An attempt to explain depression: EG-Theory

Since about the beginning of 2009 I started thinking about a theory which could explain depression and the general reduction of productivity which is associated to it. The basic idea is rather simple: Depression is a result of lacking gratification. When sliding down into a depression, productivity decreases and you start losing the ability to do actions which cost a lot of effort. My theory focuses on the two concepts of effort and gratification, so I call it EG-theory (EGT). There are some similarities with the theory of effort-reward imbalance. EGT has a wider scope than that effort-reward imbalance model, which is focused around work.

Basic definitions
Let’s begin with some definitions (that’s always a good point to start) (model assumptions which appear in these definitions are emphasized):
Gratification (G): This is the sum of all your positive emotions which appear while doing an action or as result of that action. Positive emotional effects on other persons don’t count here directly, because they only have indirect effects on your own psyche. It is possible and useful to distinguish different types of gratification:

• Flow Gratification (FG): If it’s pleasant or fun to do an action, you get flow gratification while doing that action. Playing games or listening to music are simple examples for actions which usually produce flow gratification.
• Result Gratification (RG): This is the kind of gratification you get directly after finishing a task, like solving a puzzle or building something.
• Delayed Gratification (DG): Often positive results of an action appear in the future long after finising a task, like learning for a test or doing paid work.

Effort (E): This is just the subjective amount of effort, or more generally all negative emotions, you experience when doing a specific action. In EGT it is assumed that gratification and effort theoretically can be measured with a single unit and that they can be compared with each other.
Emotional Reserves (R): By acummulating a surplus of gratification it is possible to increase one’s emotional reserves. These can be used to do actions, which require a lot of effort.
Pressure (P): There are external and internal pressure. External pressures are expectations other people have about your performance, or even threats of unpleasant consequences if you fail in some way at fulfilling these expectations. Internal pressures are expectations you have about yourself. Higher expectations create higher pressure.
Reserve Increasing Actions (R+ actions): An action which creates more flow gratification than it costs effort increases the reserves directly.
Reserve Decreasing Actions (R- actions): Actions which cost more effort than they produce flow gratification decrease the reserves. But result gratification and delayed gratification might compensate that loss in reserves, so that it’s still a good idea to do such actions (if it’s possible to do so).

Main assumptions
Let’s summarize the assumptions that were made in the definitions:

1. Gratification and effort can be measured.
2. Gratification and effort can be measured with the same unit and compared with each other directly.
3. There are emotional reserves, which are built up by accumulating gratification.
4. Effort decreases the emotional reserves.
5. The reserves are increased by actions which produce more gratification than they cost effort.
6. The reserves are decreased by actions which cost more effort than they produce gratification.
7. High expectations produce high levels of pressure.

The assumptions 1 to 6 are necessary model assumptions for EGT. The last assumption is optional, but rather plausible.

Core ideas
How can this theory be used? Its main applications are the explanations of depression and burnout, both of which are phenomena that are connected with reserve depletion. If you are high on reserves, you cannot suffer from depression or burnout. It is the reduction of your reserves, which causes these psychological problems. The main idea is that R- actions are supposed to be impossible, because they cost more than they are worth, at least from a short term perspective. Because humans can think about possible long term gains, they can come to the conclusion that it might be a good idea to do some R- actions nevertheless. But doing these is only possible by using up emotional reserves.

Connections between mood and reserves
People naturally strive for a surplus of reserves, just because that’s a side effect of feeling good. Vice versa, having lots of reserves creates contentness and emotional stability. Unfortunately, it is possible that one experiences more effort than gratification over a long period of time, so that the emotional reserves are dimished seriously. Of course, this causes discontentness, so people try to protect themselves against even further diminishing of their emotional reserves. This can be done by reducing one’s effort in the hope that the gratification won’t be severely reduced, too. The other obvious defense mechanism is to increase one’s gratification by doing more things which are pleasant, for example taking more holidays or testing out hobbies which might be fun. The more the reserves are diminished, the more dedicated the efforts to restore effort-gratification balance become. Usually, these simple compensation mechanisms prevent emotional exhaustion, so how can depression or burnout arise at all?

The role of pressure
It’s the pressure which is the critical factor here. If you think “but I have to do this!”, then you try to work harder and try to supress your need for emotional balance and your natural compensation mechanisms, so that your emotional reserves can be reduced dramatically. In the best case, this leads to a temporary emotional exhaustion, which can be overcome by caring more about your emotional needs and acting accordingly. In an extremely negative case, the pressure is so high, that you supress all natural compensation mechanisms, so that your reserves are used up completely. This would cause a complete burnout, so that you cannot do any R- actions anymore at all. So, burnout can be explained plausibly, but what about depression?

