Psychological Counseling in Combating Depression

Testing the Effectiveness of the Experimental Treatment in Addressing Symptoms of Depression and Mechanism in Individuals Attending College.

Aim

The aim of the study is to test the hypothesis that psychological counseling is better than administration of anti-depressant drugs in combating addiction and decreasing symptoms of depression in individuals who abuse alcohol

Public Health Significance

Operational Definitions

Depression is a medical condition that often results in general feeling sadness and an overall lack of enthusiasm in activities that were previously appealing (Rock et al., 2014). The condition might be caused by sustained stress, which affects the very structure of regions in the brain that are supposed to control one’s emotions and psychological well-being.

Prevalence

A study conducted by Sarokhani et al. (2014) indicated that the prevalence of depression among college students stood at 33%.  However, there are notable discrepancies across various geographical regions, with students from Asia being reported to have significantly higher rates of depression than their counterparts in Europe and North America.  The use of college students in measuring the prevalence of depression is an especially useful point of reference because this is an important point of transition in one’s life.

However, Sarokhani et al observed that the difference in stress levels that were reported across differint geographic regions could be as a direct result of the equally different backgrounds such as cultural orientations and appraisal standards. Culture, for instance, defines the way of life for a given population. Tools such as the Beck Depression Inventory (BDI) that was used by the researchers may utilize certain variable that could predispose a given population towards reporting a relatively higher score of depression when that is not necessarily the case.

There are several factors that predispose college students to higher measure of depression indices.  The variables involved in this space may include considerations for financial stress, a change in interpersonal relationships and academic pressure. The authors note that the reported depression index for college students, from the context of this study, is relatively higher that the reported averages within the rest of the population.  In Iran, for instance, Sarokhani indicates that a vast majority of the students joining college are usually leaving the comfort of their homes for the first time. The change in environment often subjects the learners into some form of ‘shock’ that, coupled with other factors in school, may culminate into depression.

Sarokhani et al. opine that married students are less susceptible to stress that their singe counterparts. This observation was attributed to the possibility that some single students could be having more trouble with seeking employment, the pressure to graduate and even the prospects of getting life time partners. In Iran, both male and female students were found to be equally predisposed to similar levels of depression. The authors indicate that this could be as result of the relatively similar levels of pressure that individuals from either gender are subject within the country.

In Prevalence and Correlates of Depression, Anxiety, and Suicidality Among University Students, Eisenberg et al. (2014) indicate that a 2005 survey within the US showed that as high as 10% of the students in the American universities were already planning how to commit suicide. To put this into perspective, the survey suggests that one in every ten students in every college was probably planning about taking his life.  Eisenberg’s study involved 2843 students respondents who agreed to participate in the exercise. The researchers noted that postgraduate students, and females, were more open towards participating in the research than their counterparts. Also, black students were more opposed to taking part in the study than student respondents from other races.

An analysis from the respondent students indicated that 15.6% of undergraduate students were depressed, while a lower 13% of graduate respondents were suffering from this condition. Going by these results, one could argue that cases of depression tended to increase as soon as one joins college, but substantially decreases after attaining the first degree. Both male and female undergraduate students reported similar levels of depression, whereas females were relatively more prone to getting depressed than their male counterparts. For both the graduate and undergraduate students, Eisenberg et al. found out that 2.5% and 1.6% of undergraduate and graduate students had had suicidal thoughts one month before the survey. About 1% of respondents from both the graduate and undergraduate schools had gone as far as drafting suicide plans.

Consequences

Depression has several negative consequences among college students. From the statistics presented above, it is evident that depressed students have the potential of ending their own lives through suicide, and the rates of such eventualities is as high as one student in every one hundred students from both the undergraduate and graduate schools within colleges.  Youths killing themselves before they can even make any meaningful impact in society might not be the best results of college education systems. Students invest a lot of time and resilience to study through lower levels of education, and its unfortunate that some of them decide to end their lives in college, which is mostly a step away from achieving their goals of making meaningful impacts in their societies.

Lowered levels of productivity that are usually associated with depressed individuals, may result in an inefficient economic system. Depressed students might not be able to study as well as they are expected. If they were to graduate from college, they might not be able to offer difference-making expertise in their subsequent professions. As a result, the entire economy would end up becoming inefficient.

