Recurrent depression and relational trauma: a single case of memory processing

Barton, Stephen B.; Armstrong, Peter V.; Meares, Kevin; Bromley, Elizabeth H.C.; Whitton, David

Abstract

Cognitive behavioural therapy (CBT) is an effective treatment for depression, but a significant minority of clients are difficult to treat, including those with histories of relational trauma. The model of Beck et al. (1979) proposes that adverse childhood experiences lead to negative core beliefs, and these create a susceptibility to depression. However, Beck’s model does not identify trauma as a subset of adverse experiences. An alternative view is that traumatised clients internalise conflicting representations of self and it is conflict, interacting with trauma memories, that creates a vulnerability for depression. In this formulation, methods from the treatment of post-traumatic stress disorder (PTSD) could be incorporated into the treatment of depression, to emotionally process trauma memories and resolve self-identity conflicts. The aims of this study were to: (1) report the treatment of a 67-year-old man with recurrent depression and a history of prolonged relational trauma, and (2) to explore how memory processing from the treatment of PTSD can be incorporated into the treatment of recurrent depression. A single case observational design was used in the long-term treatment of a depressed traumatised client. The client received 47 individual sessions over 19 months in routine clinical practice in a tertiary CBT service. He completed repeated measures of mood, memory intrusions and sleep disruption. The client responded well to treatment with clinically significant improvements across measures of mood, memory and sleep. The effects were sustained over an 18-month follow-up. Memory processing was successfully integrated into a high-intensity treatment for recurrent depression. This is a promising approach for depressed clients with histories of relational trauma.

Citation

Barton, S. B., Armstrong, P. V., Meares, K., Bromley, E. H., & Whitton, D. (2024). Recurrent depression and relational trauma: a single case of memory processing. The Cognitive Behaviour Therapist, 17, Article e14. https://doi.org/10.1017/s1754470x24000126

• Journal Article Type: Article
• Acceptance Date: Mar 4, 2023
• Online Publication Date: Apr 15, 2024
• Publication Date: 2024
• Deposit Date: May 13, 2024
• Publicly Available Date: May 13, 2024
• Journal: The Cognitive Behaviour Therapist
• Electronic ISSN: 1754-470X
• Publisher: Cambridge University Press
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Article Number: e14
• DOI: https://doi.org/10.1017/s1754470x24000126
• Public URL: https://durham-repository.worktribe.com/output/2438556