Psychological Treatments for Depression
Depression can be defined as a form of mental illness characterized by a persistent loss of interest in life and depressed mood resulting in impairment of the individual’s performance in daily life activities. It is also referred to as major depressive disorder, and it adversely affects an individual’s emotions, thinking, and behavior. Common themes of depression are feelings of emptiness, tearfulness, episodes of angry outbursts, sleep disturbances, lack of enthusiasm, anxiety, slowed thinking, trouble thinking, and physical problems such as back pains and headaches. Depression is a serious global health issue affecting over two hundred and sixty million individuals globally. This paper attempts to identify the various evidence-based psychological treatments that are effective for depression.
Effective treatments have been developed for both mild and severe clinical depression. Treatments for depression can be categorized into medications and therapies. Medications include antidepressants such as citalopram, fluvoxamine, sertraline, and vilazodone. Medications also include antianxiety medicines such as alprazolam and diazepam, and Lorazepam, and antipsychotics such as clozapine, asenapine, and risperidone (Olfson, Blanco, & Marcus, 2016). Other than psychotherapy, commonly used types of therapies include light therapy and alternative therapies. In light therapy, the patient is exposed to doses of white light that help control their mood and enhance symptoms of depression. Alternative therapies include acupuncture, where thin needles are inserted in the body of the patient, and the use of folk medicine such as fish oil, ST. John’s Wort, and SAMe. St. John’s Wort is a natural treatment used as an antidepressant, especially in European countries (Olfson, Blanco, & Marcus, 2016). S-adenosyl-L-methionine (SAMe) is commonly known to ease depression symptoms. Other measures used as interventions for depression include exercise and avoiding alcohol and drug consumption.
For psychological treatments, health care providers can resort to either of the three most effective forms of treatment: behavioral activation, cognitive-behavioral therapy (CBT), and interpersonal psychotherapy. Behavioral Activation (BA) can be described as a structured psychotherapeutic approach aimed at increasing the patient’s engagement in adaptive activities while decreasing the patient’s involvement in activities that expose them to the risk of depression. Behavioral Activation therapy also aims at solving the various factors in the patient’s life that serve to limit their access to reward or that promotes aversive control (Dimidjian et al., 2011). The main objective of behavioral activation therapy is to empower the patient to cope with the negativity in their lives and also increase positivity and awareness through the reestablishment of personal goals in the short and long term scope (Chan et al., 2017). Generally, Behavioral Activation can be described as a form of psychological model that focuses on an individual’s condition by targeting the behaviors that lead them to depression.
Behavioral activation as a treatment for depression is inspired by Lewinson & Shaffer (1971) behavioral model. These researchers argued that depression was more of behavioral concern rather than cognitive concern hence stemmed from the individual’s lack of reinforcement, especially in their social interactions. By using the behavioral model of depression, therefore, the psychologists believed that an individual’s state of depression could be best treated by restoring an appropriate schedule of positive reinforcement in the individual’s life by either changing their behavior or their environment. Studies have ascribed the efficacy of cognitive-behavioral therapy to behavioral activation. A study conducted by Jacobson et al., (1996), for example, showed that individuals with depression who had successfully gone through behavioral activation therapy experienced as many benefits as individuals with depression who had successfully gone through behavioral activation therapy and some cognitive aspects of Cognitive behavioral therapy. Analysis of the findings of the study above supported the assertion that the concept of behavioral activation therapy could be behind the success of most Cognitive behavioral therapy techniques. Psychologists have also shown more preference for the focus on an individual’s behavior rather than their cognition since behavioral patterns are easier to identify than thoughts.
Behavioral activation can also be classified under applied behavior analysis: a research field based on the principles of B.F.Skinner’s findings that in a particular environment, an individual’s behaviors that result in favorable or positive outcomes will continue to occur through reinforcement while those that result in unfavorable outcomes with decrease with time (Roane et al., 2016). One advantage of behavioral activation as a form of therapy is that it can be adjusted to suit the patient’s abilities and values. Behavioral activation therapy can also be customized for personality disorder and specific forms of Major Depressive Disorders. Among the commonly used techniques used in behavioral activation, therapy is activity scheduling, which serves to increase the daily activities a patient indulges in and social skill training, which attempts to improve the patient’s interaction with other people around them. Other techniques used include hierarchy construction, which entails ranking the ease of some of the activities and life area assessment whereby the patient is made to determine in which areas they desire success. While behavioral therapy may effective in treating depression, the therapist must also be wary of their reinforcement of the patient’s behavior.
