinsic motivation comes from external sources. Deci and Ryan developed organismic integration theory (OIT) as a sub-theory of SDT to explain the different ways extrinsically motivated behaviour is regulated.

OIT details the different forms of extrinsic motivation and the contexts in which they come about. The context of such motivation concerns the SDT theory as these contexts affect whether the motivations are internalised and so integrated into the sense of self.

OIT describes four different types of extrinsic motivations that often vary in terms of their relative autonomy:

Extrinsic MotivatorOutline
Externally Regulated Behaviour1. Is the least autonomous, it is performed because of external demand or possible reward.
2. Such actions can be seen to have an externally perceived locus of control.
Introjected Regulation of Behaviour1. This describes taking on regulations to behaviour but not fully accepting said regulations as your own.
2. Deci and Ryan claim such behaviour normally represents regulation by contingent self-esteem, citing ego involvement as a classic form of introjections.
3. This is the kind of behaviour where people feel motivated to demonstrate ability to maintain self-worth.
4. While this is internally driven, introjected behavior has an external perceived locus of causality or not coming from one’s self.
5. Since the causality of the behavior is perceived as external, the behavior is considered non-self-determined.
Regulation through Identification1. This a more autonomously driven form of extrinsic motivation.
2. It involves consciously valuing a goal or regulation so that said action is accepted as personally important.
Integrated Regulation1. Is the most autonomous kind of extrinsic motivation.
2. Occurring when regulations are fully assimilated with self so they are included in a person’s self-evaluations and beliefs on personal needs.
3. Because of this, integrated motivations share qualities with intrinsic motivation but are still classified as extrinsic because the goals that are trying to be achieved are for reasons extrinsic to the self, rather than the inherent enjoyment or interest in the task.

Extrinsically motivated behaviours can be integrated into self. OIT proposes that internalisation is more likely to occur when there is a sense of relatedness.

Ryan, Stiller and Lynch found that children internalize school’s extrinsic regulations when they feel secure and cared for by parents and teachers.

Internalisation of extrinsic motivation is also linked to competence. OIT suggests that feelings of competence in activities should facilitate internalisation of said actions.

Autonomy is particularly important when trying to integrate its regulations into a person’s sense of self. If an external context allows a person to integrate regulation—they must feel competent, related and autonomous. They must also understand the regulation in terms of their other goals to facilitate a sense of autonomy. This was supported by Deci, Eghrari, Patrick and Leone who found in laboratory settings if a person was given a meaningful reason for uninteresting behaviour along with support for their sense of autonomy and relatedness they internalised and integrated their behaviour.

Individual Differences

SDT argues that needs are innate but can be developed in a social context or learned from various life experiences and outside influences. Some people develop stronger needs than others, creating individual differences in the needs of people, whether it be autonomy, relatedness, or competence. However, individual differences within the theory focus on concepts resulting from the degree to which needs have been satisfied or not satisfied. This has the potential to lead to either need satisfaction or need frustration. Depending on which is reached, there can either be positive or negative outcomes, which vary between individual to individual and what their needs may be.

Within SDT there are two general individual difference concepts, causality orientations and life goals, which will be discussed in further detail below.

Causality Orientations

Causality orientations are motivational orientations that refer to the way people interact and adapt to an environment and regulate their behaviour in response to these adaptations; in other words, this is the extent to which people experience feelings related to self-determination across many settings. SDT created three orientations: autonomous, controlled and impersonal. This orientation helps to explain the consequences of these interactions with the environment. The orientation an individual holds dictates how that person will adapt.

Autonomous orientations refer to the results from satisfaction of the basic needs. An individual’s interactions with the environment will be oriented towards trying to satisfy those needs. They will adapt their behaviours in response to the environment that they find themselves in. Certain environments may require more heightened and more conscious effort in order to achieve their needs while others may not. Either way, the individual has oriented themselves and their behaviours, whether consciously or subconsciously, towards achieving their basic needs.

Strong controlled orientations come as a result of competence and relatedness needs but excludes autonomy; there is a link to regulation through both internal and external contingencies. This causes rigid functioning and diminished well-being, which are more negative outcomes rather than positive.

Impersonal orientations come from failure to fulfil all three needs, which leads to poor functioning and ill-being. According to the self-determination theory, each individual has each of these orientations to some extent. This makes it possible to predict their psychological and behavioural outcomes. When needs are satisfied, it has been shown to improve vitality, life satisfaction, and positive affect. On the other hand, need frustration can lead to more negative outcomes, such as emotional exhaustion.

The causality orientations may have various and unique impacts on an individual’s motivation. In one particular study, participants were presented a puzzle and asked to put it together. And, what researchers found was that those who were more oriented towards autonomy would put in more time into solving the puzzle as composed to their counterparts. Feedback was also an important contributing factor to the success and motivation of the participants.

Life Goals

Life goals are long-term goals people use to guide an individual’s activities. They may fit into a variety of different categories and vary from person to person. The period of time that the particular goal will also be different depending on the nature of the goal. Some goals may take decades while other may take a couple years. There have even been instances where a goal can last a lifetime and will not be fully achieved until the individual passes. These goals can be divided into two separate categories:

  • Intrinsic Aspirations: Contain life goals like affiliation, generativity and personal development.
  • Extrinsic Aspirations: Have life goals like wealth, fame and attractiveness.

There have been several studies on this subject that chart intrinsic goals being associated with greater health, well-being and performance. Intrinsic motivation has also been shown to be a better motivator, especially in relation to long-term goals as it leaves all motivation to be on an internal basis. It does not rely on external factors, that are typically temporary, to provide the necessary drive to complete a task. With intrinsic aspirations, they would relate to things that are more values rather than material things or have material manifestations, which fits with the examples provided. These life goals can also be related back to the needs that are stronger for the individual and that they are more motivated to satisfy. For example, the goal of affiliation would fit into the category of the need for relatedness. Wealth, on the other hand, would fit more under the category of competence.

The Connection

Both of these aspects can be related to many important aspects in a person’s life. The causality orientations held by an individual will have an impact on their life goals, including the type of goal and if they will be able to achieve it. An example of this is job engagement and its relationship to the number of resources available to employees. The researchers conducting this study found that “the autonomous and impersonal orientations were shown to moderate the relationship between job resources and work engagement; the positive relationship was weaker for both highly autonomy-oriented and highly impersonal-oriented individuals. The interaction between controlled orientation and job resources was insignificant.” So, those in these work environments will have various life goals related to their work. And, depending on their orientation, may be able to better navigate the various aspects related to how well they can perform their job. Learned helplessness may even come into play with the motivation individuals may be.

Classic Studies

Deci (1971): External Rewards on Intrinsic Motivation

Deci studied the effect of extrinsic rewards on intrinsic motivation in two labs and a field experiment. Based on the results from earlier animal and human studies on intrinsic motivation, the author explored two possibilities. In the first two experiments he looked at the effect of extrinsic rewards in terms of a decrease in intrinsic motivation to perform a task. Earlier studies showed contradictory or inconclusive findings regarding decrease in performance on a task following an external reward. The third experiment was based on findings of developmental learning theorists and looked at whether a different type of reward enhances intrinsic motivation to participate in an activity.

Experiment I

This experiment tested the hypothesis that if an individual is intrinsically motivated to perform an activity, introduction of an extrinsic reward decreases the degree of intrinsic motivation to perform the task.

Twenty-four undergraduate psychology students participated in the first laboratory experiment and were assigned to either an experimental (n = 12) or control group (n = 12). Each group participated in three sessions conducted on three different days. During the sessions, participants were engaged in working on a Soma cube puzzle – which the experimenters assumed was an activity college students would be intrinsically motivated to do. The puzzle could be put together to form numerous different configurations. In each session, the participants were shown four different configurations drawn on a piece of paper and were asked to use the puzzle to reproduce the configurations while they were being timed.

The first and third session of the experimental condition were identical to control, but in the second session the participants in the experimental condition were given a dollar for completing each puzzle within time. During the middle of each session, the experimenter left the room for eight minutes and the participants were told that they were free to do whatever they wanted during that time, while the experimenter observed during that period. The amount of time spent working on the puzzle during the free choice period was used to measure motivation.

As Deci expected, when external reward was introduced during session two, the participants spent more time working on the puzzles during the free choice period in comparison to session 1 and when the external reward was removed in the third session, the time spent working on the puzzle dropped lower than the first session. All subjects reported finding the task interesting and enjoyable at the end of each session, providing evidence for the experimenter’s assumption that the task was intrinsically motivating for the college students. The study showed some support of the experimenter’s hypothesis and a trend towards a decrease in intrinsic motivation was seen after money was provided to the participants as an external reward.

Experiment II

The second experiment was a field experiment, similar to laboratory Experiment I, but was conducted in a natural setting.

Eight student workers were observed at a college biweekly newspaper. Four of the students served as a control group and worked on Fridays. The experimental group worked on Tuesdays.

The control and experimental group students were not aware that they were being observed. The 10-week observation was divided into three time periods. The task in this study required the students to write headlines for the newspaper.

During “Time 2”, the students in the experimental group were given 50 cents for each headline they wrote. At the end of Time 2, they were told that in the future the newspaper cannot pay them 50 cent for each headline anymore as the newspaper ran out of the money allocated for that and they were not paid for the headlines during Time 3.

The speed of task completion (headlines) was used as a measure of motivation in this experiment. Absences were used as a measure of attitudes.

To assess the stability of the observed effect, the experimenter observed the students again (Time 4) for two weeks. There was a gap of five weeks between Time 3 and Time 4. Due to absences and change in assignment etc., motivation data was not available for all students. The results of this experiment were similar to Experiment I and monetary reward was found to decrease the intrinsic motivation of the students, supporting Deci’s hypothesis.

Experiment III

Experiment III was also conducted in the laboratory and was identical to Experiment I in all respects except for the kind of external reward provided to the students in the experimental condition during Session 2.

In this experiment, verbal praise was used as an extrinsic reward.

The experimenter hypothesized that a different type of reward—i.e., social approval in the form of verbal reinforcement and positive feedback for performing the task that a person is intrinsically motivated to perform—enhances the degree of external motivation, even after the extrinsic reward is removed.