Risk Factors

There several risk factors to depression.  A study conducted by Kumamoto University’s Matsudaira and Toshinori (2006) indicates that most of the specific types of depression can be attributed to various instances of immature character dimension.  Going by this construct, it becomes important to evaluate whether problems associated with sexual identity, substance abuse, relatively lower socio-economic can, in any way, be perceived as character predispositions associated with immature character manifestation, at least in accordance with Matsudaira and Toshinori’s argument.

Low socio-economic status might be associated with a difficulty in finding a place during college, or difficulty in affording various material that are integral to the learning background, or even affording college fees. Whereas students from most of the developed countries may access loans for studying, or take up some part time jobs, the lack of a dependable financial foundation throughout college may stress up the student, and later become a depression.  Getting past this hurdle may require a supportive community, presence of financial opportunities even when studying in college and a counselor to guide the student. The same case holds for cases of substance abuse and sexual identity which later result in depressed students.

Substance abuse, as a risk factor, is especially important when evaluating depression among college students. The World Health Organization (2019) defines the condition as the harmful use of psychoactive substances – such alcohol and drugs. A study by Knight et al (2001) found that more than 19.5% of students in American colleges were heavy ‘episodic’ drinkers. Only 15.6% of students abstained from drinking altogether whereas 24.6% would occasionally drink heavily. 40.3% of the respondent students were mild drinkers. Given the high risk of developing depression from heavy drinking, it is important to evaluate substance abuse – especially the heavy use of alcohol, as a causative factor in the development of depression.

Theory of the Problem

Definition of Addiction

The Center on Addiction (2019) defines addiction as chronic and complex disease that often interferes with the normal functioning of the brain, often marked by an individual sustaining the use of a drug despite negative consequences that might be associated with it. Addiction is known for resulting in strained relationships among families, within the school environment, neighborhoods and virtually every other place where an individual is expected to demonstrate a given level of productivity. In regard to college students, addiction will make it very difficult for students to concentrate on their studies, or resolve school related problems in a sober way that is actually intended to resolve problems, instead of postponing them. For instance, a college student might decide to engage in heavy drinking as a means of forgetting that he has not submitted schoolwork assignment, and will not graduate despite having spent thousands of the parents’ dollars.

Connection between Alcohol Abuse and Depression

Alcohol abuse, as part of substance abuse, will involve an indiscriminate habit of drinking alcohol without much regard for the negative effects it might have on an individual’s relationship with colleagues, class work and general life. Alcohol dependency is known to result in various undesirable effects. For instance, it might result in liver cirrhosis, throat cancer and other clinical complication that are often associated with excessive consumption of alcohol. The drink, depending on the concentration of alcohol, also causes imbalance and poor judgments. These conditions can especially prove catastrophic in instances whereby the subject wants to concentrate in other activities such as driving a car.

Depression was defined as the sustained loss of interest in activities that one might have found appealing before. The action of excessive and irresponsible consumption of alcohol may have a high likelihood of resulting in depression, since individuals can no longer concentrate in the important activities that used to define their daily schedules.  The average day of a college student is relatively ‘routined’ out.  Daily activities might involve going for class in the morning before going to work at a restaurant later in the day.  Other students might find it important to reserve weekends for family and revising through the class work material that had been learnt throughout the week.

However, alcohol dependency is likely to destroy the aforementioned schedule. For instance, a student might dutifully attend classes during the first few months into the habit. However, he will probably go out drinking instead of going at the restaurant for the part time job. This will result in lowered cash flows, probably affecting the motivation to attend morning classes as well.  A domino of ‘unfortunate events’ will then ensue, marked by dropped scores, threat of eviction from the place of residence, increased pressure from society to meet certain responsibilities and an increased dependency on alcohol. An individual who used to love his studies, working hard and integrating with the family with then start considering these activities unappealing, probably go into a withdrawal and even start contemplating about committing suicide – an action which would have marked the peak of depression. Fergusson, Boden and Horwood (2009) have carried out a research to investigate whether there is a relationship between the abuse of alcohol and major cases of depression. They concluded that incidences of alcohol abuse resulted in increased risk to the development of depression. Based on this evidence, the use of alcohol has enormous effects on potential development of depression.

