For many years, psychotherapy (counseling), as practiced by most mental health professionals, was an open-ended, unstructured process aimed at uncovering so-called “unconscious” reasons for depression. A lot of time was spent on how the individual was raised as a child, and other past events that may have shaped the person’s feelings and behavior. This lengthy, intensive effort has never been proven effective in the treatment of depression or any other mood disorder.
Fortunately, a relatively new form of psychotherapy is emerging that has been shown to be superior—cognitive behavioral therapy.
Dozens of controlled clinical trials during the past 20 years have established the effectiveness of cognitive-behavioral therapy in the treatment of major depression and dysthymic disorder.i,ii,iii,iv,v This particular type of therapy is focused, time-limited, and directed at the specific needs for the depressed individual. It aims at identifying and correcting erroneous interpretations of events and negative automatic thoughts that may initiate or perpetuate a depressed mood. The focus is very much on the depressed individual and what he can do differently—not on finding circumstances or others to blame.
Chronic depression has an earned reputation of being very difficult to treat. By definition, chronic depression has to have lasted for greater than two years. Often the depressed individual has not responded to medication, counseling, or other therapy. A recent landmark study showed that a combination of the antidepressant drug nefazodone (Serzone) and intensive psychotherapy effectively reduces or eliminates chronic depression in a record 85 percent of patients.vi No other study has ever shown such a dramatic response. Not surprisingly, the type of psychotherapy used was the cognitive-behavioral analysis system.
“We were stunned,” said lead investigator Martin Keller of Brown University. “None of us had anticipated we’d show anything close to an 85 percent response rate for the combination.” Patients on the combination did significantly better than those undergoing the counseling or the medication by themselves. The study highlights the importance of using a combination of successful approaches to more effectively combat depression.
i. M. E. Thase, J. B. Greenhouse, et al., "Treatment of major depression with psychotherapy-pharmacotherapy combinations," Arch Gen Psychiatry (1997): 1009.
ii. V. Gloaguen, J. Vottraux, et al., "A meta-analysis of the effects of cognitive therapy in depressed patients," J Affect Disord (1998): 59.
iii. H. C. Schulberg, P. A. Pilkonis, P. Houck, "The severity of major depression and choice of treatment in primary care practice," J Consult Clin Psychol (1998): 931.
iv. R. J. DeRubeis, L. A. Gelfand, et al., "Medications versus cognitive behaviour therapy for severely depressed outpatients: mega-analysis of four randomized comparisons," Am J Psychiatry (1999): 1007.
v. W. Katon, P. Robinson, et al., "A multifaceted intervention to improve treatment of depression in primary care," Arch Gen Psychiatry (1996): 924.
vi. M. B. Keller, J. P. McCullough, et al., "A comparison of nefazodone, the cognitive behavioural-analysis system of psychotherapy, and their combination for the treatment of chronic depression," N Engl J Med (May 18, 2000): 1462-1470.
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This article is adapted from the book Depression: The Way Out by Dr. Neil Nedley. Visit Dr. Nedley's website
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