The results of the experiment III confirmed the hypothesis and the students’ performance increased significantly during the third session in comparison to session one, showing that verbal praise and positive feedback enhances performance in tasks that a person is initially intrinsically motivated to perform. This provides evidence that verbal praise as an external reward increases intrinsic motivation.

The author explained differences between the two types of external rewards as having different effects on intrinsic motivation. When a person is intrinsically motivated to perform a task and money is introduced to work on the task, the individual cognitively re-evaluates the importance of the task and the intrinsic motivation to perform the task (because the individual finds it interesting) shifts to extrinsic motivation and the primary focus changes from enjoying the task to gaining financial reward. However, when verbal praise is provided in a similar situation, it increases intrinsic motivation as it is not evaluated to be controlled by external factors and the person sees the task as an enjoyable task that is performed autonomously. The increase in intrinsic motivation is explained by positive reinforcement and an increase in perceived locus of control to perform the task.

Pritchard et al. (1977): Evaluation of Deci’s Hypothesis

Pritchard et al. conducted a similar study to evaluate Deci’s hypothesis regarding the role of extrinsic rewards on decreasing intrinsic motivation.

Participants were randomly assigned to two groups. A chess-problem task was used in this study. Data was collected in two sessions.

Session I

Participants were asked to complete a background questionnaire that included questions on the amount of time the participant played chess during the week, the number of years that the participant has been playing chess for, amount of enjoyment the participant gets from playing the game, etc.

The participants in both groups were then told that the experimenter needed to enter the information in the computer and for the next 10 minutes the participant were free to do whatever they liked.

The experimenter left the room for 10 minutes. The room had similar chess-problem tasks on the table, some magazines as well as coffee was made available for the participants if they chose to have it.

The time spent on the chess-problem task was observed through a one way mirror by the experimenter during the 10 minute break and was used as a measure of intrinsic motivation. After the experimenter returned, the experimental group was told that there was a monetary reward for the participant who could work on the most chess problems in the given time and that the reward is for this session only and would not be offered during the next session. The control group was not offered a monetary reward.

Session II

The second session was the same for the two groups:

After a filler task, the experimenter left the room for 10 minutes and the time participants spent on the chess-problem task was observed. The experimental group was reminded that there was no reward for the task this time.

After both sessions the participants were required to respond to questionnaires evaluating the task, i.e. to what degree did they find the task interesting. Both groups reported that they found the task interesting.

The results of the study showed that the experimental group showed a significant decrease in time spent on the chess-problem task during the 10-minute free time from session 1 to session 2 in comparison to the group that was not paid, thus confirming the hypothesis presented by Deci that contingent monetary reward for an activity decreases the intrinsic motivation to perform that activity. Other studies were conducted around this time focusing on other types of rewards as well as other external factors that play a role in decreasing intrinsic motivation.

New Developments

Principles of SDT have been applied in many domains of life, e.g. job demands; parenting; teaching; health; including willingness to get vaccinated; morality; and technology design. Besides the domains mentioned above, SDT research has been widely applied to the field of sports.

Exercise and Physical Activity

Murcia et al. looked at the influence of peers on enjoyment in exercise. Specifically, the researchers looked at the effect of motivational climate generated by peers on exercisers by analysing data collected through questionnaires and rating scales. The assessment included evaluation of motivational climate, basic psychological needs satisfaction, levels of self-determination and self-regulation (amotivation, external, introjected, identified and intrinsic regulation) and also the assessment of the level of satisfaction and enjoyment in exercising.

Data analysis revealed that when peers are supportive and there is an emphasis on cooperation, effort, and personal improvement, the climate influences variables like basic psychological needs, motivation, and enjoyment. The task climate positively predicted the three basic psychological needs (competence, autonomy, and relatedness) and so positively predicted self-determined motivation. Task climate and the resulting self-determination were also found to positively influence the level of enjoyment that exercisers experienced during the activity.

Behzadniaa et al. studied how physical education teachers’ autonomy support versus control would relate to students’ wellness, knowledge, performance, and intentions to persist at physical activity beyond the PE classes. The study concluded that, “…perceived autonomy support was positively related to the positive outcomes via need satisfaction and frustration and autonomous motivation, and that perceptions of teachers’ control were related to students’ ill-being (positively) and knowledge (negatively) through need frustration.”

Identified regulation was found to be more consistently associated with regular physical activity than other forms of autonomous motivation, such as intrinsic regulation, which may be triggered by pleasure derived from the activity itself. This may be explained by physical activity often relating to more mundane or repetitive actions. More recent studies suggest that different types of motivation regulate different intensities of physical activity, which may be context dependent. For example, higher frequency of vigorous physical activity was associated with autonomous motivation, but not with controlled motivation in a study in rural Uganda. In an urban disadvantaged South African population, however, an association between moderate physical activity and autonomous motivation was found, but not with vigorous physical activity. The latter study also found the association between the basic psychological needs and more autonomous forms of motivation to be different across different contexts.

Awareness

Awareness has always been associated with autonomous functioning. However, only recently have the SDT researchers incorporated the concept of mindfulness and its relationship with autonomous functioning and emotional well-being into their studies.

Brown and Ryan conducted a series of five experiments to study mindfulness: They defined mindfulness as open, undivided attention to what is happening within and around oneself.

From their experiments, the authors concluded that when people act mindfully, their actions are consistent with their values and interest. Also, there is a possibility that being autonomous and performing an action because it is enjoyable to oneself increases mindful attention to one’s actions.

Vitality and Self-Regulation

Another area of interest for SDT researchers is the relationship between subjective vitality and self-regulation. Ryan and Deci define vitality as energy available to the self, either directly or indirectly, from basic psychological needs. This energy allows individuals to act autonomously.

Many theorists have posited that self-regulation depletes energy but SDT researchers have proposed and demonstrated that only controlled regulation depletes energy, autonomous regulation can actually be vitalising.

Ryan et al. used SDT to explain the effect of weekends on the well-being of adult working population. The study determined that people felt higher well-being on weekends due to greater feelings of autonomy, and feeling closer to others (relatedness), in weekend activities.

Education

In a study by Hyungshim Jang, the capacity of two different theoretical models of motivation were used to explain why an externally provided rationale for doing a particular assignment often helps in a student’s motivation, engagement, and learning during relatively uninteresting learning activities.

Undergraduate students (N = 136; 108 women, 28 men) worked on a relatively uninteresting short lesson after either receiving or not receiving a rationale. Students who received the rationale showed greater interest, work ethic, and determination.

Structural equation modelling was used to test three alternative explanatory models to understand why the rationale produced such benefits:

  • An identified regulation model based on SDT
  • An interest regulation model based on interest-enhancing strategies research
  • An additive model that integrated both models.

The data fit all three models; but only the model based on SDT helped students to engage and learn. Findings show the role that externally provided rationales can play in helping students generate the motivation they need to engage in and learn from uninteresting, but personally important, material.

The importance of these findings to those in the field of education is that when teachers try to find ways to promote student’s motivation during relatively uninteresting learning activities, they can successfully do so by promoting the value of the task. One way teachers can help students value what they may deem “uninteresting” is by providing a rationale that identifies the lesson’s otherwise hidden value, helps students understand why the lesson is genuinely worth their effort, and communicates why the lesson can be expected to be useful to them.

An example of SDT and education are Sudbury Model schools where people decide for themselves how to spend their days. In these schools, students of all ages determine what they do, as well as when, how, and where they do it. This freedom is at the heart of the school; it belongs to the students as their right, not to be violated. The fundamental premises of the school are simple: that all people are curious by nature; that the most efficient, long-lasting, and profound learning takes place when started and pursued by the learner; that all people are creative if they are allowed to develop their unique talents; that age-mixing among students promotes growth in all members of the group; and that freedom is essential to the development of personal responsibility. In practice this means that students initiate all their own activities and create their own environments. The physical plant, the staff, and the equipment are there for the students to use as the need arises. The school provides a setting in which students are independent, are trusted, and are treated as responsible people; and a community in which students are exposed to the complexities of life in the framework of a participatory democracy. Sudbury schools do not perform and do not offer evaluations, assessments, or recommendations, asserting that they do not rate people, and that school is not a judge; comparing students to each other, or to some standard that has been set is for them a violation of the student’s right to privacy and to self-determination. Students decide for themselves how to measure their progress as self-starting learners as a process of self-evaluation: real lifelong learning and the proper educational evaluation for the 21st century, they adduce.

Alcohol Use

According to SDT, individuals who attribute their actions to external circumstances rather than internal mechanisms are far more likely to succumb to peer pressure. In contrast, individuals who consider themselves autonomous tend to be initiators of actions rather than followers. Research examining the relationship between SDT and alcohol use among college students has indicated that individuals with the former criteria for decision making are associated with greater alcohol consumption and drinking as a function of social pressure. For instance, in a study conducted by Knee and Neighbours, external factors in the individuals who claim to not be motivated by internal factors were found to be associated with drinking for extrinsic reasons, and with stronger perceptions of peer pressure, which in turn was related to heavier alcohol use. Given the evidence suggesting a positive association between an outward motivation and drinking, and the potential role of perceived social influence in this association, understanding the precise nature of this relationship seems important. Further, it may be hypothesized that the relationship between self-determination and drinking may be mediated to some extent by the perceived approval of others.

Healthy Eating

Self-determination theory offers an explanatory framework to predict healthy eating and other dietary behaviour. Research on SDT in the domain of eating regulation is still in its early stages and most of these studies were conducted in high income settings. In support of SDT, A recent study in an urban township population in South Africa found that frequency of fruit, vegetable and non-refined starch intake was associated with identified regulation and negatively associated with introjected regulation among people with (pre)diabetes. The same study found perceived competence and relatedness to be positively associated with identified regulation and negatively associated with introjected regulation. In more concrete wording, individuals who experience support from friends or family and who feel competent in maintaining a healthy diet were more likely to become motivated by their own values such as having a good health. Motivation linked to pressure from others or feelings of guilt or shame showed to be negatively associated with maintaining a healthy diet.

Motivational Interviewing

Motivational interviewing (MI) is a popular approach to positive behavioural change. Used initially in the area of addiction (Miller & Rollnick, 2002), it is now used for a wider range of issues. It is a client-centred method that does not persuade or coerce patients to change and instead attempts to explore and resolve their ambivalent feelings, which allows them to choose themselves whether to change or not.

