There are many ways to treat depression successfully. Effective treatments can be as simple as getting more exercise, or as extreme as hospitalization. Between those two poles, however, are the most common forms of treatment: medication and psychotherapy. Antidepressant medications have been well-studied for their efficacy. But what about psychotherapy?
Or, better stated, what about psychotherapies? There are several types of talk therapies to choose from, and the National Institute of Mental Health reports that many have been shown to be effective for specific disorders. When many people think about psychotherapy, they still picture the laying-on-the-couch, talking-about-your-mother Freudian analysis. That still exists, but modern approaches to talk therapy are often more about helping people recover from their depression as quickly as possible.
The American Psychological Association says therapy helps patients “identify the factors that contribute to their depression and to deal effectively with the psychological, behavioral, interpersonal and situational causes.” In other words, therapists can:
— Identify negative or distorted thinking patterns that often lead to feelings of hopelessness and helplessness.
— Identify specific life problems that contribute to depression and help patients understand how to solve or improve on those problems.
— Develop options for the future and set realistic goals to improve mental and emotional well-being.
They also do so relatively quickly, after about 20 sessions of individual or group counseling. There is no need for a lifetime of analysis to treat depression, mental health experts say. Sorry, Dr. Freud.
[See: How to Find the Best Mental Health Professional for You.]
Many Types to Choose From
There is a long menu of psychotherapy options to choose from, but the three most common methods for treating depression, according to the University of Minnesota Center for Spirituality and Healing, are cognitive behavioral therapy, or CBT; interpersonal therapy, or IPT; and psychodynamic therapy, or PDT.
Cognitive behavioral therapy helps patients recognize and change patterns of negative thinking and behaving that lead to distorted and troubling views of the world and the self and are often associated with depression.
Interpersonal therapy helps patients recognize and reframe or alter unhealthy personal relationships that cause and feed into depression.
Psychodynamic therapies help patients resolve internal psychological conflicts, which are typically based on childhood trauma.
And there are still other options, such as behavioral activation therapy; problem-solving therapy, or PST; Eye Movement Desensitization Resolution, or EMDR; somatic therapies, including Hakomi and Somatic Transformation; stress- management techniques; mindfulness exercises; exposure therapy; and more. Some therapists may use one specific mode of therapy, while others incorporate elements of different therapies based the patient’s condition and needs, and on their own training.
But back to the original question. Which ones are scientifically proven to work?
[See: Am I Just Sad — or Actually Depressed?]
The Evidence of Success
The Anxiety and Depression Association of America performed a meta-analysis of all the available research. Its clinical review of practice guidelines reports that CBT is “the most studied psychotherapy for depression,” and it has “the largest weight of evidence for its efficacy.” IPT has been shown to be “an effective treatment for depression in numerous studies.” The ADAA doesn’t comment on psychodynamic therapies. But it does report that problem-solving therapy, which it describes as a therapy that teaches patients to define personal problems, develop and try solutions to those problems, and then assess their effectiveness, has a moderate base of evidence that is “effective for treating depression.”
That is echoed by one of PST’s co-creators, Arthur Nezu, professor of psychology at Drexel University in Philadelphia. Nezu also served on the American Psychological Association’s Panel on the Development of Clinical Practice Guidelines for the Treatment of Depression in 2011. “We reviewed the most recent literature and found that a handful of interventions, with both psychotherapy and medications, appear to be very helpful, including cognitive behavioral therapy, behavioral activation and another that I helped develop, problem-solving therapy.”
These reviews aren’t the end of the discussion, of course. CBT may fare so well simply because “the CBT people have taken the ball and run studies to show CBT makes [patients] better,” says Carl Tishler, a psychologist and adjunct associate professor of psychiatry and psychology at The Ohio State University. However, he feels that individuals who have suffered trauma as children and have been depressed a long time don’t respond as well to CBT. “They do well in longer-length, traditional psychotherapy or group therapy,” he says. “It just depends on the individual.”
[See: The Many Ways Exercise Fights Depression.]
And the ADAA says the best results for the most people come when patients are treated both with psychotherapy — be it CBT or some other form — and medication. Many practitioners agree. “My view is that the most serious depression should be treated with a combination of medicine and therapy,” says Carol Landau, clinical professor of psychiatry and human behavior and medicine at Brown University’s Alpert Medical School. For mild to moderate depression, she recommends therapy first, with antidepressants held in reserve. “I tell patients we can do a staged treatment,” she says. “Let’s get at this with CBT for eight weeks, and then if nothing is happening, let’s go try some medication.”
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Psychotherapy Approaches: Which Have the Most Evidence of Success? originally appeared on usnews.com