Cognitive Behavioral Therapy (CBT) can be described as a type of psychotherapy that aims at modifying the patient’s thought patterns in an attempt to alter their moods and behaviors. This form of therapy is based on the concept that negative emotions and acts are a product of an individual’s distorted perceptions and beliefs and not the unconscious aspects of their past (Wenzel, Dobson & Hays, 2016). Cognitive Behavioral Therapy can, therefore, be described as an integration of cognitive therapy with behavioral therapy. The distinction between cognitive therapy and behavioral therapy is that while cognitive therapy pays more focus on the patient’s moods and thoughts, behavioral therapy focuses on their behaviors and actions. A provider using cognitive behavioral therapy works in close corporation with the patient to evaluate the patient’s situation in an effort to identify and understand the negative thought patterns and behavioral responses to stressors (Wenzel, Dobson & Hays, 2016). Treatment using CBT entails developing what can be described as a more constructive way of responding to the stressors. The newly developed responses are thus meant to help the patient get rid of the troubling behavior. The principles of cognitive-behavioral therapy can not only be applied in the office of the therapist but also online where the patient is guided through them to track and manage their conditions and anxiety symptoms through the internet.
Unlike other forms of therapy, such as psychoanalysis and psychodynamic therapies, cognitive behavioral therapy is relatively short-term: requiring as little as ten to twenty sessions. Cognitive therapy is also different from psychoanalysis in the sense that while the latter works backward through the patient’s life history to identify their source of problems, CBT involves the identification of the patient’s current life situation that may be causing the depression. There are three main types of cognitive-behavioral therapy: rational emotive behavioral therapy (REBT), dialectal behavior therapy (DBT), and exposure and response prevention therapy (ERP). Rational emotive behavior therapy was developed by Albert Ellis, who considered emotions a product of interactions between the factors in the patient’s environment and their expectations or beliefs (Ellis, 2019). Some of these feelings, according to Elvis(2019), can be too rigid and intense for the patient, such as expecting every to like you. Through rational emotive behavior (REBT), the patient is empowered to change their beliefs so that their intensity is reduced and less likely to impact their daily lives significantly. In this case, for example, in case of the patient expecting everyone around them to like them, they would adopt the belief that while they want to be liked by everyone, not everyone will. This way, the patient will be in a better position to deal with potential stressors that may arise from confrontation or hate.
Another form of cognitive-behavioral therapy is dialectal behavioral therapy (DBT), which was conceptualized by Marsha Linehan exclusively for patients diagnosed with borderline personality disorder (BPD). Dialectal behavioral therapy emphasizes on helping the patient work on their thoughts and feelings instead of fighting them (Willis et al., 2016). The main objective of this form of therapy, therefore, is to enable the patient to accept their negative thoughts so that they can be in a better position to alter them. The third type of cognitive-behavioral therapy is Exposure and response therapy, which is mainly used for obsessive-compulsive disorder (OCD). In this form of cognitive-behavioral therapy, the patient is exposed to situations that they fear most and ate, unable to engage in compulsive behaviors that relieve the anxiety. For example, when an individual is afraid of contamination, they are made to touch objects such as money without washing their hands for a given period (Wenzel, Dobson & Hays, 2016). Practicing this form one time to another, eventually empowers the patient to gain confidence in dealing with the resultant anxiety and can significantly help relive compulsion.
Generally, cognitive behavioral therapy aims at solving particular thought patterns that expose the patient to depression. These thought patterns may entail all or nothing thinking where the patient perceives the world in absolute or “black and white terms.” They may also stem from the disqualification of the positive where the patient rejects the positive experiences insisting that they are not of significance to them (Wenzel, Dobson & Hays, 2016). Thirdly, negative thoughts and potential stressors may arise from overgeneralization, where the patient draws broad conclusions from one event. Fourthly, negativity may also stem from personalization where the individual takes things too personally, feeling that every action is directly aimed at them. Lastly, cognitive behavioral therapy focuses on thought patterns involving mental filter where the patient picks out a particular detail and over-dwells on it that their perception of reality is obscured (Wenzel, Dobson & Hays, 2016). By identifying the main cause of the source of negativity in the patient’s thought patterns, CBT then empowers the patient to learn to control the distorted emotions and thoughts. Secondly, it empowers the patient to learn to precisely evaluate an external situation or behavior. Thirdly, CBT enables the patient to use self-evaluation to have a better understanding of their environment and respond appropriately.
One advantage of cognitive behavioral therapy as a form of psychotherapy is that it can be effective in cases where medicines such as antidepressants have failed. The second advantage is that it can be done in a relatively shorter period compared to other forms of talk therapy. The third advantage is that it is structured in a way that it can be done in various formats, from groups to online forums (Dobson & Dobson, 2018). The third advantage of CBT is that it teaches the patient useful life strategies even long after the end of the treatment. One limitation of CBT, however, is that the patient must commit themselves to the therapy process to optimize its efficacy. Secondly, the patient’s daily life scheduled is significantly affected as they may have to all of the sessions and participate in extra activities (Fava et al., 2018). Thirdly, CBT may not be effective for individuals with serious mental health issues or learning disabilities as it is characterized by structured sessions. Fourthly, CBT focuses on the patient’s ability to focus on their anxieties and emotions, which can be emotionally uncomfortable during the initial stages. Other critics argue that CBT only narrows on the individual’s ability to change themselves without focusing on wider issues in systems or families that may have a significant impact on an individual’s wellbeing.