Markland, Ryan, Tobin, and Rollnick believe that SDT provides a framework behind how and the reasons why MI works. They believe that MI provides an autonomy-supportive atmosphere, which allows clients to find their own source of motivation and achieve their own success (in terms of overcoming addiction). Patients randomly assigned to an MI treatment group found the setting to be more autonomy-supportive than those in a regular support group.

Environmental Behaviours

Several studies explored the link between SDT and environmental behaviours to determine the role of intrinsic motivation for environmental behaviour performance and to account for the lack of success of current intervention strategies.

Consumer Behaviour

Self-determination theory identifies a basic psychological need for autonomy as a central feature for understanding effective self-regulation and well-being. As adopting these services increases both individual and collective well-being, research has to delve more deeply into the origins of consumers’ motivations. For this reason aim at augmenting the understanding of how different types of motivation determine consumers’ intention to adopt transformative services. They examine whether Self-Determination Theory (SDT) can be of help in fostering more sustainable food choices by taking a closer look at the relationship between food-related types of motivation and different aspects of meat consumption, based on a survey among 1083 consumers in the Netherlands.

Motivation toward the Environment Scale

Environmental attitudes and knowledge are not good predictors of behaviour. SDT suggests that motivation can predict behaviour performance. Pelletier et al. (1998) constructed a scale of motivation for environmental behaviour, which consists of 4×6 statements (4 statements for each type of motivation on the SDT motivation scale: intrinsic, integrated, identified, introjected, external, and amotivation) responding to a question ‘Why are you doing things for the environment?’. Each item is scored on a 1–7 Likert scale. Utilising MTES, Villacorta (2003) demonstrates a correlation between environmental concerns and intrinsic motivations together with peer and parental support; further, intrinsically motivated behaviours tend to persist longer.

Environmental Motivation

Pelletier et al. (1999) shows that four personal beliefs: helplessness, strategy, capacity, and effort, lead to greater amotivation, while self-determination has an inverse relationship with amotivation. The Amotivation toward the Environment Scale measures the four reasons for amotivation by answering the question ‘Why are you not doing things for the environment?’. The participants rank 16 total statements (four in each category of amotivation) on a 1–7 Likert scale.

Intervention Strategies

Intervention strategies have to be effective in bridging the gap between attitudes and behaviours. Monetary incentives, persuasive communication, and convenience are often successful in the short term, but when the intervention is removed, behaviour is discontinued. In the long run, such intervention strategies are therefore expensive and difficult to maintain.

SDT explains that environmental behaviour that is not motivated intrinsically is not persistent. On the other hand, when self-determination is high, behaviour is more likely to occur repeatedly. The importance of intrinsic motivation is particularly apparent with more difficult behaviours. While they are less likely to be performed in general, people with high internal motivation are more likely to perform them more frequently than people with low intrinsic motivation. 5 Subjects scoring high on intrinsic motivation and supporting ecological well-being also reported a high level of happiness.

According to Osbaldiston and Sheldon (2003), autonomy perceived by an individual leads to an increased frequency of environmental behaviour performance. In their study, 162 university students chose an environmental goal and performed it for a week. Perceived autonomy, success in performing chosen behaviour, and their future intention to continue were measured. The results suggested that people with higher degree of self-perceived autonomy successfully perform behaviours and are more likely to do so in the long term.

Based on the connection between SDT and environmental behaviours, Pelletier et al. suggest that successful intervention should emphasize self-determined motivation for performing environmental behaviours.

Industrial and Organisational Psychology

SDT has been applied to Industrial and organisational psychology.

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An Overview of Socioeconomic Status and Mental Health

Introduction

Numerous studies around the world have found a relationship between socioeconomic status and mental health.

There are higher rates of mental illness in groups with lower socioeconomic status (SES), but there is no clear consensus on the exact causative factors. The two principal models that attempt to explain this relationship are the social causation theory, which posits that socioeconomic inequality causes stress that gives rise to mental illness, and the downward drift approach, which assumes that people predisposed to mental illness are reduced in socioeconomic status as a result of the illness. Most literature on these concepts dates back to the mid-1990s and leans heavily towards the social causation model.

Social Causation

The social causation theory is an older theory with more evidence and research behind it. This hypothesis states that one’s socioeconomic status (SES) is the cause of weakening mental functions. As Perry writes in The Journal of Primary Prevention, “members of the lower social classes experience excess psychological stress and relatively few societal rewards, the results of which are manifested in psychological disorder”. The excess stress that people with low SES experience could be inadequate health care, job insecurity, and poverty, which can bring about many other psycho-social and physical stressors like crowding, discrimination, crime, etc. Thus, lower SES predisposes individuals to the development of a mental illness.

Research

The Faris and Dunham (1939), Hollingshead and Redlich (1958), and Midtown Manhattan (1962) studies are three of the most influential in the debate between social causation and downward drift. They lend important evidence to the linear correlation between mental illness and SES, more specifically that a low SES produces a mental illness. The higher rates of mental illness in lower SES are likely due to the greater stress individuals experience. Issues that are not experienced in high SES, such as lack of housing, hunger, unemployment, etc., contribute to the psychological stress levels that can lead to the onset of mental illness. Additionally, while experiencing greater stress levels, there are fewer societal rewards and resources for those at the bottom of the socioeconomic ladder. The moderate economics assets available to those just one level above the lowest socioeconomic group allows them to take preventative action or treatment for psychoses. However, the hypothesis of the social causation model is disputed by the downward drift model.

Faris and Dunham (1939)

Faris and Dunham analysed the prevalence of mental disorders, including schizophrenia, in different areas of Chicago. The researchers plotted the homes of patients preceding their admission to hospitals. They found a remarkable increase of cases from the outskirts of the city moving inwards to the centre. This reflected other rates of distributions, such as unemployment, poverty and family desertion. They also found that cases of schizophrenia were most pervasive in public housing neighbourhoods as well as communities with higher numbers of immigrants. This was one of the first empirical, evidence-based studies supporting social causation theory.

Hollingshead and Redlich (1958)

Hollingshead and Redlich conducted a study in New Haven, Connecticut, that was considered a major breakthrough in this field of research. The authors identified anyone who was hospitalised or in treatment for mental illness by looking at files from clinics, hospitals, and the like. They were able to design a valid and reliable construct to relate these findings to social class using education and occupation as measures for five social class groups. Their results showed high disproportions of schizophrenia among the lowest social group. They also found that the lower people were on the scale of social class, the likelier they were to be admitted to a hospital for psychosis.

Midtown Manhattan Study (1962)

The study by Srole, Langer, Micheal, Opler, and Rennie, known as the Midtown Manhattan Study, has become a quintessential study in mental health. The main focus of the research was to “uncover [the] unknown portion of mental illness which is submerged in the community and thus hidden from sociological and psychiatric investigators alike”. The researchers managed to probe deep into the community to include subjects usually left out of such studies. The experimenters used both parental and personal SES to investigate the correlation between mental illness and social class. When basing their results on parental SES, approximately 33% of Midtown inhabitants in the lowest SES showed some signs of impairments in mental functioning while only 18% of the inhabitants in the highest SES showed these signs. When assessing the relationship based on personal SES, 47% of inhabitants in the lowest SES showed signs of weakening mental functions while only 13% of the highest SES demonstrated these symptoms. These findings remained the same for all ages and genders.

Downward Drift

In contrast to social causation, downward drift (also known as social selection) postulates that there is likely a genetic component that causes the onset of mental illness which may then lead to “a drift down into or fail to rise out of lower SES groups”. This means that a person’s SES level is a consequence rather than a cause of weakening mental functions. The downward drift theory shows promise specifically for individuals with a diagnosis of schizophrenia.

Research

Weich and Lewis (1998)

The Weich and Lewis study was conducted in the United Kingdom where researchers looked at 7,725 adults who had developed mental illnesses. They found that while low SES and unemployment may increase the length of psychiatric episodes they did not increase the likelihood of the initial psychotic break.

Isohanni et al. (2001)

In the Isohanni et al. longitudinal study in Finland, the researchers looked at patients treated in hospitals for mental disorders and who were aged between 16 and 29. The study followed the patients for 31 years and looked at how their illness affected their educational achievement. The study had a total of 80 patients and it compared patients who had been treated in the hospital for diagnoses of schizophrenia, and other psychotic or non-psychotic diagnoses, to those of the same 1966 birth cohort who had received no psychiatric treatment. They found that individuals who were hospitalised at 22 years or younger (early onset) were more likely to only complete a basic level of education and remain stagnant.

Some patients were able to complete secondary education, but none advanced to tertiary education. Those who had not been hospitalised had lower completion rates of basic education but much higher percentages of completing both secondary and tertiary education, 62% and 26%, respectively. This study suggests that mental disorders, especially schizophrenia, impede educational achievement. The inability to complete higher education may be one of the possible contributors to the downward drift in SES by individuals with mental illness.

Wiersma, Giel, De Jong and Slooff (1983)

The researchers in the Wiersma, Giel, De Jong and Slooff study looked at both educational and occupational attainment of patients with psychosis compared to their fathers. Researchers assessed both topic areas in the fathers as well as in the patients. In a two-year follow-up, the downward mobility in both education and occupation was greater than expected in the patients. Only a small percentage of patients were able to keep their job or find a new one after the onset of psychosis. Most of the individuals participating in the study had a lower SES than when they were born. This study also showed that the drift may begin with prodromal symptoms rather than at full onset.

Debate

Many researchers argue against the downward drift model, because unlike its counterpart, “it does not address the psychological stress of being impoverished and fails to validate that persistent economic stress can lead to psychological disturbance”. Mirowsky and Ross discuss in their book, Social Causes of Psychological Distress, that stress frequently stems from lack of control, or the feeling of lack of control, over one’s life. Those in lower SES have a minimal sense of control over the events that occur in their lives.

They argue that lack of control does not only stem from jobs with low income, but that “minority status also lowers the sense of control, partly because of lower education, income, and unemployment, and partly because any given level of achievement requires greater effort and provides fewer opportunities”. The arguments posed in their book support social causation since such high stress levels are involved. Although both models can be existing, they do not need to be mutually exclusive, researchers tend to agree that downward drift has more relevance to someone diagnosed with schizophrenia.

