Situational Analysis: An Effective Tool to Address Maladaptive Social Patterns in Chronic Depression

Approximately 30% of individuals with depressed mood develop a chronic course as defined by the criteria for persistent depressive disorder (PDD) (Struck et al., 2021). Research shows that depressed individuals have difficulties in handling another person's negative state or suffering, getting overwhelmed in emotionally tense situations, a condition called empathic distress. This leads to an avoidant interpersonal style due to fear of interaction with others, which in turn deprives these individuals of positive interpersonal experiences, thus perpetuating depressive symptoms (Struck et al., 2021). Situational analysis is a technique used in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). CBASP is one of the few psychotherapies effective for chronic depression and PDD (Wiersma et al., 2014; Wiersma et al., 2021).

CBASP combines behavioral and cognitive strategies with a problem-solving focus and emphasizes interpersonal issues. Its primary goals are to help individuals learn and recognize how their behavior affects others, and to develop social problem-solving skills and empathy. Unlike traditional cognitive-behavioral therapy (CBT), learning in CBASP is translated into actions that tend to have a longer-lasting impact on depressive symptoms. Studies show that CBASP is more effective as a supplement to standard treatment compared to Mindfulness-Based Cognitive Therapy (MBCT) (Michalak et al., 2015). One of CBASP's key techniques is situational analysis, as described next (McCullough, Jr., 2003a,b).

What is situational analysis?

Situational analysis is a multi-step problem-solving exercise helpful in a social context. It is used to accomplish three things:

1. Recognize and dislodge your unhelpful, rigid thinking patterns.
2. Assist you in identifying unhelpful behaviors so they can be changed.
3. Make you realize that your behavior has consequences.

 
By recognizing that your behaviors have consequences, even if they go against your expectations or previous learning experiences, situational analysis helps you break free from learned hopelessness and helplessness, leading to behavioral change. This change then encourages shifts in other social situations. Additionally, situational analysis counters global thinking by guiding you to focus on one specific problem at a time.

What are the steps of situational analysis?

Situational analysis is conducted in two stages – the exploration stage (also known as the elicitation stage) and the solution stage (also called the remediation stage). During the exploration stage, a person describes a recent problematic social situation objectively – from the viewpoint of an external observer. The event description includes a beginning, an end, and a story in between. The end is referred to as the Actual Outcome (AO), and the person is asked to create a Desired Outcome (DO) for the situation. The gap between AO and DO causes discomfort in the individual, which is essential for prompting change. In the solution stage, the person evaluates whether their interpretation of the situation can help achieve DO and what changes are needed. The questions that will assist someone in conducting a situational analysis are listed below (McCullough, Jr., 2003a):

A. Exploration phase:
1. “What happened in the situation?” Describe the situation objectively with a starting point, an ending point, and a story in between. (Situational Description)
2. “What did the situation mean to me?” You can have more than one interpretation for the situation (Situational Interpretations)
3. “What did I do in the situation?” (Situational Behavior)
4. “How did the situation come out for me?” (Actual Outcome – AO)
5. Thinking about the situation, how would I have liked it to turn out for me? (Desired Outcome – DO). If you have more than one desired outcome, rank them based on how desirable they are and pick the most desirable one. Also, select a desired outcome that can be described in behavioral terms rather than emotional ones. For example, “I want to be more assertive in my interactions with my neighbor” is better than “I want to feel better in my interactions with my neighbor.” Besides focusing on behavioral change, the desired outcome should be achievable and realistic.
6. “Why didn’t I get what I wanted in the situation?”

B. Solution phase:
Ask yourself:
1. “Do I think my interpretation of the situation would have led to the Desired Outcome (DO)?” Use this question for each interpretation.
2. “What are my revised interpretations?”
3. “Based on my revised interpretations, how would I have behaved differently?”
4. “What have I learned from this situational analysis?”
5. “How does what I have learned from this situational analysis apply to other similar situations?”

Benefits of situational analysis 

• Situational analysis redirects your attention to a specific problem that occurs at a particular time and place.
• Situational analysis nips in the bud your defeatist attitude and empowers you by making you learn that your actions can have positive consequences.
• Situational analysis helps you remedy your interpersonal problems.
• Situational analysis makes you a goal-oriented thinker – making you learn to think about solutions at the beginning of an encounter rather than at the end of it.

If you are experiencing chronic depression that leads to feelings of isolation and loneliness, situational analysis can be a valuable tool for overcoming patterns of interpersonal fear and avoidance that result from previously learned maladaptive behaviors. This approach is also beneficial for individuals prone to rejection sensitivity—the tendency to overinterpret, worry about, or strongly react to real or perceived rejection (Wiersma et al., 2021). People with chronic depression are more vulnerable to rejection sensitivity due to their avoidant or submissive interpersonal behaviors, decreased social connectedness, and reduced empathy and compassion toward those close to them (Frick et al., 2021).

Visit Dr. Duggal’s Author Page to explore effective self-management strategies for enhancing mental health and well-being.

HARPREET S. DUGGAL, MD, FAPA

REFERENCES

Frick  A., Thinnes, I., Hofmann, S.G., Windmann, S., & Stangier, U. (2021). Reduced social connectedness and compassion toward closer others in patients with chronic depression compared to a non-clinical sample. Frontiers in Psychiatry, 12:608607. doi: 10.3389/fpsyt.2021.608607

Michalak, J., Schultze, M., Heidenreich, T., & Schramm, E. (2015). A randomized controlled trial on the efficacy of mindfulness-based cognitive therapy and a group version of cognitive behavioral analysis system of psychotherapy for chronically depressed patients. Journal of Consulting and Clinical Psychology, 83(5), 951-963.

McCullough, J. P., Jr. (2003a). Treatment for chronic depression using cognitive behavioral analysis system of psychotherapy. Journal of Clinical Psychology, 59(8), 833-846.

McCullough, J. P., Jr. (2003b). Patient’s manual for CBASP. New York, NY: The Guilford Press.

Struck, N., Gartner, T., Kircher, T., & Brakemeier, E. (2021). Social cognition and interpersonal problems in persistent depressive disorder vs. episodic depression: The role of maltreatment.  Frontiers in Psychiatry, 11:608795. doi: 10.3389/fpsyt.2021.608795  

Wiersma, J. E., Van Schaik, D. J., Hoogendorn, A. W., Dekker, J. J., Van, H. L., Schoevers, R. A., Blom, M. B., Maas, K., Smit, J. H., McCullough, J. P., Jr., Beekman, A. T., & Van Oppen, P. (2014). The effectiveness of the cognitive behavioral analysis system of psychotherapy for chronic depression: a randomized controlled trial. Psychotherapy and Psychosomatics, 83(5), 263-269.

Wiersma, J., Klein, P., Schramm, E., Furukawa. T., & Favorite, T. (2021). Editorial: CBASP in the treatment of persistent depressive disorder. Frontiers in Psychiatry, 12:804602. doi: 10.3389/fpsyt.2021.804602