The third commonly used form of psychotherapy for depression is interpersonal therapy (IPT). Interpersonal therapy was conceptualized by Gerald Klerman and Myrna Weissman in the 70s based on the theoretical works of scholars such as Harry Stack Sullivan and John Bowlby. Interpersonal therapy focuses on the patient and their relationships with other individuals in their lives. The therapy model is not based on the idea that depression is caused by events surrounding interpersonal relationships but that depression is a product of the interpersonal context that impacts relationships and the people involved. By addressing these interpersonal concerns, therefore, interpersonal therapy attempts to place more emphasis on the way the patient’s symptoms are related to their interactions and relationships with peers, friends, and family. The immediate objective of IPT is rapid symptom reduction and enhanced social judgment. The long term goal is to enable the patient to make their required adjustments so that they are empowered to cope with depressive symptoms.
Interpersonal therapy was initially developed as a depression treatment for adults. Empirical evidence has, however, shown that the therapy is also effective in treating depression in children and teenagers (Hetrix et al., 2016). The therapy method has grown to be among the most commonly used as most patients with depressive symptoms also experience issues in their interpersonal relationships. The therapy model is thus inspired by the idea that once addressed, strengthened relationships can play an integral role as a support network throughout the patient’s recovery process (Hetrix et al., 2016). The therapist is thus supposed to provide what can be described as an active and non-judgmental intervention to help the patient handle their social challenges and enhance their mental health. The most common themes addressed during this therapy process are role disputes, relational conflict, grief, life stage transitions, and attachment issues. While proven to be effective in treating depression, interpersonal therapy has also been modified to treat other psychological issues like anxiety, dysthymia, bipolar, and postpartum depression, social phobia, and posttraumatic stress (Hetrix et al., 2016). Studies have likened the efficacy of interpersonal therapy in treating depression to antidepressants, with some therapists integrating the two.
Interpersonal therapy treatment often begins with the therapist conducting an interview with the patient. Based on the issues raised by the patient, the therapist is able to identify the goals of the therapy process and develop the appropriate treatment outline. The patient and the therapist then focus on the main concerns to be addressed. A normal interpersonal therapy program involves a total of 20-hour long sessions conducted over a period of five months. Interpersonal therapy is different from other forms of psychotherapy in the sense that instead of focusing on the unconscious origin of the patient’s feelings and behaviors, it focuses on the reality of their depression (Hetrix et al., 2016). The therapy model pays more attention to how the patient’s immediate difficulties are causing the symptoms. Interpersonal therapy entails a psycho-educational component where the therapist also educates the patient about the causes of depression, the available treatment options, and the opportunities for improvement. The patient is also often advised to assume a “sick role,” which entails being exempted from blame for missing activities due to the symptoms.
Three of the most common Interpersonal therapy manuals are Comprehensive Guide to Interpersonal Psychotherapy, The Clinician’s Quick Guide to Interpersonal Psychotherapy, and the Interpersonal Psychotherapy: A Clinician’s Guide. The Comprehensive Guide to Interpersonal Psychotherapy was written by Myrna et al. (2000), and it mainly offers historical information, training resources, and deeper therapeutic insight into IPT. The Clinician’s Quick Guide to Interpersonal Psychotherapy, released in 2007, is also written by the same authors, and it serves to address the unique applications of Interpersonal therapy for other psychological concerns (Barkham et al., 2016). Interpersonal Psychotherapy by Stuart and Robertson (2003) serves to explain the theoretical parts of interpersonal therapy, outlining the techniques and application of the therapy process (Barkham et al., 2016). The main advantages if interpersonal therapy is that they are short term: lasting for as short as five months. The second advantage is that a successful interpersonal therapy process results in a stronger and healthier relationship and enhanced interactions with other people in society. One limitation of the interpersonal therapeutic process is that it is based on the assumption that the patient is willing and motivated to change. For the interpersonal therapy process to be effective, therefore, the patient must be dedicated to the cause and willing to examine their role in the issue. Another limitation of IPT is that the patient must possess a certain level of awareness and understanding of social relationships in order to effectively work on them (Barkham et al., 2016). The third weakness of IPT is that it is based on the assumption that individuals suffering from depression do so due to strained interpersonal relationships and not other independent factors such as genetics.
In conclusion, depression being the world’s leading cause of disability according to the Centers for Disease Control, is a major global issue that must be addressed with care by the collaborative effort of not only the stakeholders in the health care systems but also the society. While several treatment models have been developed from medications to psychotherapy, there is a need for further research in the field so that a more effective model that integrates the advantages of all of the models while mitigating the disadvantages of each is developed. This model, combined with other strategies such as community sensitization, will play an integral role in reducing the global prevalence of depression.
References
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