Implications for schizophrenia

Although social causation can explain some forms of mental illnesses, downward drift “has the greatest empirical support and is one of the cardinal features of schizophrenia”. The downward drift theory is more applicable to schizophrenia for a number of reasons. There are varying degrees of the disease, but once a psychotic break is experienced, the person often cannot function at the same level as before. This impairment affects all areas of life—education, occupation, social and family connections, etc. Due to the many challenges, patients will likely drift to a lower SES because they are unable to keep up with previous standards.

Another reason why the downward drift theory is preferred is that, unlike other mental illnesses such as depression, once someone is diagnosed with schizophrenia they have the diagnosis for life. While symptoms may not be constant, “individuals with this diagnosis often experience cycles of remission and relapse throughout their lives”.

This explains the large discrepancy between the incidence of schizophrenia and prevalence of the disease. There is a very low rate of new cases of schizophrenia in comparison to the number of total cases because “it often starts in early adult life and becomes chronic”. Patients will usually function at a lower level once the illness has manifested itself. Even with the help of antipsychotic medication and psycho-social support, most patients will still experience some symptoms making moving up out of a lower SES nearly impossible.

Another possible explanation discussed in literature regarding the relation between the downward drift theory and schizophrenia is the stigma associated with mental illness. Individuals with mental illness are often treated differently, usually negatively, by their community. Although great strides have been made, mental illness is often unfavourably stigmatised. As Livingston explains, “stigma can produce a negative spiraling effect on the life course of people with mental illnesses, which tends to create…a decline in social class”.

Individuals who develop schizophrenia cannot function at the level they are used to, and “are particularly likely to experience the effects of ostracism, being amongst the most stigmatized of all the mental illnesses.” The complete exclusion they experience helps to maintain their new lower status, preventing any upward mobility. The downward drift theory may be mainly applicable to schizophrenia; however, it may also apply to other mental illnesses since each is accompanied by a negative stigma.

While it can be hard to maintain status once the schizophrenia appears, some individuals are able to resist a downward drift, particularly if they start out at a higher SES. For example, if a person is from a high SES, they have the ability to access preventative resources and possible treatment for the disease which can help buffer the drift downwards and help maintain their status. It is also important for those with schizophrenia to have a strong network of friends and family because friends and family may notice signs of the illness before full onset. For example, individuals that are married show less of a drift downwards than those who are not. Individuals who do not have a support system may show early signs of psychotic symptoms that go unnoticed and untreated.

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Yes or No: Brain Electrodes May Be Long-Lasting Aid for Depression?

In connection with our previous post ‘Yes or No: There is a Link Between Depression and Serotonin?’, a small study (of 25 participants over 6-9 years) reported in the New Scientist (Klein, 2020) suggests that brain electrodes may be a long-lasting aid for those suffering with depression (Bergfeld et al., 2022).

References

Bergfeld, I.O., Ooms, P., Lok, A., de Rue, L., Vissers, P., de Knijff, D., Horst, F., Beute, G., van den Munckhof, P., Schuurman, P.R & Denys, D. (2022) Efficacy and Quality of Life after 6-9 Years of Deep Brain Stimulation for Depression. Brain Stimulation. 15(4), pp.957-964. https://www.brainstimjrnl.com/article/S1935-861X(22)00114-0/fulltext.

Klein, A. (2022) Brain Electrodes May Be Long-Lasting Aid for Depression. New Scientist. 09 July 2022, pp.12.

Yes or No: Is there a Link Between Depression and Serotonin?

Every year many suffering with depression are prescribed antidepressants to manage their condition, with antidepressants being described – by a spokesperson for the Royal College of Psychiatrists – as “an effective evidence-based treatment” (The Pharmaceutical Journal, 2022).

Within England, UK, “From 2021-22, there was a 5% rise in the number of adults receiving them – from 7.9 million in the previous 12 months to 8.3 million. [… with …] “An estimated 83.4 million antidepressant drug items were prescribed between 2021 and 2022, which marks a 5% increase from the previous year.” (BBC, 2022).

Within the US, Brody and Gu (2020) reported that “During 2015–2018, 13.2% of adults aged 18 and over used antidepressant medications in the past 30 days. [… and … ] In 2018, an estimated 7.2% of American adults had a major depressive episode in the past year. Carey and Geberloff reported in 2018 that “Nearly 25 million adults, like Ms. Toline, have been on antidepressants for at least two years, a 60 percent increase since 2010.”

Now it is important to remember that:

  • Depression is associated with diminished quality of life and increased disability;
  • Antidepressants are one of the primary treatments for depression;
  • Antidepressants are among the most frequently used therapeutic medications in the UK and US; and
  • There is research to suggest antidepressants work, at least in some people.

However, a new major analysis (by Moncrief et al., 2022) reported in the New Scientist suggests there is no link between serotonin levels and depression, raising questions about antidepressants that focus on this brain-signalling molecule (Wild, 2022, p.20).

Although this analysis suggests antidepressants might not be as effective as previously stated, brain electrodes might be. Read our next post about brain electrodes and depression here.

References

BBC (British Broadcasting Corporation). (2022) Nearly Half a Million More Adults on Antidepressants in England. Available from World Wide Web: https://www.bbc.co.uk/news/health-62094744. [Accessed: 17 November, 2022].

Carey, B. & Gebeloff, R. (2018) Many People Taking Antidepressants Discover They Cannot Quit. Available from World Wide Web: https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html. [Accessed: 17 November, 2022].

Moncrief, J., Cooper, R.E., Stockman, T., Amendola, S., Hengartner, M.P. & Horowitz, M.A. (2022) The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence. Molecular Psychiatry. doi.org/gqh6nd.

The Pharmaceutical Journal. (2022) Antidepressant Prescribing Increases by 35% in Six Years. Available from World Wide Web: https://pharmaceutical-journal.com/article/news/antidepressant-prescribing-increases-by-35-in-six-years. [Accessed: 17 November, 2022].

Wild, S. (2022) No Link between Depression and Serotonin, Finds Major Analysis. New Scientist. 30 July 2022, pp.20.

What is the Maudsley Bipolar Twin Study?

Introduction

The Maudsley Bipolar Twin Study is an ongoing twin study of bipolar disorder running at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London since 2003.

Refer to Maudsley Hospital.

Outline

The study is investigating possible differences between people with a diagnosis of bipolar disorder and people without the diagnosis. In particular it is investigating difference in cognition and brain structure/function.

The Maudsley Study of bipolar disorder investigates different aspects of thinking, such as memory and attention, in twins with and without bipolar disorder. The tasks participants complete involve defining words and solving different kinds of problems. With adequate numbers of twins participating in the study, the hope is to understand any differences between these two groups. The eventual aim is to increase understanding of this complex mood disorder and to enhance future therapies for it.

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Research: Partnership History and Mental Health over Time

Study Objective

To describe the mental health of men and women with differing histories of partnership transitions.

Design

Data from nine waves of the British Household Panel Survey, a stratified general population sample, were used to calculate age standardised ratios and 95% confidence intervals for mean General Health Questionnaire scores for groups with different partnership transition histories.

Participants

2,127 men and 2,303 women aged under 65 who provided full interviews at every survey wave.

Main Results

Enduring first partnerships were associated with good mental health. Partnership splits were associated with poorer mental health, although the reformation of partnerships partially reversed this. Cohabiting was more beneficial to men’s mental health, whereas marriage was more beneficial to women’s mental health. The more recently a partnership split had occurred the greater the negative outcome for mental health. Women seemed more adversely affected by multiple partnership transitions and to take longer to recover from partnership splits than men. Single women had good mental health relative to other women but the same was not true for single men relative to other male partnership groups.

Conclusions

Partnership was protective of mental health. Mental health was worse immediately after partnership splits, and the negative outcomes for health were longer lasting in women. Future work should consider other factors that may mediate, confound, or jointly determine the relation between partnership change and health.

Reference

Willitts, M., Benzeval, M. & Stansfield, S. (2004) Partnership History and Mental Health Over Time. Journal of Epidemiology and Community Health. 58(1), pp.53-58. https://jech.bmj.com/content/58/1/53.short.

An Overview of the Biology of Depression

Introduction

Scientific studies have found that different brain areas show altered activity in people with major depressive disorder (MDD), and this has encouraged advocates of various theories that seek to identify a biochemical origin of the disease, as opposed to theories that emphasize psychological or situational causes.

Factors spanning these causative groups include nutritional deficiencies in magnesium, vitamin D, and tryptophan with situational origin but biological impact. Several theories concerning the biologically based cause of depression have been suggested over the years, including theories revolving around monoamine neurotransmitters, neuroplasticity, neurogenesis, inflammation and the circadian rhythm. Physical illnesses, including hypothyroidism and mitochondrial disease, can also trigger depressive symptoms.

Neural circuits implicated in depression include those involved in the generation and regulation of emotion, as well as in reward. Abnormalities are commonly found in the lateral prefrontal cortex whose putative function is generally considered to involve regulation of emotion. Regions involved in the generation of emotion and reward such as the amygdala, anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), and striatum are frequently implicated as well. These regions are innervated by a monoaminergic nuclei, and tentative evidence suggests a potential role for abnormal monoaminergic activity.

Genetic Factors

Difficulty of Gene Studies

Historically, candidate gene studies have been a major focus of study. However, as the number of genes reduces the likelihood of choosing a correct candidate gene, Type I errors (false positives) are highly likely. Candidate genes studies frequently possess a number of flaws, including frequent genotyping errors and being statistically underpowered. These effects are compounded by the usual assessment of genes without regard for gene-gene interactions. These limitations are reflected in the fact that no candidate gene has reached genome-wide significance.

Gene Candidates

5-HTTLPR

The 5-HTTLPR, or serotonin transporter promoter gene’s short allele, has been associated with increased risk of depression; since the 1990s, however, results have been inconsistent. Other genes that have been linked to a gene-environment interaction include CRHR1, FKBP5 and BDNF, the first two of which are related to the stress reaction of the HPA axis, and the latter of which is involved in neurogenesis. Candidate gene analysis of 5-HTTLPR on depression was inconclusive on its effect, either alone or in combination with life stress.

