Depression - Psychotherapy
Psychotherapy, also known as "talk therapy" or just "therapy" is often the first form of treatment recommended for depression.
During psychotherapy, a person with depression talks to a licensed and trained behavioral health care professional who helps him or her identify and work through the factors that may be causing their depression.
Sometimes these factors work in combination with heredity or chemical imbalances in the brain to trigger depression. Taking care of the psychological and psychosocial aspects of depression is important.
Psychotherapy helps people with depression:
• Understand the behaviors, emotions, and ideas that contribute to his or her depression.
• Understand and identify the life problems or events -- like a major illness, a death in the family, a loss of a job or a divorce -- that contribute to their depression and help them understand which aspects of those problems they may be able to solve or improve.
• Regain a sense of control and pleasure in life.
• Learn coping techniques and problem-solving skills.
Approaches to Psychotherapy for Depression
There are several different approaches that behavioral health professionals can take to provide therapy. After talking with the patient about their depression, the therapist will decide which approach to use based on the suspected underlying factors contributing to the depression.
Cognitive Behavioral Therapy for Depression
Cognitive behavioral therapy (CBT) includes several different approaches to therapy, all of which focus on how thinking affects the way a person feels and acts. The idea of cognitive behavioral therapy is that you can change your way of thinking about yourself, a situation, the world and the future, and when you do, you also change the way you feel and act. As a result, you can feel better, or at least remain calm, even when the situation stays the same.
While other approaches to therapy rely heavily on analyzing and exploring people's relationship with the world around them, the focus of CBT is on learning. The therapist functions as a teacher and guides the client through the process of learning and developing new and more flexible thinking patterns that are alternatives to their depressive way of thinking about the world and then teaching them how to act on that learning. Because there is a specific goal and a process for arriving at it, CBT is often more narrowly focused. It also is typically completed in less time than other therapies.
Two examples of different types of CBT are:
• Rational emotive behavior therapy or REBT. REBT focuses on the way emotions affect thinking and actions. It helps the client recognize that the intensity of negative emotions can change the quality of his or her thinking. The result is often overreaction and loss of perspective. The emphasis of therapy then is on learning how to restore emotional balance by thinking more realistically about situations.
• Dialectical behavior therapy or DBT. DBT emphasizes the validity of a person's behavior and feelings and reassures the individual that those feelings and behaviors are understandable. At the same time, it encourages the individual to understand that the responsibility for changing unhealthy or disruptive behavior is his or her own.
Interpersonal Therapy for Depression
Interpersonal therapy (IPT) focuses on improving current social function in one or more of the following four problem areas:
1. Grief reaction to "exit events," losses, and bereavement, which is treated by facilitating grief work and encouraging the patient to compensate for losses by engaging in other relationships;
2. Interpersonal role disputes and conflicts with significant others, which are treated by strategies for resolving disputes or facilitating the process of ending negative relationships;
3. Role transitions and changes that add stress and threaten self-esteem, which are treated by helping the patient develop a sense of mastery in new roles; and
4. Interpersonal deficits reflected in the patient's history and current circumstances involving inadequate or unsatisfying relationships, which are treated by strategies to reduce social isolation by building the social skills and opportunities needed to develop and maintain supportive relationships.
The primary goal of IPT is to improve communication skills and increase self-esteem. It also works on the premise the depression is defined as a disorder that happens to the patient and requires treatment and there is no blame assigned to the patient or significant others for the depression. IPT helps people understand and work through troubled personal relationships that may cause their depression or make it worse. IPT usually lasts three to four months and works particularly well for depression caused by loss and grief, relationship conflicts, major life events, social isolation, or role transitions (such as becoming a mother or a caregiver).
Psychodynamic Therapy for Depression
Psychodynamic therapy is based on the assumption that a person is depressed because of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by talking about the experiences. Psychodynamic therapy is administered over a period of weeks to months to years.
How is psychotherapy delivered?
Therapy can be given in a variety of formats, including:
• Individual -- This therapy involves only the patient and the therapist.
• Group -- Two or more patients may participate in therapy at the same time. Patients are able to share experiences and learn that others feel the same way, and have had the same experiences.
• Marital/couples -- This type of therapy helps spouses and partners understand why their loved one has depression, what changes in communication and behaviors can help, and what they can do to cope.
• Family -- Because family is a key part of the team that helps people with depression get better, it is sometimes helpful for family members to understand what their loved one is going through, how they themselves can cope, and what they can do to help.
Therapy Tips
Therapy works best when you attend all of your scheduled appointments. The effectiveness of therapy depends on your active participation. It requires time, effort, and regularity. As you begin therapy, establish some goals with your therapist. Then spend time periodically reviewing your progress with your therapist.
If you don't like your therapist's approach or if you don't think the therapist is helping you, talk to him or her about it and/or seek a second opinion, but don't diskontinue therapy abruptly.
Tips to Help You Get Started With Therapy
• Identify sources of stress: Try keeping a journal and note stressful as well as positive events.
• Restructure priorities: Emphasise positive, effective behavior.
• Make time for recreational and pleasurable activities.
• Communicate: Explain and assert your needs to someone you trust; write in a journal to express your feelings.
• Try to focus on positive outcomes and finding methods for reducing and managing stress.
Therapy involves evaluating your thoughts and behaviors, identifying stresses that contribute to depression, and working to modify both. People who actively participate in therapy recover more quickly and have fewer relapses. Therapy is treatment that addresses specific causes of depression; it is not a "quick fix." Some regimens are short–term (10 to 20 weeks) and other regimens are longer–term, depending on the needs of the individual. Therapy also generally takes longer to begin to work than antidepressants, but there is evidence to suggest that its effects last longer. Antidepressants may be needed immediately in cases of severe depression, but the combination of therapy and medicine is often considered most effective.21, 25
