Psychological treatment of depression
Psychological treatment of depression can assist the depressed individual in several ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations and overly critical self evaluation that creates depression and sustains it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps the patient to develop positive life goals and more positive self assessment. Third, problem solving therapy changes the areas of the person’s life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills to assist in solving relationship problems. At first glance this may seem like several different therapies being used to treat depression. However all of these treatments are used as a part of a cognitive behavioral therapy approach to depression. Cognitive behavior therapy combines two very effective kinds of psychotherapy, cognitive therapy and behavior therapy. Behavior therapy helps the patient weaken the connections between troublesome situations and his habitual reactions to them. Reactions may include fear, depression, rage, and self-damaging behavior. It also teaches the patient how to calm his mind and body, so he can feel better, think more clearly, and make better decisions. Cognitive therapy teaches the client how certain thinking patterns are causing his symptoms. This is achieved by giving the client a distorted picture of what is going on in his or her life, and making the client feel anxious, depressed or angry for no good reason, or provoking him into ill-chosen actions. When combined into CBT, behavior therapy and cognitive therapy provide very powerful tools for stopping symptoms and getting life on a more satisfying track.
It is estimated that one of every twenty adolescents suffers from clinical depression. When depression begins during the teenage years, the risks are significant. Major depression in children and adolescents is a serious condition that should be adequately treated, which includes careful follow-up and monitoring. Each child should be carefully and thoroughly evaluated by a physician to determine if medication is appropriate. Those who are prescribed a selective serotonin reuptake inhibitor (SSRI) medication should receive ongoing medical monitoring, with particular care paid in the first four weeks of taking the drug. Psychotherapy is often used as an initial treatment for milder forms of depression. Many times, psychotherapy accompanied by an early follow-up appointment may help to establish the persistence of depression before a decision is made to try antidepressant medications. Psychotherapies include “cognitive behavior therapy” and “interpersonal Therapy.” (Brent, 1997) For moderate to severe forms of depression, especially if persistent, the current evidence supports the use of fluoxetine alone or in combination with cognitive behavioral therapy (CBT).
Depressive episodes can reoccur and interrupt important learning and development. And among depressed teens, suicide is a significant risk, making it imperative to identify and treat young people quickly and effectively. (Edelman, 2005) Among the newer antidepressant drugs, only Prozac is approved for children and teens. But as Michelle Trudeau reports, one particular type of psychotherapy has proven especially effective in alleviating depression in young people: cognitive behavior therapy, or CBT. Group CBT programs are also widely used for assisting teenagers with anxiety, depression and other psychological problems. The majority of reported programs have targeted school or clinical populations however few have specifically targeted adolescents from highly troubled and disadvantaged backgrounds. In this study Edelman and Remond describe a group CBT program that was developed for teenagers who have not responded well to formal structures of school and traditional models of classroom management. Problems such as low levels of motivation, poor attention span, learning difficulties, poor impulse control, substance abuse and or other mental health problems were common with this population. A number of challenges arose in running the program and several modifications were made in order to make it more relevant to participants. These changes resulted in more rapid engagement with the program, improved cooperation within the group, fewer interruptions and improved rapport. The clinical outcomes associated with the program could not be measured due to difficulties with completing self-report questionnaires. (Edelman, 2005)
Initial treatment of major depressive disorder in adolescents may include cognitive behavioral therapy or a selective serotonin reuptake inhibitor (SSRI). However, little is known about their relative or combined effectiveness. To evaluate the effectiveness of four treatments among adolescents with major depressive disorder. Randomized controlled trial of a volunteer sample of 439 patients between the ages of twelve to seventeen years old with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depressive disorder participated. The trial was conducted at thirteen United States academic and community clinics between spring 2000 and summer 2003. Twelve weeks of (1) fluoxetine alone (10 to 40 mg/d), (2) cognitive behavior therapy alone, (3) cognitive behavior therapy along with fluoxetine (10 to 40 mg/d), or (4) placebo (equivalent to 10 to 40 mg/d). Placebo and fluoxetine alone were administered double-blind; CBT alone and CBT along with fluoxetine were administered unblended.
Traditional models of psychotherapy for depression have focused primarily on modification of a single area, either cognition or behavior. The Group, Individual, an Family Treatment (GIFT) program is an integrative psychotherapy program designed to build on cognitive and behavioral theory and technology. The authors describe the emotional fitness model of mental health that underlies the GIFT program. They propose that psychological problems are developed and maintained in the social context of the system that the client or clients are a part of. This new perspective relocated the responsibility for the problems and the focus of the treatment from the internal world of the individual patient to the entire system. This shift in understanding human events in terms of interactional patterns of behavior also calls for a new way to explain the existence of emotional distress according to Bockting. They then describe how GIFT integrates group, individual, and family-based interventions.