A 2003 study proposed that a gene-environment interaction (GxE) may explain why life stress is a predictor for depressive episodes in some individuals, but not in others, depending on an allelic variation of the serotonin-transporter-linked promoter region (5-HTTLPR). This hypothesis was widely-discussed in both the scientific literature and popular media, where it was dubbed the “Orchid gene”, but has conclusively failed to replicate in much larger samples, and the observed effect sizes in earlier work are not consistent with the observed polygenicity of depression.

BDNF

BDNF polymorphisms have also been hypothesized to have a genetic influence, but early findings and research failed to replicate in larger samples, and the effect sizes found by earlier estimates are inconsistent with the observed polygenicity of depression.

SIRT1 and LHPP

A 2015 GWAS study in Han Chinese women positively identified two variants in intronic regions near SIRT1 and LHPP with a genome-wide significant association.

Norepinephrine Transporter Polymorphisms

Attempts to find a correlation between norepinephrine transporter polymorphisms and depression have yielded negative results.

One review identified multiple frequently studied candidate genes. The genes encoding for the 5-HTT and 5-HT2A receptor were inconsistently associated with depression and treatment response. Mixed results were found for brain-derived neurotrophic factor (BDNF) Val66Met polymorphisms. Polymorphisms in the tryptophan hydroxylase gene was found to be tentatively associated with suicidal behaviour. A meta analysis of 182 case controlled genetic studies published in 2008 found Apolipoprotein E verepsilon 2 to be protective, and GNB3 825T, MTHFR 677T, SLC6A4 44bp insertion or deletions, and SLC6A3 40 bpVNTR 9/10 genotype to confer risk.

Circadian Rhythm

Depression may be related to abnormalities in the circadian rhythm, or biological clock.

A well synchronised circadian rhythm is critical for maintaining optimal health. Adverse changes and alterations in the circadian rhythm have been associated various neurological disorders and mood disorders including depression.

Depression may be related to the same brain mechanisms that control the cycles of sleep and wakefulness.

Sleep

Sleep disturbance is the most prominent symptom in depressive patients. Studies about sleep electroencephalograms have shown characteristic changes in depression such as reductions in non-rapid eye movement sleep production, disruptions of sleep continuity and disinhibition of rapid eye movement (REM) sleep. Rapid eye movement (REM) sleep – the stage in which dreaming occurs – may be quick to arrive and intense in depressed people. REM sleep depends on decreased serotonin levels in the brain stem, and is impaired by compounds, such as antidepressants, that increase serotonergic tone in brain stem structures. Overall, the serotonergic system is least active during sleep and most active during wakefulness. Prolonged wakefulness due to sleep deprivation activates serotonergic neurons, leading to processes similar to the therapeutic effect of antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs). Depressed individuals can exhibit a significant lift in mood after a night of sleep deprivation. SSRIs may directly depend on the increase of central serotonergic neurotransmission for their therapeutic effect, the same system that impacts cycles of sleep and wakefulness.

Light Therapy

Research on the effects of light therapy on seasonal affective disorder suggests that light deprivation is related to decreased activity in the serotonergic system and to abnormalities in the sleep cycle, particularly insomnia. Exposure to light also targets the serotonergic system, providing more support for the important role this system may play in depression. Sleep deprivation and light therapy both target the same brain neurotransmitter system and brain areas as antidepressant drugs, and are now used clinically to treat depression. Light therapy, sleep deprivation and sleep time displacement (sleep phase advance therapy) are being used in combination quickly to interrupt a deep depression in people who are hospitalised for MDD.

Increased and decreased sleep length appears to be a risk factor for depression. People with MDD sometimes show diurnal and seasonal variation of symptom severity, even in non-seasonal depression. Diurnal mood improvement was associated with activity of dorsal neural networks. Increased mean core temperature was also observed. One hypothesis proposed that depression was a result of a phase shift.

Daytime light exposure correlates with decreased serotonin transporter activity, which may underlie the seasonality of some depression.

Monoamines

Monoamines are neurotransmitters that include serotonin, dopamine, norepinephrine, and epinephrine.

Illustration of the major elements in a prototypical synapse. Synapses are gaps between nerve cells. These cells convert their electrical impulses into bursts of chemical relayers, called neurotransmitters, which travel across the synapses to receptors on adjacent cells, triggering electrical impulses to travel down the latter cells.

Monoamine Hypothesis of Depression

Many antidepressant drugs acutely increase synaptic levels of the monoamine neurotransmitter, serotonin, but they may also enhance the levels of norepinephrine and dopamine. The observation of this efficacy led to the monoamine hypothesis of depression, which postulates that the deficit of certain neurotransmitters is responsible for depression, and even that certain neurotransmitters are linked to specific symptoms. Normal serotonin levels have been linked to mood and behaviour regulation, sleep, and digestion; norepinephrine to the fight-or-flight response; and dopamine to movement, pleasure, and motivation. Some have also proposed the relationship between monoamines and phenotypes such as serotonin in sleep and suicide, norepinephrine in dysphoria, fatigue, apathy, cognitive dysfunction, and dopamine in loss of motivation and psychomotor symptoms.[31] The main limitation for the monoamine hypothesis of depression is the therapeutic lag between initiation of antidepressant treatment and perceived improvement of symptoms. One explanation for this therapeutic lag is that the initial increase in synaptic serotonin is only temporary, as firing of serotonergic neurons in the dorsal raphe adapt via the activity of 5-HT1A autoreceptors. The therapeutic effect of antidepressants is thought to arise from autoreceptor desensitization over a period of time, eventually elevating firing of serotonergic neurons.

Serotonin

Initial studies of serotonin in depression examined peripheral measures such as the serotonin metabolite 5-Hydroxyindoleacetic acid (5-HIAA) and platelet binding. The results were generally inconsistent, and may not generalise to the central nervous system. However evidence from receptor binding studies and pharmacological challenges provide some evidence for dysfunction of serotonin neurotransmission in depression. Serotonin may indirectly influence mood by altering emotional processing biases that are seen at both the cognitive/behavioural and neural level. Pharmacologically reducing serotonin synthesis, and pharmacologically enhancing synaptic serotonin can produce and attenuate negative affective biases, respectively. These emotional processing biases may explain the therapeutic gap.

Dopamine

While various abnormalities have been observed in dopaminergic systems, results have been inconsistent. People with MDD have an increased reward response to dextroamphetamine compared to controls, and it has been suggested that this results from hypersensitivity of dopaminergic pathways due to natural hypoactivity. While polymorphisms of the D4 and D3 receptor have been implicated in depression, associations have not been consistently replicated. Similar inconsistency has been found in post-mortem studies, but various dopamine receptor agonists show promise in treating MDD. There is some evidence that there is decreased nigrostriatal pathway activity in people with melancholic depression (psychomotor retardation). Further supporting the role of dopamine in depression is the consistent finding of decreased cerebrospinal fluid and jugular metabolites of dopamine, as well as post mortem findings of altered Dopamine receptor D3 and dopamine transporter expression. Studies in rodents have supported a potential mechanism involving stress-induced dysfunction of dopaminergic systems.

Monoamine receptors affect phospholipase C and adenylyl cyclase inside of the cell. Green arrows means stimulation and red arrows inhibition. Serotonin receptors are blue, norepinephrine orange, and dopamine yellow. Phospholipase C and adenylyl cyclase start a signalling cascade which turn on or off genes in the cell. Sufficient ATP from mitochondria is required for these downstream signalling events. The 5HT-3 receptor is associated with gastrointestinal adverse effects and has no relationship to the other monoamine receptors.

Catecholamines

A number of lines of evidence indicative of decreased adrenergic activity in depression have been reported. Findings include the decreased activity of tyrosine hydroxylase, decreased size of the locus coeruleus, increased alpha 2 adrenergic receptor density, and decreased alpha 1 adrenergic receptor density. Furthermore, norepinephrine transporter knockout in mice models increases their tolerance to stress, implicating norepinephrine in depression.

One method used to study the role of monoamines is monoamine depletion. Depletion of tryptophan (the precursor of serotonin), tyrosine and phenylalanine (precursors to dopamine) does result in decreased mood in those with a predisposition to depression, but not in persons lacking the predisposition. On the other hand, inhibition of dopamine and norepinephrine synthesis with alpha-methyl-para-tyrosine does not consistently result in decreased mood.

Monoamine Oxidase

An offshoot of the monoamine hypothesis suggests that monoamine oxidase A (MAO-A), an enzyme which metabolises monoamines, may be overly active in depressed people. This would, in turn, cause the lowered levels of monoamines. This hypothesis received support from a PET study, which found significantly elevated activity of MAO-A in the brain of some depressed people. In genetic studies, the alterations of MAO-A-related genes have not been consistently associated with depression. Contrary to the assumptions of the monoamine hypothesis, lowered but not heightened activity of MAO-A was associated with depressive symptoms in adolescents. This association was observed only in maltreated youth, indicating that both biological (MAO genes) and psychological (maltreatment) factors are important in the development of depressive disorders. In addition, some evidence indicates that disrupted information processing within neural networks, rather than changes in chemical balance, might underlie depression.

Limitations

Since the 1990s, research has uncovered multiple limitations of the monoamine hypothesis, and its inadequacy has been criticised within the psychiatric community. For one thing, serotonin system dysfunction cannot be the sole cause of depression. Not all patients treated with antidepressants show improvements despite the usually rapid increase in synaptic serotonin. If significant mood improvements do occur, this is often not for at least two to four weeks. One possible explanation for this lag is that the neurotransmitter activity enhancement is the result of auto receptor desensitization, which can take weeks. Intensive investigation has failed to find convincing evidence of a primary dysfunction of a specific monoamine system in people with MDD. The antidepressants that do not act through the monoamine system, such as tianeptine and opipramol, have been known for a long time. There have also been inconsistent findings with regard to levels of serum 5-HIAA, a metabolite of serotonin. Experiments with pharmacological agents that cause depletion of monoamines have shown that this depletion does not cause depression in healthy people. Another problem that presents is that drugs that deplete monoamines may actually have antidepressant properties. Further, some have argued that depression may be marked by a hyperserotonergic state. Already limited, the monoamine hypothesis has been further oversimplified when presented to the general public.

