Psychotherapy is often the first form of treatment recommended for depression. Called "therapy" for short, the word psychotherapy actually involves a variety of treatment techniques. During psychotherapy, a person with depression talks to a licensed and trained mental 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.
How Does Psychotherapy Help Depression?
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.
- Help to restructure ways of thinking, negative attributes and attitudes someone has about himself, and ways in which faulty thinking may perpetuate depression.
- Regain a sense of control and pleasure in life.
- Learn coping techniques and problem-solving skills.
Types of Therapy for Depression
Therapy can be given in a variety of formats, including:
- Individual: This therapy involves only the patient and the therapist.
- Group: 2 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.
Approaches to Therapy
While therapy can be done in different formats -- like family, group, and individual -- there are also several different approaches that mental 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.
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.
What Is Maintenance Therapy for Depression?
While some people only need therapy for short periods of time, people with treatment-resistant depression might need it for longer. This is called maintenance therapy. Studies show that maintenance therapy lowers your risk of relapse. You and your therapist can watch for signs that your depression might be worsening. Over time, you will also learn about the patterns in your life that lead to depression.
If you have treatment-resistant depression, you may have already tried therapy. Maybe you didn't feel like it worked. But it may be time to give it a second chance.
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Interpersonal Therapy for Depression
Interpersonal therapy focuses on the behaviors and interactions a depressed patient has with family, friends, co-workers, and other important people encountered on a day-to-day basis. The primary goal of this therapy is to improve communication skills and increase self-esteem during a short period of time. It usually lasts three to four months and works 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).
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 a situation, and when you do, you also change the way you feel and act. As a result, you can feel better, and behave differently in response to life
stresses, 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 in many ways similar to a teacher. He or she guides the client through the process of learning how to change his or her way of thinking and then 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.
Therapy works best when you attend all of your scheduled appointments and participate actively in the work of treatment. The effectiveness of therapy is not a passive process depends on your active participation. It requires time, effort, and consistency.
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 discontinue 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: Emphasize 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.
Remember, 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 reactions to depression as an illness; it is not a "quick fix." It takes longer to begin to work than antidepressants, but there is evidence to suggest that its effects may sometimes last longer, depending on the type of depression being treated. Antidepressants may be needed immediately in cases of severe depression, but the combination of therapy and medicine is very effective
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Quick GuidePhysical Symptoms of Depression in Pictures
American Psychological Association: "Different approaches to psychotherapy."
National Association of Cognitive-Behavioral Therapists: "Cognitive Behavioral Therapy."
National Institute of Mental Health: "Psychotherapies."
The Albert Ellis Institute: "Rational Emotive Behavior Therapy: Frequently Asked Questions."
Reviewed by Joseph Goldberg, MD on July 24, 2012