3.4 Neurotic depression

Joseph Wolpe (1986) introduced the idea of ‘neurotic depression’ based on earlier concepts of ‘neuroses’ (a term that is no longer widely used) that made reference to forms of ‘nervousness’ − psychological or behavioural conditions in which anxiety was a primary characteristic (as opposed to ‘psychoses’ in which people experience distortion of reality or a disorganisation of personality). He viewed some forms of depression as ‘neurotic’ in the sense that they were ‘secondary to learned maladaptive anxiety responses that are the core of neuroses’. Wolpe saw maladaptive anxiety (i.e. anxiety which was not ‘useful’) as the core problem. He hypothesised that maladaptive anxiety was acquired through classical conditioning, associated with an ‘environmental’ stimulus or trigger, and that generalised anxiety disorders and depression were both grounded by specific fears. He identified social anxiety as a common and specific ‘cause’.

Wolpe distinguished two categories of depression, one which correlated highly with anxiety (termed ‘neurotic depressions’) and another which correlated less well with anxiety (which he referred to as ‘endogenous depressions’). He considered neurotic depression to arise:

• secondary to a severe and prolonged conditioned anxiety

• as a consequence of a cognitively-based anxiety

• secondary to social anxiety or to a feeling of interpersonal intimidation

• as a result of unresolved bereavement.

He considered that treating the underlying anxiety or ‘symptomatic neuroses’ by relearning methods (using behaviour therapy based on the classical conditioning model) would also resolve the depression ‘without [specific] measures being taken against the depression as such’. Once the focus of the maladaptive anxiety was identified it would then be treated as an anxiety problem which would also resolve the depression.