Receptor Binding

As of 2012, efforts to determine differences in neurotransmitter receptor expression or for function in the brains of people with MDD using positron emission tomography (PET) had shown inconsistent results. Using the PET imaging technology and reagents available as of 2012, it appeared that the D1 receptor may be under-expressed in the striatum of people with MDD. 5-HT1A receptor binding literature is inconsistent; however, it leans towards a general decrease in the mesiotemporal cortex. 5-HT2A receptor binding appears to be unregulated in people with MDD. Results from studies on 5-HTT binding are variable, but tend to indicate higher levels in people with MDD. Results with D2/D3 receptor binding studies are too inconsistent to draw any conclusions. Evidence supports increased MAO activity in people with MDD, and it may even be a trait marker (not changed by response to treatment). Muscarinic receptor binding appears to be increased in depression, and, given ligand binding dynamics, suggests increased cholinergic activity.

Four meta analyses on receptor binding in depression have been performed, two on serotonin transporter (5-HTT), one on 5-HT1A, and another on dopamine transporter (DAT). One meta analysis on 5-HTT reported that binding was reduced in the midbrain and amygdala, with the former correlating with greater age, and the latter correlating with depression severity. Another meta-analysis on 5-HTT including both post-mortem and in vivo receptor binding studies reported that while in vivo studies found reduced 5-HTT in the striatum, amygdala and midbrain, post mortem studies found no significant associations. 5-HT1A was found to be reduced in the anterior cingulate cortex, mesiotemporal lobe, insula, and hippocampus, but not in the amygdala or occipital lobe. The most commonly used 5-HT1A ligands are not displaced by endogenous serotonin, indicating that receptor density or affinity is reduced. Dopamine transporter binding is not changed in depression.

Emotional Processing and Neural Circuits

Emotional Bias

People with MDD show a number of biases in emotional processing, such as a tendency to rate happy faces more negatively, and a tendency to allocate more attentional resources to sad expressions. Depressed people also have impaired recognition of happy, angry, disgusted, fearful and surprised, but not sad faces. Functional neuroimaging has demonstrated hyperactivity of various brain regions in response to negative emotional stimuli, and hypoactivity in response to positive stimuli. One meta analysis reported that depressed subjects showed decreased activity in the left dorsolateral prefrontal cortex and increased activity in the amygdala in response to negative stimuli. Another meta analysis reported elevated hippocampus and thalamus activity in a subgroup of depressed subjects who were medication naïve, not elderly, and had no comorbidities. The therapeutic lag of antidepressants has been suggested to be a result of antidepressants modifying emotional processing leading to mood changes. This is supported by the observation that both acute and sub-chronic SSRI administration increases response to positive faces. Antidepressant treatment appears to reverse mood congruent biases in limbic, prefrontal, and fusiform areas. dlPFC response is enhanced and amygdala response is attenuated during processing of negative emotions, the former or which is thought to reflect increased top down regulation. The fusiform gyrus and other visual processing areas respond more strongly to positive stimuli with antidepressant treatment, which is thought to reflect the a positive processing bias. These effects do not appear to be unique to serotonergic or noradrenergic antidepressants, but also occur in other forms of treatment such as deep brain stimulation.

Neural Circuits

One meta analysis of functional neuroimaging in depression observed a pattern of abnormal neural activity hypothesized to reflect an emotional processing bias. Relative to controls, people with MDD showed hyperactivity of circuits in the salience network (SN), composed of the pulvinar nuclei, the insula, and the dorsal anterior cingulate cortex (dACC), as well as decreased activity in regulatory circuits composed of the striatum and dlPFC.

A neuroanatomical model called the limbic-cortical model has been proposed to explain early biological findings in depression. The model attempts to relate specific symptoms of depression to neurological abnormalities. Elevated resting amygdala activity was proposed to underlie rumination, as stimulation of the amygdala has been reported to be associated with the intrusive recall of negative memories. The ACC was divided into pregenual (pgACC) and subgenual regions (sgACC), with the former being electrophysiologically associated with fear, and the latter being metabolically implicated in sadness in healthy subjects. Hyperactivity of the lateral orbitofrontal and insular regions, along with abnormalities in lateral prefrontal regions was suggested to underlie maladaptive emotional responses, given the regions roles in reward learning. This model and another termed “the cortical striatal model”, which focused more on abnormalities in the cortico-basal ganglia-thalamo-cortical loop, have been supported by recent literature. Reduced striatal activity, elevated OFC activity, and elevated sgACC activity were all findings consistent with the proposed models. However, amygdala activity was reported to be decreased, contrary to the limbic-cortical model. Furthermore, only lateral prefrontal regions were modulated by treatment, indicating that prefrontal areas are state markers (i.e. dependent upon mood), while subcortical abnormalities are trait markers (i.e. reflect a susceptibility).

Reward

While depression severity as a whole is not correlated with a blunted neural response to reward, anhedonia is directly correlated to reduced activity in the reward system. The study of reward in depression is limited by heterogeneity in the definition and conceptualisations of reward and anhedonia. Anhedonia is broadly defined as a reduced ability to feel pleasure, but questionnaires and clinical assessments rarely distinguish between motivational “wanting” and consummatory “liking”. While a number of studies suggest that depressed subjects rate positive stimuli less positively and as less arousing, a number of studies fail to find a difference. Furthermore, response to natural rewards such as sucrose does not appear to be attenuated. General affective blunting may explain “anhedonic” symptoms in depression, as meta analysis of both positive and negative stimuli reveal reduced rating of intensity. As anhedonia is a prominent symptom of depression, direct comparison of depressed with healthy subjects reveals increased activation of the subgenual anterior cingulate cortex (sgACC), and reduced activation of the ventral striatum, and in particular the nucleus accumbens (NAcc) in response to positive stimuli. Although the finding of reduced NAcc activity during reward paradigms is fairly consistent, the NAcc is made up of a functionally diverse range of neurons, and reduced blood-oxygen-level dependent (BOLD) signal in this region could indicate a variety of things including reduced afferent activity or reduced inhibitory output. Nevertheless, these regions are important in reward processing, and dysfunction of them in depression is thought to underlie anhedonia. Residual anhedonia that is not well targeted by serotonergic antidepressants is hypothesized to result from inhibition of dopamine release by activation of 5-HT2C receptors in the striatum. The response to reward in the medial orbitofrontal cortex (OFC) is attenuated in depression, while lateral OFC response is enhanced to punishment. The lateral OFC shows sustained response to absence of reward or punishment, and it is thought to be necessary for modifying behaviour in response to changing contingencies. Hypersensitivity in the lOFC may lead to depression by producing a similar effect to learned helplessness in animals.

Elevated response in the sgACC is a consistent finding in neuroimaging studies using a number of paradigms including reward related tasks. Treatment is also associated with attenuated activity in the sgACC, and inhibition of neurons in the rodent homologue of the sgACC, the infralimbic cortex (IL), produces an antidepressant effect. Hyperactivity of the sgACC has been hypothesized to lead to depression via attenuating the somatic response to reward or positive stimuli. Contrary to studies of functional magnetic resonance imaging response in the sgACC during tasks, resting metabolism is reduced in the sgACC. However, this is only apparent when correcting for the prominent reduction in sgACC volume associated with depression; structural abnormalities are evident at a cellular level, as neuropathological studies report reduced sgACC cell markers. The model of depression proposed from these findings by Drevets et al. suggests that reduced sgACC activity results in enhanced sympathetic nervous system activity and blunted HPA axis feedback. Activity in the sgACC may also not be causal in depression, as the authors of one review that examined neuroimaging in depressed subjects during emotional regulation hypothesized that the pattern of elevated sgACC activity reflected increased need to modulate automatic emotional responses in depression. More extensive sgACC and general prefrontal recruitment during positive emotional processing was associated with blunted subcortical response to positive emotions, and subject anhedonia. This was interpreted by the authors to reflect a downregulation of positive emotions by the excessive recruitment of the prefrontal cortex.

Neuroanatomy

While a number of neuroimaging findings are consistently reported in people with major depressive disorder, the heterogeneity of depressed populations presents difficulties interpreting these findings. For example, averaging across populations may hide certain subgroup related findings; while reduced dlPFC activity is reported in depression, a subgroup may present with elevated dlPFC activity. Averaging may also yield statistically significant findings, such as reduced hippocampal volumes, that are actually present in a subgroup of subjects. Due to these issues and others, including the longitudinal consistency of depression, most neural models are likely inapplicable to all depression.

Structural Neuroimaging

Meta analyses performed using seed-based d mapping have reported grey matter reductions in a number of frontal regions. One meta analysis of early onset general depression reported grey matter reductions in the bilateral anterior cingulate cortex (ACC) and dorsomedial prefrontal cortex (dmPFC). One meta analysis on first episode depression observed distinct patterns of grey matter reductions in medication free, and combined populations; medication free depression was associated with reductions in the right dorsolateral prefrontal cortex, right amygdala, and right inferior temporal gyrus; analysis on a combination of medication free and medicated depression found reductions in the left insula, right supplementary motor area, and right middle temporal gyrus. Another review distinguishing medicated and medication free populations, albeit not restricted to people with their first episode of MDD, found reductions in the combined population in the bilateral superior, right middle, and left inferior frontal gyrus, along with the bilateral parahippocampus. Increases in thalamic and ACC grey matter was reported in the medication free and medicated populations respectively. A meta analysis performed using “activation likelihood estimate” reported reductions in the paracingulate cortex, dACC and amygdala.

GMV reductions in MDD and BD.

Using statistical parametric mapping, one meta analysis replicated previous findings of reduced grey matter in the ACC, medial prefrontal cortex, inferior frontal gyrus, hippocampus and thalamus; however reductions in the OFC and ventromedial prefrontal cortex grey matter were also reported.

Two studies on depression from the ENIGMA consortium have been published, one on cortical thickness, and the other on subcortical volume. Reduced cortical thickness was reported in the bilateral OFC, ACC, insula, middle temporal gyri, fusiform gyri, and posterior cingulate cortices, while surface area deficits were found in medial occipital, inferior parietal, orbitofrontal and precentral regions. Subcortical abnormalities, including reductions in hippocampus and amygdala volumes, which were especially pronounced in early onset depression.

