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 the person identify and work through the factors that may be triggering the 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 are just as important as treating its medical cause.
How does psychotherapy help?
Psychotherapy helps people with depression:
* Understand the behaviors, emotions, and ideas that contribute to his or her depressed state
* 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
* Regain a sense of control and pleasure in life
* Learn coping techniques and problem-solving skills
Types of therapy
Therapy can be given in a variety of formats, including:
* Individual — This therapy involves only the patient and the therapist.
* Group — Two 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
Although therapy can be done in different formats—like family, group, and individual—there also are several different approaches that mental health professionals can take to provide therapy. After talking with the patient about his or her depression, the therapist will decide which approach to use based on the suspected underlying factors contributing to the depression.
Psychodynamic therapy
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 better cope with these feelings by talking about the experiences. Psychodynamic therapy is administered over a period of three to four months, although it can last longer, even years.
Interpersonal therapy
Interpersonal therapy focuses on the behaviors and interactions a depressed patient has with family and friends. The primary goal of this therapy is to improve communication skills and increase self esteem during a short period of time. Therapy usually lasts three to four months and works well for depression caused by mourning, relationship conflicts, major life events, and social isolation.
Psychodynamic and interpersonal therapies help patients resolve depression caused by:
* Loss (grief)
* Relationship conflicts
* Role transitions (such as becoming a mother or a caregiver)
Cognitive behavioral therapy
Cognitive behavioral therapy helps people with depression to identify and change inaccurate perceptions that they may have of themselves and the world around them. The therapist helps patients establish new ways of thinking by directing attention to both the "wrong" and "right" assumptions they make about themselves and others.
Cognitive-behavioral therapy is recommended for patients:
* Who think and behave in ways that trigger and perpetuate depression
* With mild-to-moderate depression as the only treatment or in addition to treatment with antidepressant medication
* Who refuse or are unable to take antidepressant medication
* Of all ages who have depression that causes suffering, disability, or interpersonal problems
Therapy tips
Therapy works best when you attend all of your scheduled appointments. The effectiveness of therapy depends on your active participation. It requires time, effort, and regularity.
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 seek a second opinion if both you and your therapist agree, but don’t discontinue therapy abruptly.
Tips to help you get started
* 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 find methods to reduce and manage 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 causes of depression; it is not a "quick fix." It takes longer to begin to work than antidepressants, but there is evidence that suggests that its effects last longer. Antidepressants may be needed immediately in cases of severe depression, and the combination of therapy and medicine is very effective.