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Information about various types of Counseling for Depression

There are four main types of counseling for depression that have tested and found to be effective for those suffering from periodic major depression. There are some surprising and important findings from this research, which potential patients will want to know about. I will discuss these findings after briefly describing each counseling method.

Cognitive-behavioral therapy (CBT)

CBT is a widely used form of counseling for depression. It has been found effective for mild to moderate depression and, in the hands of experienced therapists, there is evidence it may work in severe depression, as well. Patients are helped to identify and correct inaccurate thoughts and beliefs (cognitions) associated with depression. Therapists using this form of counseling for depression also encourage patients to become involved in activities that may bring pleasure, a sense of accomplishment and that serve to test the accuracy of their negative thoughts.

Behavioral activation (BA)

This type of counseling for depression was developed as a result of efforts to determine whether the cognitive or the behavioral component of CBT was the most helpful. One study showed that this form of counseling for depression was equal in effectiveness to antidepressant medication and that both BA and medication were better than CBT, which did not provide much more help than a sugar pill placebo. In the latest study, BA was equal to antidepressant medication even in severe depression. Both BA and medication were much more effective than CBT in this study.

Therapists practicing BA help patients shift away from dwelling on depressing thoughts to activities that are meaningful to them and that will enrich their lives. BA therapists typically put little direct effort into trying to change patients’ negative thinking.

Interpersonal therapy (IPT)

IPT therapists focus on helping patients develop skills to resolve relationship problems that may be contributing to depression. These therapists look for problems in four areas: 1) role transitions (divorce, retirement) 2) role disputes (what the patient and their partner want from each other) 3) unresolved grief 4) isolation, withdrawal and lack of skill in relationship building.

IPT and CBT were found to be equally effective in mild to moderate depression in early studies that compared the two methods. These studies indicated that IPT was better than CBT in helping people with severe depression.

Psychodynamic therapy

In this form of counseling for depression , therapists try to help patients understand and resolve emotional conflicts lying outside conscious awareness that contribute to depression and repetitive relationship problems. Therapists may also try to help patients understand how current difficulties repeat or are based on unresolved conflicts or relationship patterns from childhood.

Although psychodynamic therapy has not been tested as extensively as other types of counseling for depression, some studies have suggested that it is as effective as CBT and IPT.

Surprising findings from 25 years of psychotherapy research.

  • CBT, IPT and Psychodynamic therapy all work about equally well for mild to moderate depression. Early studies also showed that simple supportive care provided by doctors dispensing sugar pills was just as effective as IPT and CBT for mild to moderate depression. This suggests that there is nothing special or uniquely effective about any one method of counseling for depression.
  • One study showed that patients who did well in CBT had low levels of negative thinking and that patients who did well in IPT had low levels of interpersonal problems. This suggests that counseling for depression may work best when therapists help patients focus on making small changes using skills they already have in areas in which they do not have major problems.
  • BA is a simpler and more effective method of counseling for depression than CBT, especially for patients overwhelmed by negative thinking and severe depression.

What about this issue of medication vs. psychotherapy? Although research studies have shown counseling for depression is as effective as medication, the way medications are used in these studies typically leads to an underestimation of the actual effectiveness of the drugs. The same medication (usually at the same dose) is given to all patients, regardless of the subtype of depression they have. In actual practice, a prescriber uses the medication most likely to work for the kind of depression from which the patient suffers. The prescriber will also switch to another medication when the first one is not effective. Early government-sponsored studies on counseling for depression showed that medication was superior to psychotherapy when the severity and type of depression was taken into account.

Here’s the bottom line on counseling for depression.

You will probably get the most help from a therapist who is warm, understanding, supportive and whose approach to your problems makes sense to you. The therapist should focus on helping you make small changes in your behavior. These might include learning to assert yourself or getting busy doing things that can make life more fulfilling. Making these changes may be easier if the therapist can help you understand the emotional forces and conflicts that contribute to your difficulties and block your efforts. At the same time, the therapist should not push you to change problems that feel overwhelming. He or she should focus on areas of competence and strength to help build self-confidence and reverse demoralization.

Counseling for depression should produce noticeable results in 6 to 12 weeks. If it does not, consider the use of medication. Always be sure you and your therapist have explored the possibility you may have bipolar depression before starting antidepressants.

Some of the information discussed above is drawn from the work of my colleague and friend Scott Temple, Ph.D. at University of Iowa. Dr. Temple is the author of Psychotherapy for Depression: Current empirical status and future directions. In P. Tyrer & K. Silk, Eds. (2007). Cambridge Handbook of Effective Treatments in Psychiatry. Cambridge University Press.
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