Most people who are treated for major depression receive antidepressants prescribed by their primary family doctor. Most people also never see a mental health specialist for depression until it worsens. Then they may be referred to a psychiatrist for additional medication options. Sometimes, they may also be referred to talk to a psychotherapy for psychotherapy. But the latter option doesn’t occur nearly as much as the medication treatment, despite an overwhelming amount of research that shows that both work together more than either work by themselves.
So Kuyken and associates, in recently published research, help us understand how effective the most popular type of psychotherapy for depression is — cognitive behavioral therapy (CBT).
CBT provides a sophisticated, empirically grounded account of depression and an evidence-based therapeutic approach for people who suffer from depression. Beyond its efficacy in treating acute depression, it has prophylactic effects and is acceptable to various populations in a range of settings. Good theoretical accounts of the emergence of depression in adolescence are forthcoming; to date, however, attempts at primary prevention are unconvincing. Our understanding of factors contributing to positive outcomes is growing, allowing CBT to be tailored to individual client needs.
CBT is a mainstay approach to depression. Significant remaining challenges include tailoring it to different populations and settings and, most importantly, ensuring that it is more readily accessible.
CBT works, of that there is no doubt. It probably works even better than most antidepressants do, but it has to be wielded by a skilled, trained therapist (just like surgery is best done by a skilled, trained surgeon). It’s been used for decades in the treatment of depression and unlike the movie accounts of psychotherapy, it doesn’t require years of therapy, or talking about your childhood.
Another type of behavioral psychotherapy treatment is called activity scheduling. Activity scheduling is a behavioral treatment of depression in which patients learn to monitor their mood and daily activities, and how to increase the number of pleasant activities and to increase positive interactions with their environment.
Cuijpers and friends found that activity scheduling is an attractive treatment for depression because, not only is it effective, but because it is relatively uncomplicated, time-efficient and does not require complex skills from patients or therapist.
I think that activity scheduling is a simplistic treatment, perhaps too simplistic for many people grappling with depression for more than a few months. The challenge, too, is maintaining gains after treatment has ended, as the reinforcement for monitoring one’s daily moods and activities (via the therapy session) is no longer a factor. While therapy teaches people to do this, I think self-rewards are less reinforcing than another person “keeping tabs” with you.
References: Kuyken W, Dalgleish T, & Holden ER. (2007). Advances in cognitive-behavioural therapy for unipolar depression. Can J Psychiatry, Jan;52(1):5-13.
Cuijpers P, van Straten A, & Warmerdam L. (2007). Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev, Apr;27(3):318-26.