Psychotherapy
Most mental health professionals todaycontend that biological treatments for unipolar depression should be a part of any treatment plan. The relative speed with which pharmacological treatments alleviate symptoms, their relative cost, and decades of clinical trials have shown that they are invaluable, but where does this leave psychotherapy?
Why Psychotherapy?
Research has suggested although psychotherapy may take slightly longer to begin alleviating the specific and acute symptoms of depressive mood disorder than does active treatment with the faster-acting antidepressants, it can improve symptoms in appropriate patient groups. In addition, when compared with pharmacotherapy, psychotherapy appears to result in longer-lasting benefits and maintenance of a higher quality of life. Although the risk of relapse or recurrence of depression is significant with either medication or psychotherapy, studies have shown that the interval between stopping of active psychotherapy and subsequent episodes of depression appears to be lengthened after psychotherapeutic intervention.
In addition to reducing or eradicating specific symptoms, psychotherapy can be helpful in monitoring and managing suicide risk, major concern of mental health professionals. It also has been shown to increase compliance with both medical and psychosocial intervention programs. Moreover, it can be helpful in dealing with impairments of psychosocial function and help develop coping mechanisms to stress, disappointment, loss, bereavement, and the other psychosocial issues that are common triggers or consequences of persistent depression. Additional psychosocial impairments that remain after stabilization of acute depressive symptoms also respond to psychotherapy. When other medical conditions or treatments, pregnancy or lactation, or sensitivity to medications in elderly patients complicates the situation, physicians may prefer to recommend psychotherapy as the treatment of choice.
How Does Psychotherapy Help People Recover From Depression?
The following from a 2004 American Psychological Assoiation Factsheet explains well the basic aims of psychotherapy.
"Several approaches to psychotherapy, including cognitive-behavioral, interpersonal, and psychodynamic, help depressed people recover. Psychotherapy offers people the opportunity to identify the factors that contribute to their depression and to deal effectively with the psychological, behavioral, interpersonal, and situational causes. Skilled therapists can work with depressed individuals to:
Pinpoint the life problems that contribute to their depression
and help them understand which aspects of those problems they may be
able to solve or improve.
A trained therapist can help depressed patients identify options for
the future and set realistic goals that enable them to enhance their
mental and emotional well-being. Therapists also help individuals identify
how they have successfully dealt with similar feelings if they have
been depressed in the past.
Identify negative or distorted thinking patterns that contribute
to feelings of hopelessness and helplessness that accompany depression.
For example, depressed individuals may tend to overgeneralize, that
is, to think of circumstances in terms of "always" or "never."
They may also take events personally. A trained and competent therapist
can help nurture a more positive outlook on life.
Explore other learned thoughts and behaviors that create problems
and contribute to depression.
For example, therapists can help depressed individuals understand and
improve patterns of interacting with other people that contribute to
their depression.
Help people regain a sense of control and pleasure in life.
Psychotherapy helps people see choices as well as gradually incorporate
enjoyable, fulfilling activities back into their lives.Having one episode
of depression greatly increases the risk of having another episode.
There is some evidence that ongoing psychotherapy may lessen the chance
of future episodes or reduce their intensity. Through therapy, people
can learn skills to avoid unnecessary suffering from later bouts of
depression.
In addition, The support and involvement of family and friends can play a crucial role in helping someone who is depressed. Individuals in the "support system" can help by encouraging a depressed loved one to stick with treatment and practice the coping techniques and problem-solving skills he or she is learning through psychotherapy.
Living with a depressed person can be very difficult and stressful on family members and friends. The pain of watching a loved one suffer from depression can bring about feelings of helplessness and loss. Family or marital therapy may be beneficial in bringing together all the individuals affected by depression and helping them learn effective ways to cope together. This type of psychotherapy can also provide a good opportunity for individuals who have never experienced depression themselves to learn more about it and identify constructive ways of supporting a loved one who is suffering from depression."
Common Therapy Styles
These different types thereapy are not exclusive, so many are used in combination to achieve the optimum outcome for each patient.
Cognitive-Behavioral Therapy: The goals of cognitive-behavioral therapy are to alleviate depressive symptoms and prevent their recurrence by helping patients identify, test, and reshape negative cognitions about themselves, the world, and the future, develop new and more flexible cognitive patterns or schema that are alternatives to depressogenic ways of viewing life experiences, and rehearse new cognitive and behavioral responses.
Interpersonal Psychotherapy: In interpersonal therapy, depression is defined as a disorder that happens to the patient and requires treatment. The patient can then explore their feelings without concern for assigning blame to self or significant others.
Interpersonal therapy focuses on improving current social function in 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
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
Behavioral Therapies: Behavioral approaches to treating depression include social learning therapy, self-control therapy, social skills training, and multimodal therapies. All these therapies make use of the following techniques:
• Self-monitoring and self-evaluation of mood and activity
• Scheduled increases in levels of general, social, and pleasurable
activity and behavioral productivity
• Decrease in or management of aversive events
• Development of self-reinforcement patterns
• Cognitive skills training to modify self-statements and attributions
and to improve cognitive self-control, problem-solving and decision-making
skills, and time management
• Relaxation and mental imagery training to encourage active stress
management by development of positive coping and mastery images
• Assertiveness training, improvement of communication skills,
and role play to enhance social skills and interpersonal effectiveness
Conclusion
Psychotherapy may have been laregely eclipsed by antidepressant medications as the primary care option for sufferers of unipolar depression, but it is by no means obsolete.
While it no longer alone serves as an efficient and effective means of treatment, its ability to enhance the effectiveness of biological therapies, as well as provide a sense of stabilty for patents, suggest that it will have a place in the treatment of unipolar depression for years to come.
Biological treatments for depression continue to grow ever complex and precise, making it not unreasonable to suggest that one day the disease will be manageable completely without other treatments. In the meantime, the mental heath community must be patient, and remember the lessons of the emptying of the wards when the first pharmacological treatments for depression arrived. Biological treatments can do wonders for patient quality of life and corporate profits, but without interpersonal treatment, the risk of misuse is too high to slim down psychotherapy just yet, if at all.