Connection between Alcohol Abuse and Addiction

A WebMD publication (2012) showed that drinking alcohol trigger the brain’s ‘feel good’ region into releasing chemical substances known as endorphins. As a result, alcohol users feel good about themselves. Excessive consumption of alcohol, however, has been shown to result in an increased release of the endorphins. As a result, frequent alcohol users are prone to get more intoxicated, although they may have ingested volumes equal the ones consumed by individuals that are not heavy drinkers.

Further research and imaging showed that drinking alcohol would push the brain into producing more opiomds in the orbitofrontal cortex – which is an area associated with the brain’s ‘reward processing’.  Th research concluded that the continued use of large volumes of alcohol will result in several other dependency conditions in the brain, eventually resulting in addiction and making it incredibly difficult for heavy drinkers to ‘unhook themselves’ from this abuse.

Therefore, the addiction that develops due to continued consumption of large volumes of alcohol is as a result of a medical condition, analogous with disease that develops on the victim’s brain. Any effort to break this habit becomes incredibly difficult hence making the negative health and social effects of excessive alcohol consumption more probable.  This trend may subsequently result in depression, especially among college students who often wish to feel ‘happy’ as a way of addressing their daily stressing activities. Dani and Harris (2005) indicate that individuals that abuse alcohol, or are addicted to the drug, are also more predisposed to develop addiction form similar substances such as nicotine. This comorbidity is dangerous since an addiction for one drug will often result in the abuse of yet another one drug, with near-similar symptoms.

Connection between Addiction and Depression

Addiction, by definition, has negative effects on the subject that is affected.  For instance, a college students that depends on alcohol will always go out to get his ‘fix’ irrespective of the other responsibilities and duties that would otherwise require him to be fully sober. The postponement of critical activities such as completing class assignments and passing examinations will eventually prove themselves untenable. Also, the student will need to find money for his alcohol treats, despite facing the possibility of losing all sources of income due to addiction and substance dependency. The inability to excel at school, loss of financial backup and chastise from society could pile up as stress for the student, and eventually morph out to become a source of depression. Alavi et al. (2012) indicate that addiction can go beyond alcohol usage, to habitual tendencies. This presents a new challenge and possible cause of depressions among college students.

Theory of the Solution

Description and Justification of the Experimental Treatment Chosen

Counseling is a process that may involve talking to a professional psychologist with the aim of resolving emotional or physical issues (Hansen, Speciale & Lemberger, 2014). The treatment regiment behind this practice is particularly different from other treatment plans because it delves more on the psychological aptitude than the physiological wellbeing of the subject, and it will help treat depressed students. Depression manifests itself more on the mental level than physical. Although some depressed people might develop noticeable physical manifestation of the condition, such as getting to tiny or fat, these eventualities are secondary to the mental problem that underpins the patient.  There is almost no point of trying to treat the secondary ‘conditions’ since they cannot be used for substantive diagnosis in the first place. For instance, one cannot objectively declare that a college student who has thinned out is depressed – since the individual in question might have decided to ‘get on diet’.

Psychologists are specially trained in understanding and mapping out human behavior, which often originates from one’s brain. Professionals working as psychologists, and psychiatrists, in counseling have mastered the science of dealing with issues such as depression. Well-structured counseling section between an alcohol addict and an experienced counselor should enable the former rehabilitate. Also, the psychologist might recommend drugs that are specifically designed to suppress the effects of alcohol by, for instance, acting on the specific regions in the brain that respond to alcohol.

Counseling in the college environment, for the students with depression, will comprise professional psychologists and scheduled consultation sessions.  Both the counselors and affected students will need to draft a mutually agreeable consultation schedules, depending on the severity of depression and exposure to other risk factors.  Counseling for depression, unlike other clinical treatment plans that might have quantifiable result, will require continuous monitoring by the psychologist about each affected student’s recovery trajectory.

Evidence

Chilvers et al (2001) carried out a study to evaluate the efficacy of using drugs vis a vis counseling as the primary forms of treatment among individuals with depression.  She found out that both form of treatment have similar patient remission rates, especially among user who had not yet sunk into chronic depression. Chilvers’ research was derived from the Beck Depression Inventory scores. The concluded results show that counseling could play a bigger role in promoting patient recovery than one might imagine.  The authors established that patients treated with antidepressants might recover quickly within the first four months, but there are no differences between the two groups at the end of twelve months.

