Evidence Based Psychotherapy for Depression

Psychotherapy has long been established as an effective treatment for depression. Research in the past two decades has identified Cognitive Behavioral Therapy and Interpersonal Therapy as the most effective for major depression. More recently, Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has emerged as an effective treatment for chronic depressive and dysthymic disorders.

Cognitive Behavior Therapy (CBT)

Cognitive Behavior Therapy is a structured, present –focused and problem-solving oriented therapy. It is a form of psychotherapy that hypothesizes that it is not the event itself that changes our mood but our perception of event that determines how we feel about it. For example, if a noise is heard in the back yard, a person who thinks there is an intruder will become nervous and call the police. Another person, who thinks it is family dog, will calmly go on with their chores. Yet another person who thinks the neighbors are annoying them will become angry and maybe shout out to the neighbors. Therefore, the Cognitive Model suggests that people react differently to situations based on how they think about them.

The quick evaluative thought (there is an intruder who could come and attack me, it is nothing so I don’t have to worry) that occurs without deliberation or reasoning is called an automatic thought. Automatic thoughts are evaluations made about an event based on one’s belief about themselves, others and the world around them. The therapist works collaboratively with the patient to identify these thoughts and consequent behaviors. Once the patient is able to recognize the thoughts and behaviors they learn how to replace them with more helpful ones that will alleviate their mood. In addition, CBT also focuses on learning new interpersonal and problem solving skills. CBT uses home work to facilitate the use and practice of strategies and techniques outside the therapy session.

Interpersonal Psychotherapy

IPT is based on the assumption that the patient’s interpersonal relations may play a significant role in both the onset and maintenance of depression.

The key objectives of the treatments are to:

§ Link one’s mood to his /her present interpersonal difficulties.

§ Provide relief from the symptoms of depression

§ Enhance social skills by helping the individual solve current interpersonal problems.

IPT focuses on the identification and amelioration of the problematic interpersonal circumstances that contribute to or are a consequence of current mood problems. Such interpersonal problems may include unresolved grief, interpersonal disputes, relationship problems, role transitions (new job, new relationship, new baby) and social isolation.

Some of the strategies one would learn include:

§ How to effectively express emotions. Communicating how one feels effectively will help decrease the frustration associated with bottling up emotions.

§ Analyze blocks in communication with significant others. Conversing freely with the people we love is sometimes not as easy as it appears. An understanding of what gets in the way will help identify ways to overcome these blocks.

§ Problem solving aimed at resolving differences of opinion. Diverse points of view can become frustrating when we are unable to discuss our point view without getting angry or taking it personally. Problem solving can help us understand another person’s opinion as well as identify ways to resolve conflict

§ Social Skills training to reduce social isolation and develop better romantic, peer and professional relationships. This technique uses rehearsal and role play to learn ways of communicating and thus, decreasing inter personal discomfort.

Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

CBASP is an empirically supported psychotherapy developed to treat chronic or persistent depression. A recent study published in the August, 2004 edition of the Journal of Consulting and Clinical Psychology, found CBASP to be just as effective as medication treatment in a large sample of chronically depressed patients.

The hallmark of this treatment is an integration of the elements of behavioral, cognitive, interpersonal, and psychodynamic psychotherapy. The major goals of CBASP include helping patients understand the consequences of their behavior, change their coping styles, improve their interpersonal skills and interact more effectively with others. CBASP uses a collaborative approach where the patient-therapist team work together to understand the patient’s thoughts and behavior and how they may be preventing him or her from reaching a desired goal or getting a much wanted result.

CBASP is similar to cognitive and behavioral approaches in that it is highly structured, focuses on teaching problem solving skills, and makes use of homework assignments to reinforce the skills learnt in therapy. It is similar to IPT in its focus on interpersonal problems, and it borrows from psychodynamic psychotherapy in that the relationship with the therapist can be used as a tool to help patients become more aware of the impact of their thoughts and behavior on others and distinguish between adaptive and maladaptive relationships

The major technique used in CBASP is situational analysis (SA). In SA, patients identify a recent, problematic, interpersonal situation and examine it with the therapist. This technique has two phases: elicitation and remediation.

In the elicitation phase, patient describes the interpersonal event and their interpretation of what occurred, how they behaved in that situation and the outcome of the event. In addition, they articulate what they would have liked the outcome to be (desired outcome) and whether the desired outcome was achieved.

In the remediation phase, patients work with the therapist to alter their interpretations, behaviors, and/or desired outcome during the situation with a goal of increasing the probability of achieving the desired outcome.

This technique is used in situations that arise in the therapy session as well as in the patient’s everyday life. This helps the patient test out the skills in a safe therapeutic environment. In addition, the therapist- patient team explores how the patient's new understanding and skills could be applied to similar situations in the past and future.

The Cognitive Model

The Cognitive Model indicates that our thoughts, feelings, behavior and physiology influence each other.

Sources:

CBASP manual
Judith Beck
IPT- Harvard Review