Psychotherapy

CBT is a well-established, evidence-based treatment approach for depression. CBT is a goal-oriented approach that helps patients recognize and modify thought and behavior patterns that interfere with functioning or make depressive symptoms worse. CBT has also been shown to result in improvement in brain functioning. People with depression often experience distorted negative thoughts about themselves or their situations (for example, characterizing their lives as worthless).

By working to reveal more accurate information about themselves, these negative thoughts can be countered with a more realistic picture of both the present and the future. As depression also tends to cause people to isolate, some of CBT often involves changing patterns of avoidance to help a person continue to move toward life aims. CBT commonly combines eight to twelve regular weekly sessions (sometimes more, sometimes less) with a trained therapist who assigns exercises that individuals can practice on their own in between sessions.

These exercises encourage individuals to practice replacing negative thoughts with more realistic ones based on past experience or to write negative thoughts in a journal. Once patients learn to recognize these automatic thinking patterns, they are taught more adaptive ways of thinking and acting to meet their aims. This typically has a beneficial impact on mood and future behaviors.

IPT focuses on current relationships and interactions as they are related to a person’s mood. Improvements to relationships can often lead to improvements in mood. It usually involves up to 20 weekly sessions, each lasting approximately one hour. Sessions are focused on one or two key interpersonal issues that have been identified as most closely related to a person’s depression. These issues may include disputes with others, life changes or transitions that affect relationships, or unresolved grief over the loss of a relationship.

DBT is a psychological treatment method that encourages individuals to accept uncomfortable thoughts, emotions, and behaviors instead of struggling with them. It combines traditional CBT with two additional techniques: Dialectics, which relies on discussion or dialogue to explore and resolve issues. Mindfulness, which encourages individuals to become more aware of and present in the moment, so that concerns about the future or thoughts about the past do not interfere as much with their ability to enjoy life. Patients participating in DBT take part in both individual and group sessions:

• During individual sessions, the patient and therapist meet to discuss issues that have come up during the previous week and work on skills.
• During group sessions, several DBT patients meet to practice different life skills in a safe, controlled environment. These skills include recognizing and managing emotions, tolerating distress, being effective in relationships, and developing mindfulness. Individuals are usually instructed to practice these methods as homework between sessions.

MBCT is a psychotherapy approach that combines the principles of mindfulness meditation with the tools of cognitive therapy. MBCT was originally created to prevent relapse in depression. It is clinically proven to reduce symptoms of depression and prevent future episodes of depression.

• Cognitive therapy aims to modify thought and behavior patterns that interfere with functioning or make depressive symptoms worse.
• Mindfulness involves continuous awareness of our thoughts, feelings, and emotions and purposely attending to the present moment without attaching judgment to our thoughts.

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: A meta‐analysis of direct comparisons. World Psychiatry, 12(2), 137-148.

MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J. V., ... & Ravindran, A. V. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 6. special populations: youth, women, and the elderly. The Canadian Journal of Psychiatry, 61(9), 588-603.

Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Beaulieu, S., Alda, M., ... & Ravindran, A. (2013). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar disorders, 15(1), 1-44.