Depression as a Failed Anxiety: The Continuum of Precision-Weighting Dysregulation in Affective Disorders

Abstract

Depressive, anxiety, and trauma-related disorders have many symptoms in common such as unstable mood, high anxiety, sleep disturbance, impaired concentration among others. This degeneracy creates ambiguity in classifying psychiatric disorders and raises the question of their categorical vs. dimensional nature. Consequently, such ambiguity presents a dilemma for choosing diagnosis-specific vs. trans-diagnostic therapies. In this paper, I build on a theory that considers affective disorders on the continuum of stress response from normative to traumatic. Using an integrative evolutionary-stress response-predictive processing (iESP) model, I arrange affective disorders on a continuum of precision-weighting dysregulation, where depressive, anxiety and trauma-induced disorders have a characteristic pattern of precision-weighting dysregulation. I specifically address the relationship between anxiety and depressive stress responses, exploring the role of anxiety in the dynamics of depressive stress response and the resulting high co-occurrence of anxiety and depression symptoms. Finally, I discuss the model's relevance for therapy of depression.

Investigating Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Validation Cohort Study

“…It is known that anxiety is more likely to precede depression through a causal link, suggesting that this is facilitated by the anxiety response style. 22 It can be argued that parturients with greater pre-operative anxiety possess certain personality traits that result in a defective stress response, 23 predisposing them to PND, among other post-operative complications such as increased post-operative analgesia usage and poor patient satisfaction, 24 and may even arguably influence the parturient’s preference for anesthesia modality for CD. 25 …”

I like therefore I can, and I can therefore I like: the role of self-efficacy and affect in active inference of allostasis

“…The putative mechanism of confidence regulation is by adjusting the model’s precision through neuromodulation of the synaptic gain ( Feldman and Friston, 2010 ). SE can be conceived of as a nested hierarchy ( Krupnik, 2020a , 2021 , 2022 ) that comprises domain and task-general and specific levels, e.g., “I can do well in life”—“I can do well at physical fitness”—“I can run well”—“I can catch that bus.” It has to be noted that here we extend the original construct of SE as a person’s conscious subjective confidence that a chosen action will achieve the desired outcome ( Bandura, 1977 ) to a more general concept. It includes model confidence at any level and considers it a probability function as in Friston et al (2013) .…”

“…Building on the idea of self-efficacy as a metacognitive regulator of allostasis and its role in depression, SE was proposed as a metacognitive regulator of the depressive type of stress response ( Krupnik, 2020a , 2021 ). We expand this idea here within the proposed model of the role SE plays in cognitive and physiological homeostasis.…”

Piloting the Update: The Use of Therapeutic Relationship for Change – A Free Energy Account

“…For more integrative therapeutic approaches, the concept of free energy has been suggested as a guiding principle for strategic modification of priors ( Krupnik, 2019 ). Overall, interesting ideas are developing under this umbrella, which could provide a common theoretical framework for a wide variety of psychotherapeutic streams ( Chekroud, 2015 ; Duquette, 2017 ; Papalini et al, 2020 ; Krupnik, 2021 ).…”