Multiple meta analysis have been performed on studies assessing white matter integrity using fractional anisotropy (FA). Reduced FA has been reported in the corpus callosum (CC) in both first episode medication naïve, and general major depressive populations. The extent of CC reductions differs from study to study. People with MDD who have not taken antidepressants before have been reported to have reductions only in the body of the CC and only in the genu of the CC. On the other hand, general MDD samples have been reported to have reductions in the body of the CC, the body and genu of the CC, and only the genu of the CC. Reductions of FA have also been reported in the anterior limb of the internal capsule (ALIC) and superior longitudinal fasciculus.

Functional Neuroimaging

Studies of resting state activity have utilised a number of indicators of resting state activity, including regional homogeneity (ReHO), amplitude of low frequency fluctuations (ALFF), fractional amplitude of low frequency fluctuations (fALFF), arterial spin labelling (ASL), and positron emission tomography measures of regional cerebral blood flow or metabolism.

MDD is associated with reduced FA in the ALIC and genu/body of the CC.

Studies using ALFF and fALFF have reported elevations in ACC activity, with the former primarily reporting more ventral findings, and the latter more dorsal findings. A conjunction analysis of ALFF and CBF studies converged on the left insula, with previously untreated people having increased insula activity. Elevated caudate CBF was also reported A meta analysis combining multiple indicators of resting activity reported elevated anterior cingulate, striatal, and thalamic activity and reduced left insula, post-central gyrus and fusiform gyrus activity. An activation likelihood estimate (ALE) meta analysis of PET/SPECT resting state studies reported reduced activity in the left insula, pregenual and dorsal anterior cingulate cortex and elevated activity in the thalamus, caudate, anterior hippocampus and amygdala. Compared to the ALE meta analysis of PET/SPECT studies, a study using multi-kernel density analysis reported hyperactivity only in the pulvinar nuclei of the thalamus.

Brain Regions

Research on the brains of people with MDD usually shows disturbed patterns of interaction between multiple parts of the brain. Several areas of the brain are implicated in studies seeking to more fully understand the biology of depression:

Subgenual Cingulate

Studies have shown that Brodmann area 25, also known as subgenual cingulate, is metabolically overactive in treatment-resistant depression. This region is extremely rich in serotonin transporters and is considered as a governor for a vast network involving areas like hypothalamus and brain stem, which influences changes in appetite and sleep; the amygdala and insula, which affect the mood and anxiety; the hippocampus, which plays an important role in memory formation; and some parts of the frontal cortex responsible for self-esteem. Thus disturbances in this area or a smaller than normal size of this area contributes to depression. Deep brain stimulation has been targeted to this region in order to reduce its activity in people with treatment resistant depression.

Prefrontal Cortex

One review reported hypoactivity in the prefrontal cortex of those with depression compared to controls. The prefrontal cortex is involved in emotional processing and regulation, and dysfunction of this process may be involved in the aetiology of depression. One study on antidepressant treatment found an increase in PFC activity in response to administration of antidepressants. One meta analysis published in 2012 found that areas of the prefrontal cortex were hypoactive in response to negative stimuli in people with MDD. One study suggested that areas of the prefrontal cortex are part of a network of regions including dorsal and pregenual cingulate, bilateral middle frontal gyrus, insula and superior temporal gyrus that appear to be hypoactive in people with MDD. However the authors cautioned that the exclusion criteria, lack of consistency and small samples limit results.

Amygdala

The amygdala, a structure involved in emotional processing appears to be hyperactive in those with major depressive disorder. The amygdala in unmedicated depressed persons tended to be smaller than in those that were medicated, however aggregate data shows no difference between depressed and healthy persons. During emotional processing tasks right amygdala is more active than the left, however there is no differences during cognitive tasks, and at rest only the left amygdala appears to be more hyperactive. One study, however, found no difference in amygdala activity during emotional processing tasks.

Hippocampus

Atrophy of the hippocampus has been observed during depression, consistent with animal models of stress and neurogenesis.

Stress can cause depression and depression-like symptoms through monoaminergic changes in several key brain regions as well as suppression in hippocampal neurogenesis. This leads to alteration in emotion and cognition related brain regions as well as HPA axis dysfunction. Through the dysfunction, the effects of stress can be exacerbated including its effects on 5-HT. Furthermore, some of these effects are reversed by antidepressant action, which may act by increasing hippocampal neurogenesis. This leads to a restoration in HPA activity and stress reactivity, thus restoring the deleterious effects induced by stress on 5-HT.

The hypothalamic-pituitary-adrenal axis is a chain of endocrine structures that are activated during the body’s response to stressors of various sorts. The HPA axis involves three structure, the hypothalamus which release CRH that stimulates the pituitary gland to release ACTH which stimulates the adrenal glands to release cortisol. Cortisol has a negative feedback effect on the pituitary gland and hypothalamus. In people with MDD this often shows increased activation in depressed people, but the mechanism behind this is not yet known. Increased basal cortisol levels and abnormal response to dexamethasone challenges have been observed in people with MDD. Early life stress has been hypothesized as a potential cause of HPA dysfunction. HPA axis regulation may be examined through a dexamethasone suppression tests, which tests the feedback mechanisms. Non-suppression of dexamethasone is a common finding in depression, but is not consistent enough to be used as a diagnostic tool. HPA axis changes may be responsible for some of the changes such as decreased bone mineral density and increased weight found in people with MDD. One drug, ketoconazole, currently under development has shown promise in treating MDD.

Hippocampal Neurogenesis

Reduced hippocampal neurogenesis leads to a reduction in hippocampal volume. A genetically smaller hippocampus has been linked to a reduced ability to process psychological trauma and external stress, and subsequent predisposition to psychological illness. Depression without familial risk or childhood trauma has been linked to a normal hippocampal volume but localised dysfunction.

Animal Models

A number of animal models exist for depression, but they are limited in that depression involves primarily subjective emotional changes. However, some of these changes are reflected in physiology and behaviour, the latter of which is the target of many animal models. These models are generally assessed according to four facets of validity; the reflection of the core symptoms in the model; the predictive validity of the model; the validity of the model with regard to human characteristics of aetiology; and the biological plausibility.

Different models for inducing depressive behaviours have been utilised; neuroanatomical manipulations such as olfactory bulbectomy or circuit specific manipulations with optogenetics; genetic models such as 5-HT1A knockout or selectively bred animals; models involving environmental manipulation associated with depression in humans, including chronic mild stress, early life stress and learned helplessness. The validity of these models in producing depressive behaviours may be assessed with a number of behavioural tests. Anhedonia and motivational deficits may, for example, be assessed via examining an animal’s level of engagement with rewarding stimuli such as sucrose or intracranial self-stimulation. Anxious and irritable symptoms may be assessed with exploratory behaviour in the presence of a stressful or novelty environment, such as the open field test, novelty suppressed feeding, or the elevated plus-maze. Fatigue, psychomotor poverty, and agitation may be assessed with locomotor activity, grooming activity, and open field tests.

Animal models possess a number of limitations due to the nature of depression. Some core symptoms of depression, such as rumination, low self-esteem, guilt, and depressed mood cannot be assessed in animals as they require subjective reporting. From an evolutionary standpoint, the behaviour correlates of defeats of loss are thought to be an adaptive response to prevent further loss. Therefore, attempts to model depression that seeks to induce defeat or despair may actually reflect adaption and not disease. Furthermore, while depression and anxiety are frequently comorbid, dissociation of the two in animal models is difficult to achieve. Pharmacological assessment of validity is frequently disconnected from clinical pharmacotherapeutics in that most screening tests assess acute effects, while antidepressants normally take a few weeks to work in humans.

Neurocircuits

Regions involved in reward are common targets of manipulation in animal models of depression, including the nucleus accumbens (NAc), ventral tegmental area (VTA), ventral pallidum (VP), lateral habenula (LHb) and medial prefrontal cortex (mPFC). Tentative fMRI studies in humans demonstrate elevated LHb activity in depression. The lateral habenula projects to the RMTg to drive inhibition of dopamine neurons in the VTA during omission of reward. In animal models of depression, elevated activity has been reported in LHb neurons that project to the ventral tegmental area (ostensibly reducing dopamine release). The LHb also projects to aversion reactive mPFC neurons, which may provide an indirect mechanism for producing depressive behaviours. Learned helplessness induced potentiation of LHb synapses are reversed by antidepressant treatment, providing predictive validity. A number of inputs to the LHb have been implicated in producing depressive behaviours. Silencing GABAergic projections from the NAc to the LHb reduces conditioned place preference induced in social aggression, and activation of these terminals induces CPP. Ventral pallidum firing is also elevated by stress induced depression, an effect that is pharmacologically valid, and silencing of these neurons alleviates behavioural correlates of depression. Tentative in vivo evidence from people with MDD suggests abnormalities in dopamine signalling. This led to early studies investigating VTA activity and manipulations in animal models of depression. Massive destruction of VTA neurons enhances depressive behaviours, while VTA neurons reduce firing in response to chronic stress. However, more recent specific manipulations of the VTA produce varying results, with the specific animal model, duration of VTA manipulation, method of VTA manipulation, and subregion of VTA manipulation all potentially leading to differential outcomes. Stress and social defeat induced depressive symptoms, including anhedonia, are associated with potentiation of excitatory inputs to Dopamine D2 receptor-expressing medium spiny neurons (D2-MSNs) and depression of excitatory inputs to Dopamine D1 receptor-expressing medium spiny neurons (D1-MSNs). Optogenetic excitation of D1-MSNs alleviates depressive symptoms and is rewarding, while the same with D2-MSNs enhances depressive symptoms. Excitation of glutaminergic inputs from the ventral hippocampus reduces social interactions, and enhancing these projections produces susceptibility to stress-induced depression. Manipulations of different regions of the mPFC can produce and attenuate depressive behaviours. For example, inhibiting mPFC neurons specifically in the intralimbic cortex attenuates depressive behaviours. The conflicting findings associated with mPFC stimulation, when compared to the relatively specific findings in the infralimbic cortex, suggest that the prelimbic cortex and infralimbic cortex may mediate opposing effects. mPFC projections to the raphe nuclei are largely GABAergic and inhibit the firing of serotonergic neurons. Specific activation of these regions reduce immobility in the forced swim test but do not affect open field or forced swim behaviour. Inhibition of the raphe shifts the behavioural phenotype of uncontrolled stress to a phenotype closer to that of controlled stress.

