Psychotherapy for Depression

It may be an exaggeration to say that there are as many types of psychotherapy as there are therapists, but a great many psychological perspectives and therapeutic techniques have certainly been developed for treating patients with depression. Research studies have even been used to investigate specific types of psychotherapy in the treatment of depression. The use of psychotherapy can be very beneficial, whether done independently or in combination with other treatments such as antidepressant medications.

Psychotherapy can address life circumstances, including factors that may have contributed to the onset of depression or those that perpetuate it. By working with therapists, patients with depression can explore their own role in situations and come up with strategies to make changes in their lives. Psychotherapists can help educate patients about illnesses and offer support related to other treatments, such as maintaining adherence with medications.

The particular advantages of psychotherapy for depression include a relatively rapid and long-lasting improvement in mood. Patients often feel somewhat better soon after beginning therapy. These long-term benefits mean that patients may be less likely to have future recurrences.

The most common forms of psychotherapy for depressed patients are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Psychodynamic therapy also sometimes may be effective.

Cognitive behavioral therapy. CBT generally is provided during a short-term series of individual sessions that address current issues and strategies for problem solving. CBT is usually structured and goal oriented. The cognitive focus highlights distorted or illogical thinking that contributes to depression. A few examples of distorted thinking:

* focusing exclusively on the negative aspects of a situation
* dreading or expecting the worst possible outcome, however unlikely
* thinking that a situation is unbearable or impossible when it is merely uncomfortable
* making decisions and arguments based on how you feel rather than on objective reality
* concentrating on what you think "should" be, rather than on the actual situation

Often the goal of cognitive therapy is to help patients view themselves in a more positive way and avoid negative assumptions about their current circumstances and the future. Typically, CBT incorporates behavioral plans and homework between sessions.

Interpersonal therapy. IPT is an outpatient therapy that focuses on identifying and solving problems in key areas of a patient's life that are assumed to be contributing to depression. Like cognitive behavioral therapy, IPT is a practical type of therapy that addresses current symptoms. The identified problems typically are in the realms of loss and grief, adaptations of changing life circumstances, interpersonal conflicts and disputes, and social limitations.

Psychodynamic psychotherapy. This type of therapy is based on psychoanalytic theory and examines unconscious conflicts. Current conflicts often are viewed in relationship with early development. It is a less structured approach not specifically designed to directly address the symptoms of depression. However, limited research has demonstrated benefits with longer durations of therapy.

Both CBT and IPT are regarded as standard treatments for depression and their use is supported by numerous research studies. However, these psychotherapies are somewhat limited, especially in severely depressed patients unable to engage in therapy. Often the best response in the treatment of patients with major depression is achieved with a combination of medications and psychotherapy.