Since CBT is a short-term treatment approach, most treatment programs are time limited (having a fixed ending date after a set number of treatment sessions). As a result, clients are encouraged to plan how they will apply what they have learned once the treatment has ended. This makes CBT quite different from more traditional approaches which are more open ended.
Research studies have demonstrated the effectiveness of CBT in the treatment of substance abuse, depression, eating disorders, and other mental health problems. Large-scale studies of CBT in the treatment of depression and other mood disorders have found it to be highly effective for many people. Combining CBT with other treatment approaches such as antidepressant medication can be particularly useful in steering clients toward a healthier lifestyle.
43. What is mindfulness therapy?
Originally a part of Buddhist teachings, mindfulness deals with the process of focusing attention on the here and now without worrying about past experiences or having fears about the future. Among the different mindfulness-based treatment approaches available are mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction (MBSR), and mindful-oriented recovery enhancement (MORE). For that matter, there are also a growing number of “third-wave” behavioral treatments that have included mindfulness training as modules in their programs. These include acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT).
Despite the numerous different approaches using mindfulness training, they all involve the use of meditation, guided imagery, or mental visualization exercises to allow people to focus on those specific thoughts, physical sensations, and desires that might be undermining their mental or physical health. This means that participants can learn how to take in and accept all incoming thoughts and feelings without resorting to automatic thoughts and beliefs that might be destructive. Also, much like with CBT, participants are given regular homework assignments so that they can regularly practice what they learn in the treatment sessions. This allows them to become more comfortable with the techniques as well as use them on a daily basis.
Now widely used in the treatment of a range of mental health issues such as depression, stress, and social anxiety, mindfulness training represents one of the most promising approaches for people to come to terms with emotional issues and negative thinking.
For people dealing with depression, mindfulness training can be especially useful in accepting negative emotions and the self-talk that can influence mood. Since people have an innate need to avoid painful situations and seek out pleasurable sensations, dealing with cravings is a perpetual problem for substance abusers who might otherwise want to stay clean.
Research looking at the effectiveness of mindfulness-based treatment has shown that it can be especially beneficial in reducing depression and other mood disorders. Researchers examining the effects of mindfulness meditation on brain functioning have found evidence of significantly increased activity in the prefrontal cortex during meditation. This can help with negative self-talk and emotional regulation and can make coping much easier during depressive episodes.
One of the advantages of mindfulness training is the way that it can be combined with other group and individual treatment approaches and even included as part of family or couple therapy. Mindfulness training seems to work especially well when combined with CBT, which can reinforce the benefits this kind of treatment can provide.
A recent research review of nine clinical trials of people with severe depression showed that MBCT helps reduce the risk of relapsing in depression regardless of age, sex, relationship status, or level of education. Mindfulness-based therapy has also been found to be as effective as medication in many cases, and in one recent study, many of the patients completing a mindfulness therapy program felt confident enough to stop their medication completely.
While mindfulness-based therapy is hardly a cure-all for people dealing with depression, it is a promising treatment tool that is likely to become more widely used in future.
44. What is interpersonal psychotherapy?
Once known as “high contact” therapy, interpersonal psychotherapy (IPT for short) was first developed by psychologists at Yale University as a brief intervention for the treatment of major depression and has since been adapted for a wide range of other mental health issues. Partly based on attachment theory (see Question 21), IPT focus on relieving symptoms by improving the way people interact with family, friends, and peers. One of the central concepts of IPT is that psychological issues such as depression and anxiety occur due to problems in the everyday relationships we all have with the important people in our lives.
People undergoing IPT learn to focus on developing their relationship skills and learning better communication strategies to overcome those conflicts that can lead to emotional distress. The relationship problems that may be explored in IPT usually fall into four categories:
conflict in relationships leading to tension and distress
significant life transitions—for example, losing or starting a new job or starting a new school—that can affect how participants may view themselves and others
unresolved grief and loss
difficulties in starting or sustaining relationships; this includes identifying the interpersonal shortfalls that can sabotage relationships
With IPT, the first three treatment sessions usually focus on helping participants create a list of all their important relationships as well as identifying the problems they may be experiencing. Based on what is discovered during these early sessions, the therapist then prepares a treatment contract outlining what the therapy is intended to achieve as well as how long the treatment will take. While a standard IPT usually runs from twelve to sixteen treatment sessions, the therapist may well decide that additional sessions will be needed based on the kind of relationship problems that need to be addressed.