Depression as emergency mechanism
Depression seems to be a kind of emergency state which sets in when the reserves reach a dangerously low level and there is a lot of internal pressure. If internal pressure is low, you would just take extreme measures to increase your gratification by massively pursuing very strong R+ actions like playing computer games excessively, having sexual intercourse or taking drugs. Or you would reduce your efforts dramatically, or use both measures at the same time. But if your internal pressure is too high, you do not react in that way, but you rather think something like this: “Damn, my life is terrible! I have to change something dramatically” or “Oh no, I’m a loser, because I’m lazy and worthless.” Then you might think something like this “Perhaps I could fix my life, just by trying harder.” But it is not possible to really try harder, because of a lack of emotional reserves, so such efforts fail. This leads to even more frustration and may finally cause real desperation. So, a depression arises and the negative thoughts increase in frequency and intensity. Also, the efforts to change something may become more extreme, so you start behaving in rather unusual ways, like retreating yourself from societal obligations, friends and peers, becoming much more irritable, demanding or agressive. Even more extreme actions may be hurting or even trying to kill yourself, because you are convinced that your life is pointless or not worth living anymore and you have lost all hope that your situation will become better in the future. These reactions could be seen as adaptive mechanisms for trying to escape from a subjectively unbearable situation. But it’s hard to imagine what would happen if those mechanisms were not present and there were neither a warning about low reserves nor any urgency to change anything about that. Maybe, the alternative would just consist in total apathy, resulting in a slow and painful death by dehydration or starvation.

Mechanisms and symptoms of depression
Why can a depression become so bad? As emergency mode it changes a lot of things:

• Your priorities shift from living your normal life to trying to escape from your terrible state.
• That’s why the gratification of your usual R+ actions are reduced so much that they may even become R- actions during depression. Therefore, even your usual spare time activities will drain up your reserves.
• The effort of doing normal actions which aren’t aimed at improving your situation increases, because they seem to be pointless and you are obsessed with your depressed thoughts.
• All remaining emotional reserves are put into thinking about radical problem solving efforts.
• If these efforts fail (which doesn’t have to be the case), this can lead to perceived hopelessness or burnout.
• Because your energy level is at a dangerously low level, your sexual drive might be turned down to save energy and concentrate on the really important things.
• Psychosomatic symptoms may appear or become stronger as a signal of extreme distress or exhaustion.
• If your emotional reserves are (almost) at zero, this can lead to apathy.

The more your reserves are exhausted, the more you get the impression that your life is terrible, and the lower your motivation (for usual actions) and performance become. Low motivation and performance levels can cause feelings of discontentment and worthlessness. Prolonged phases of these negative emotions and futile efforts to improve your situation can create the impression that your situation is hopeless. That’s why many depressed patients think that they are “hopeless cases” (which is wrong in most cases, because there are effective treatments for depression like cognitive behavorial therapy or antidepressants).

Internal pressure versus external pressure
Why have I written explicitly that interal pressure is a necessary condition for depression? That’s because external pressures are not really relevant, unless they are internalized. If you fail to meet expectations of others that only means that they may be disappointed or may threaten you with negative consequences. This, in itself, is not a sufficient reason to become depressed. An adaptive response to the threat of negative consequences is to ignore those threats, or to fight against such a kind of oppression. Only if (assumed) external expectations are internalized, they can become psychologically dangerous. If you set your expectations about yourself to an unrealistically high level, this can easily lead to (permanent) frustration, which tends to eat up your reserves.

Why does reserve depletion occur?
Now, let’s take a look at the possible causes of reserve depletion:

• Having a job that is too exhausting, or just living in a way that uses up “energy” pretty quickly (for example by over-commitment).
• Not having sufficiently strong sources of gratification.
• Having to deal with a serious crisis like the loss of a loved person or bankruptcy.
• Downplaying the value or importance of positive experiences. This reduces the amount of gratification.
• Focusing on the negative aspects of life. This increases the amount of effort.
• Having high expectations. The resulting frustration both increases effort and reduces gratification.
• Internalization of external pressures.
• Putting oneself under increased pressure.

Both objective circumstances of life as subjective valuations play important roles. Methods from cognitive therapy can help improving subjective patterns of valuation, for example by reducing negative cognitive distortions. Perhaps, building up positive cognitive distortions might be useful, too, but that method might come at the price of a loss of critical thinking.

Conclusions
This theory suggests that methods for increasing subjective gratification – especially flow gratification, because that’s attainable even when very low on reserves – and for decreasing subjective effort might be effective tools against depression, burnout and a general lack in life satisfaction or productivity. If those methods aren’t effective enough, a radical change of personal environment might be necessary.

Open questions
It’s not clear whether the size of the reserves is limited or not and how effects of diminishing returns could play a role in this theory. Further, it would be pretty interesting to find out what those supposed reserves might actually be. Are they just levels of neurotransmitter concentration, or memories of good experiences minus memories of bad experiences, or something completely different? Finally, it is reasonable to suspect that reserves regenerate naturally in a state of complete inactivity. But it’s not really sure whether that’s actually the case.