In essence, based on Chilvers et al. study, counseling is almost as effective as the use of antidepressant medicines among affected individuals.  Nevertheless, counseling might prove itself as the more efficient option because it does not involve taking drugs to address existing drug issues. The fact that psychologist and his patient can establish a rapport might help identify other factors, such as risk factors, that might have led to the depression in the first place. Therefore, counseling will make it easier to address the problem in its entirety hence reducing the possibility of a depression from recurring.

Juhnke et al. (2003) indicate that psychiatrists may, at time, make wrong diagnosis – especially in regard to substance abuse, and hastily accept the wrong treatment decision. This could lead to catastrophic resuls, especially when dealing with college students who need to be ‘fixed’ and get back to their studies in order to make meaningful contributions to their communities.  Scheduled counseling sessions that are conducted over a long term might not suffer from the negative effects of misdiagnosis and subsequent administration of wrong medicines because of the very nature of the treatment programs during counseling processes.  The authors also not that there are specialty tools and courses that  have been designed to addresses counseling issues – such as the lack of proper and standardized score measure across the profession. Therefore, counseling is bound to become more effective, making it a critical approach in treating individuals that have been diagnosed with depression and other related conditions.

Mechanism of Action in Reducing Symptom of Depression

Counseling will make it easy to identify and address the risk factors that might have caused depression. The prescriptions of anti-depressant medicines, for instance, try to address the problem without much background knowledge of its causative factors.  For instance, a psychiatrist treating an alcohol addict might only be interested in finding drugs to suppress the predisposition to alcohol at a physiological level within the brain. A counseling psychologist, however, will try to establish the root cause of the problem through extensive talks with the client.  Counselors have been trained to handle depression cases. These professional might need to ‘reinstate’ hope among college students who are on the edge of committing suicide hence removing the possibility of such eventuality taking place.

One of the most common signs of depression is withdrawal. Patients in this stage might lose all interest in life, daily activities and tend to segregate themselves from the rest of society.   A counselor might be the only company that a depressed college student has. From this point, the counselor should then be able to identify the correct topics to talk about in order to enable the patient recover from depression and other tendencies that could probably result in self harm.  In essence, counselors may help their patients recover from depression by presenting a personal entity that not only understand the underlying problem but becomes an important and active component in combating it. This specialized support will make it easier for the affected students to get on remission.

Theory of the Solution, Gaps in Knowledge

Incomprehensive studies: In the study by Eisenberg et al. (2014), the authors indicate that the data that was used to arrive at conclusion regarding the percentages of college students with depression is not comprehensive. The study indicates most of the focus was only based on factors such as anxiety and suicidality. There are several mental conditions that could result in depression among college students. The ideal conclusions would be derived from scientifically analyzing data regarding the entire spectrum of mental disorders that could result in depression among college students.

Limited scope of data analysis space and technologies: Most of the conclusions, by a vast majority of the studies, was based on data from single universities. This is way too small a sample and it might not be representative of the actual cases and rates of depression among college students.  This partly explains the reason why some articles indicated that married students are less stressed than their single counterpart, and other asserting the opposite. Carrying out a large scale, and coordinated research across several universities around the world is relatively difficult. This challenge is compounded by the fact that data about student depression rate is relatively private and researches will need to maneuver through several bureaucratic systems before even getting the permissions to publish such data. As a result, the utilized researches have only utilized ‘narrow’ perspective to build to their case.

The web based survey tools that are predominantly used to collect data are subject to large errors of margin.  Subjects such as depression are very sensitive and, for instance, an individual that truly to plans to commit suicide may turn down to provide information about such plans, whereas individuals who indicate that they have had such plans could be making such statement out of fun.  A reliable source of data, ideally, should be presented as a ‘big data’ data set spanning over several years and containing responses from millions of students from all over the world. This way, it would be easier to substantially reduce the margin of error. Therefore, the treatment plan proposed in this study could potentially be flawed since it draws on information and evidence that might never be considered as a true representation of depression cases among college students.

