ref, Acceptance and Commitment Therapy (ACT), Marital Therapy, Mind over Mood, The Feeling Good Handbook, chronic Depression, Dysthymia, episodes of Major Depression, medications"/> Psychotherapy for Depression | PsychVisit
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Psychotherapy for Depression

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

Various forms of psychotherapy have been tried for treating Depressive Disorders (mainly Major Depressive Disorder), and have been found to be effective. These include Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), Psychodynamic Therapy, and Behavioral Therapy,among others. Even unstructured counselling, also known as Supportive Therapy, which involves simply allowing the person to express their thoughts and feelings to the therapist and to receive emotional support, can be quite helpful [ref].

To the best of our knowledge, these different forms of psychotherapy are, on average, all equally effective for treating Depression [ref].

Group formats of most of the kinds of treating psychotherapies have been developed, and at least in the case of CBT and IPT, these formats have been shown to be more or less equivalent to the individual formats in terms of the chances of a successful outcome [ref]. 

Probably more than the actual type of therapy, what seems to predict a successful psychotherapy is one that is given by an experienced therapist, where the patient has a strong motivation to collaborate in the process of the therapy, and where there is a strong therapeutic alliance [ref, ref]. 

Because CBT and IPT have been the most extensively studies forms of therapy for Depression, they are often considered the first-choice recommendations for this purpose [ref]. They have been shown to be as effective as antidepressant medications [ref].

Cognitive Behavioral Therapy (CBT) for Major Depression

CBT is the most extensively studied psychotherapy for treating Depression. It has been found to be equally effective to antidepressant medications for treating Depressive Episodes that range from mild to severe [ref]. People who recover from a Depressive Episode with the help of CBT also have better chances of remaining well compared with those who received medications [ref]. However, up to half of all people who are successfully treated with CBT will nevertheless have another Depressive Episode within the following 2 years, and for this reason, it is recommended that monthly "booster" sessions of CBT are given for about a year following recovery from a Depressive Episode, as this tends to lower the chances that the person will have a relapse [ref].

Interpersonal Therapy (IPT) for Major Depression

IPT was developed specifically for treating Major Depression, and there is now a large body of research supporting its usefulness. It seems to be as effective as CBT for treating Depressive Episodes, and also seems useful for preventing relapses through the use of monthly "booster" sessions following recovery [ref].

Psychodynamic Psychotherapy for Major Depression

Short-term Psychodynamic Psychotherapy has been shown to be effective for treating Depressive Disorders, with some studies concluding that it is equally effective to CBT [ref]. However, the amount of evidence supporting these findings is quite small compared to the body of research on CBT or IPT, and for that reason Psychodynamic Psychotherapy is not yet considered a first-line option for Depression [ref]. Still, it is a useful form of psychotherapy that may have a particular advantage for depressed individuals who also have Personality Disorders [ref]. Too little is known about the ability of short-term Psychodynamic Psychotherapy to prevent relapses of Depression to make any firm recommendations about this [ref].

So far, there are no studies that have examined the effectiveness of long-term Psychodynamic Psychotherapy in the treatment for Depressive Disorders.  In theory, this longer and more in depth form of therapy could help to address some of the psychological roots of depression and in this way perhaps reduce the chances of relapse. Yet the substantial costs required for long-term therapy means that research findings are required before firm recommendations can be made.

Behavioral Therapy for Major Depression

Behavioral Therapy, especially when using techniques of Behavioral Activation, can be effective for treating Depression [ref], but the evidence supporting its use is not as substantial as for CBT or IPT, and for this reason it is not considered a first-line treatment.

"Third Generation" Therapies for Depression

The "third generation" therapies are ones that have been more recently developed and that derive from CBT.

Cognitive-Behavioral Analysis System of Psychotherapy (CBASP) is a type of psychotherapy that combines elements of CBT and IPT, and it was developed specifically for treating chronic Depression. Although it seems to be effective, most of the evidence supporting its use comes from one study [ref], and this particular brand of psychotherapy is still not commonly available in most community treatment settings. As a result, it is not a first-line recommendation.

Acceptance and Commitment Therapy (ACT) has a small amount of research evidence to support its use in treating Depression, but not enough for it to be considered a first-line treatment [ref].

Marital Therapy for Major Depression

Marital Therapy has been shown to be helpful for individuals whose Depression seems to be influenced by marital discord [ref].  

Self-Help Methods for Major Depression

Bibliotherapy is the term used for when individuals will read certain books that provide therapeutic instructions on how to overcome mental health symptoms. For Depression, examples of two popular self-help books are Mind over Mood and The Feeling Good Handbook. Bibliotherapy seems to offer some therapeutic effects for milder forms of Depression, especially when compared to receiving no treatment at all [ref].

Computer-based psychotherapies are computer programs, some of which are available on-line, that use principles of formal psychotherapy such as CBT to help users overcome symptoms of Depression. These types of programs have been found to have some measure of success [ref]. Telephone administered counseling has also shown some success in helping certain individuals overcome their symptoms of Depression [ref].

All of these self-help methods should be used within the context of active treatment and follow-up with a mental health professional.

Psychotherapy for Chronic Depression and Dysthymia

When it comes to treating chronic Depression or Dysthymia, the available evidence to date suggests that the therapeutic effects of the currently available psychotherapies, especially CBT and IPT, are measurable but small [ref, ref]. These forms of Depressive Disorders, which last much longer than most episodes of Major Depression, may require psychotherapies that use different techniques or that are continued for longer periods of time. Until such techniques are developed, medications remain superior to psychotherapy for treating chronic Depression and Dysthymia [ref, ref].

 

 

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