Altered Neuroplasticity

Recent studies have called attention to the role of altered neuroplasticity in depression. A review found a convergence of three phenomena:

  • Chronic stress reduces synaptic and dendritic plasticity;
  • Depressed subjects show evidence of impaired neuroplasticity (e.g. shortening and reduced complexity of dendritic trees); and
  • Anti-depressant medications may enhance neuroplasticity at both a molecular and dendritic level.

The conclusion is that disrupted neuroplasticity is an underlying feature of depression, and is reversed by antidepressants.

Blood levels of BDNF in people with MDD increase significantly with antidepressant treatment and correlate with decrease in symptoms. Post mortem studies and rat models demonstrate decreased neuronal density in the prefrontal cortex thickness in people with MDD. Rat models demonstrate histological changes consistent with MRI findings in humans, however studies on neurogenesis in humans are limited. Antidepressants appear to reverse the changes in neurogenesis in both animal models and humans.

Inflammation

Various reviews have found that general inflammation may play a role in depression. One meta analysis of cytokines in people with MDD found increased levels of pro-inflammatory IL-6 and TNF-a levels relative to controls. The first theories came about when it was noticed that interferon therapy caused depression in a large number of people receiving it. Meta analysis on cytokine levels in people with MDD have demonstrated increased levels of IL-1, IL-6, C-reactive protein, but not IL-10. Increased numbers of T-Cells presenting activation markers, levels of neopterin, IFN gamma, sTNFR, and IL-2 receptors have been observed in depression. Various sources of inflammation in depressive illness have been hypothesized and include trauma, sleep problems, diet, smoking and obesity. Cytokines, by manipulating neurotransmitters, are involved in the generation of sickness behaviour, which shares some overlap with the symptoms of depression. Neurotransmitters hypothesized to be affected include dopamine and serotonin, which are common targets for antidepressant drugs. Induction of indolamine-2,3 dioxygenease by cytokines has been proposed as a mechanism by which immune dysfunction causes depression. One review found normalization of cytokine levels after successful treatment of depression. A meta analysis published in 2014 found the use of anti-inflammatory drugs such as NSAIDs and investigational cytokine inhibitors reduced depressive symptoms. Exercise can act as a stressor, decreasing the levels of IL-6 and TNF-a and increasing those of IL-10, an anti-inflammatory cytokine.

Inflammation is also intimately linked with metabolic processes in humans. For example, low levels of Vitamin D have been associated with greater risk for depression. The role of metabolic biomarkers in depression is an active research area. Recent work has explored the potential relationship between plasma sterols and depressive symptom severity.

Oxidative Stress

A marker of DNA oxidation, 8-Oxo-2′-deoxyguanosine, has been found to be increased in both the plasma and urine of people with MDD. This along with the finding of increased F2-isoprostanes levels found in blood, urine and cerebrospinal fluid indicate increased damage to lipids and DNA in people with MDD. Studies with 8-Oxo-2′ Deoxyguanosine varied by methods of measurement and type of depression, but F2-Isoprostane level was consistent across depression types. Authors suggested lifestyle factors, dysregulation of the HPA axis, immune system and autonomics nervous system as possible causes. Another meta-analysis found similar results with regards to oxidative damage products as well as decreased oxidative capacity. Oxidative DNA damage may play a role in MDD.

Mitochondrial Dysfunction:

Increased markers of oxidative stress relative to controls have been found in people with MDD. These markers include high levels of RNS and ROS which have been shown to influence chronic inflammation, damaging the electron transport chain and biochemical cascades in mitochondria. This lowers the activity of enzymes in the respiratory chain resulting in mitochondrial dysfunction. The brain is a highly energy-consuming and has little capacity to store glucose as glycogen and so depends greatly on mitochondria. Mitochondrial dysfunction has been linked to the dampened neuroplasticity observed in depressed brains.

Large-Scale Brain Network Theory

Instead of studying one brain region, studying large scale brain networks is another approach to understanding psychiatric and neurological disorders, supported by recent research that has shown that multiple brain regions are involved in these disorders. Understanding the disruptions in these networks may provide important insights into interventions for treating these disorders. Recent work suggests that at least three large-scale brain networks are important in psychopathology.

Central Executive Network

The central executive network is made up of fronto-parietal regions, including dorsolateral prefrontal cortex and lateral posterior parietal cortex. This network is involved in high level cognitive functions such as maintaining and using information in working memory, problem solving, and decision making. Deficiencies in this network are common in most major psychiatric and neurological disorders, including depression. Because this network is crucial for everyday life activities, those who are depressed can show impairment in basic activities like test taking and being decisive.

Default Mode Network

The default mode network includes hubs in the prefrontal cortex and posterior cingulate, with other prominent regions of the network in the medial temporal lobe and angular gyrus. The default mode network is usually active during mind-wandering and thinking about social situations. In contrast, during specific tasks probed in cognitive science (for example, simple attention tasks), the default network is often deactivated. Research has shown that regions in the default mode network (including medial prefrontal cortex and posterior cingulate) show greater activity when depressed participants ruminate (that is, when they engage in repetitive self-focused thinking) than when typical, healthy participants ruminate. People with MDD also show increased connectivity between the default mode network and the subgenual cingulate and the adjoining ventromedial prefrontal cortex in comparison to healthy individuals, individuals with dementia or with autism. Numerous studies suggest that the subgenual cingulate plays an important role in the dysfunction that characterizes major depression. The increased activation in the default mode network during rumination and the atypical connectivity between core default mode regions and the subgenual cingulate may underlie the tendency for depressed individual to get “stuck” in the negative, self-focused thoughts that often characterise depression. However, further research is needed to gain a precise understanding of how these network interactions map to specific symptoms of depression.

Salience Network

The salience network is a cingulate-frontal operculum network that includes core nodes in the anterior cingulate and anterior insula. A salience network is a large-scale brain network involved in detecting and orienting the most pertinent of the external stimuli and internal events being presented. Individuals who have a tendency to experience negative emotional states (scoring high on measures of neuroticism) show an increase in the right anterior insula during decision-making, even if the decision has already been made. This atypically high activity in the right anterior insula is thought to contribute to the experience of negative and worrisome feelings. In MDD, anxiety is often a part of the emotional state that characterises depression.

What was the National Survey of Mental Health and Wellbeing?

Introduction

The 2007 National Survey of Mental Health and Wellbeing (NSMHWB) was designed to provide lifetime prevalence estimates for mental disorders.

Purpose

To gain statistics on key mental health issues including the prevalence of mental disorders, the associated disability, and the use of services.

As such the NSMHWB was a national epidemiological survey of mental disorders that used similar methodology to the NCS. It aimed to answer three main questions:

  1. How many people meet DSM-IV and ICD-10 diagnostic criteria for the major mental disorders?
  2. How disabled are they by their mental disorders? and
  3. How many have seen a health professional for their mental disorder?

Background

Respondents were asked about experiences throughout their lifetime. In this survey, 12-month diagnoses were derived based on lifetime diagnosis and the presence of symptoms of that disorder in the 12 months prior to the survey interview. Assessment of mental disorders presented in this publication are based on the definitions and criteria of the World Health Organisation’s (WHO) International Classification of Diseases, Tenth Revision (ICD-10). Prevalence rates are presented with hierarchy rules applied (i.e. a person will not meet the criteria for particular disorders because the symptoms are believed to be accounted for by the presence of another disorder).

Results

  • Among the 16,015,300 people aged 16-85 years, 45% (or 7,286,600 people) had a lifetime mental disorder (i.e. a mental disorder at some point in their life).
  • More than half (55% or 8,728,700 people) of people had no lifetime mental disorders.
  • Of people who had a lifetime mental disorder:
    • 20% (or 3,197,800 people) had a 12-month mental disorder and had symptoms in the 12 months prior to the survey interview; and
    • 25% (or 4,088,800 people) had experienced a lifetime mental disorder but did not have symptoms in the 12 months prior to the survey interview.

Prevalence of 12-Month Mental Health Disorders

Prevalence of mental disorders is the proportion of people in a given population who met the criteria for diagnosis of a mental disorder at a point in time

  • Among the 3,197,800 people (or 20% of people) who had a 12-month mental disorder and had symptoms in the 12 months prior to interview:
    • 14.4% had a 12-month Anxiety disorder (includes Panic disorder (2.6%); Agoraphobia (2.8%); Social Phobia (4.7%); Generalised Anxiety Disorder (2.7%); Obsessive-Compulsive Disorder (1.9%); and Post-Traumatic Stress Disorder (6.4%))
    • 6.2% had a 12-month Affective disorder (includes Depressive Episode (4.1%) (includes severe, moderate and mild depressive episodes); Dysthymia (1.3%); and Bipolar Affective Disorder (1.8%)), and
    • 5.1% had a 12-month Substance Use Disorder (includes Alcohol Harmful Use (2.9%); Alcohol Dependence (1.4%); and Drug Use Disorders (includes harmful use and dependence) (1.4%)).
  • Note that a person may have had more than one mental disorder.
    • The components when added may therefore not add to the total shown.
    • Includes Severe Depressive Episode, Moderate Depressive Episode, and Mild Depressive Episode.
    • Includes Harmful Use and Dependence.

There were 3.2 million people who had a 12-month mental disorder. In total, 14.4% (2.3 million) of Australians aged 16-85 years had a 12-month Anxiety disorder, 6.2% (995,900) had a 12-month Affective disorder and 5.1% (819,800) had a 12-month Substance Use disorder.

Women experienced higher rates of 12-month mental disorders than men (22% compared with 18%). Women experienced higher rates than men of Anxiety (18% and 11% respectively) and Affective disorders (7.1% and 5.3% respectively). However, men had twice the rate of Substance Use disorders (7.0% compared with 3.3% for women).

The prevalence of 12-month mental disorders varies across age groups, with people in younger age groups experiencing higher rates of disorder. More than a quarter (26%) of people aged 16-24 years and a similar proportion (25%) of people aged 25-34 years had a 12-month mental disorder compared with 5.9% of those aged 75-85 years old.

You can read the full survey results here and a shorter analysis can be found here.