Psychiatrists are yet to make a comprehensive mapping of the brain functions and human behavior. The extent of the efficacy of counseling as part of a treatment plan cannot be substantiated, and the practice ends up being implemented as an art rather than a science. The lack of a truly definitive approach to treating depression makes counseling uncertain.  Also, it lacks the assurance of yielding the same results for several similar cases. To this effect, there will be need for medical practitioners to conduct and publish several studies that document the behavior of depressed alcoholic patients, with the view of developing appropriate and specific approaches to treat affected individuals.

Control Treatment

As a control treatment, the research will evaluate the efficacy of using anti-depressant drugs instead of psychological counseling to treat depression.  By presenting evidence about patient remission, using the two treatment approaches, it will be possible to determine whether there is any similarity in terms of remission. The research will also evaluate whether the use of counseling can prove itself more effective, especially when putting epidemiological considerations into perspective. The control group for this research design will comprise college students who do not drink alcohol but still exhibit signs of depression. This way, it will be possible to fully test the plausibility of the hypothesis, and conduct a equivalence trial. The control treatment plan does not present any new delivery format. This makes it important and appropriate in evaluating the efficacy of the actual treatment proposition.

As part of addressing the gaps identified above, the research will seek to compile and utilize the latest publications regarding the medical understanding of human behavior, the functioning of the brain when exposed to alcohol and depression, especially among young people in colleges. More focus will be put on searching for existing datasets about incidences of depression among alcohol addicts across several universities across the world. This should substantially increase the sample size and limit the effect of errors as a result of using small sample size from an isolated university. Billions of data bytes are released into the cloud on a daily basis, and it would only be prudent to leverage on these vast amounts of data by developing a schema for understanding depression among college students throughout the world.

Therefore, the aim of the research design will involve addressing the use of small sample sizes in creating critical conclusions about the alcohol addiction and its relationship with depression. The use of big data, and associated data sets, will increase the margin of errors associated with the analysis of data and subsequent discussions. Although the research will evaluate the latest publications about depression to understand how the conditions interacts with the human brain, this area will receive lowered attention because there is nothing much that can be done to develop the appropriate knowledge about the human brain and behavior, when depressed.

References

Alavi, S. S., Ferdosi, M., Jannatifard, F., Eslami, M., Alaghemandan, H., & Setare, M. (2012). Behavioral addiction versus substance addiction: Correspondence of psychiatric and psychological views. International journal of preventive medicine3(4), 290.

Center on Addiction. (2018, April 25). What is Addiction. R

Chilvers, C., Dewey, M., Fielding, K., Gretton, V., Miller, P., Palmer, B., … & Duggan, C. (2001). Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms. Bmj322(7289), 772.

Dani, J. A., & Harris, R. A. (2005). Nicotine addiction and comorbidity with alcohol abuse and mental illness. Nature neuroscience8(11), 1465.

Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American journal of orthopsychiatry77(4), 534-542.

Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2009). Tests of causal links between alcohol abuse or dependence and major depression. Archives of general psychiatry66(3), 260-266.

Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2009). Tests of causal links between alcohol abuse or dependence and major depression. Archives of general psychiatry66(3), 260-266.

Hansen, J. T., Speciale, M., & Lemberger, M. E. (2014). Humanism: The foundation and future of professional counseling. The Journal of Humanistic Counseling53(3), 170-190.

Juhnke, G. A., Vacc, N. A., Curtis, R. C., Coll, K. M., & Paredes, D. M. (2003). Assessment instruments used by addictions counselors. Journal of Addictions & Offender Counseling23(2), 66-72.

Knight, J. R., Wechsler, H., Kuo, M., Seibring, M., Weitzman, E. R., & Schuckit, M. A. (2002). Alcohol abuse and dependence among US college students. Journal of studies on alcohol63(3), 263-270.

Matsudaira, T., & Kitamura, T. (2006). Personality traits as risk factors of depression and anxiety among Japanese students. Journal of clinical psychology62(1), 97-109.

Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: a systematic review and meta-analysis. Psychological medicine44(10), 2029-2040.

Sarokhani, D., Delpisheh, A., Veisani, Y., Sarokhani, M. T., Manesh, R. E., & Sayehmiri, K. (2013). Prevalence of depression among university students: a systematic review and meta-analysis study. Depression research and treatment2013.

WebMD. (2012, January 11). Why Is Alcohol Addictive? Study Offers Clues.

World Health Organization. (2019). Substance Abuse.

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