Participants are encouraged to examine their important relationships and determine the type of problem they may be experiencing. This allows participants to work with the counselor to decide on what relationship issues they may want to concentrate on in the following sessions.
In the weekly sessions that follow, participants also learn about attachment theory and how it may be used to understand how relationship problems first develop and why the difficulties they may be experiencing keep occurring. They also learn about positive and negative communication strategies that can help or hinder the forming of new relationships or maintaining existing ones.
During the course of these treatment sessions, participants are encouraged to examine past and present relationships to identify what may have led to problems forming. This includes looking at specific interpersonal situations that may have been especially distressing and exploring how they responded to those situations as well as possible alternatives that might have worked better.
One important feature of IPT treatment sessions is the assigning of “homework” that participants can do on their own. These homework assignments help clarify the different skills learned in the treatment programs and allow for additional practice at home.
During the final two or three sessions, the therapist reviews what has been learned and allows the participant to provide feedback about the treatment and the kind of issues that may need to be addressed in future. As with CBT, people who have successfully completed IPT treatment may follow up with maintenance sessions that allow them to review the material presented and practice the skills they have been taught.
Numerous research studies have already demonstrated the value of IPT in the treatment of depression and other mood disorders. Though originally developed for adults with depression, specialized IPT programs have also been developed for adolescents and preadolescents that focus on relationship problems experienced at a younger age.
Much like other treatment programs that are widely available, IPT isn’t necessarily suitable for all people who experience depression. Still, it can be highly beneficial in helping them d
eal with relationship issues and learn to cope better with their mood problems.
45. Who should receive group therapy?
Many people suffering from depression or other mood disorders find group therapy to be extremely valuable in helping them come to terms with their symptoms. Listening to other people share their own stories can help patients in the group feel less isolated. Also, people in the group can develop deep emotional bonds with other group members and help overcome their own issues in the course of treatment. Still, group therapy isn’t for everybody and should be used as part of a broader treatment process along with individual counseling sessions.
Any potential group therapy patient needs to be carefully screened to ensure that they benefit from being in a group with other patients. Some patients may not have be comfortable sharing their lives with other group members or may have poor social skills that might lead to them becoming disruptive. Also, socially anxious patients may decide to stay silent without ever participating.
Group therapy patients need to be properly motivated to be part of a treatment group and show proper empathy for what other group members are sharing about their own lives. Most importantly, they need to respect their fellow group members and respect their right to privacy by keeping all information they may learn in the group strictly confidential.
Along with mood-disordered clients who share their stories as part of the group, group therapy sessions can also include sessions looking at different coping strategies such as relaxation training, social skills development, self-confidence building, anger management, and mindfulness training. Though some participants may not feel that this material is immediately helpful to them, the skills they develop in these sessions can be essential in helping them move on with their recovery.
Unfortunately, some group members may feel a need to “compete” with the other patients in the group either through acting as if their problems are more important or else by trying to dominate the group and not giving other patients a chance to contribute. Ideally, the ground rules for participation in the group will be laid down at the beginning, and patients may begin with individual counseling until the therapist decides that they are ready.
For people dealing with depression, there is another issue that needs to be considered. Group members who are feeling suicidal or who have attempted suicide in that past may provide potentially gruesome details, even if they aren’t trying to shock the other people in the group. Hearing many of these details can be deeply disturbing for depressed people who are dealing with similar suicidal ideas. This is why therapists first need to work with their patients on an individual basis to ensure they are ready to cope with the intensity that can often occur in group therapy sessions.
By attending group therapy sessions on a regular basis, participants can develop a sense of hope at seeing how others have succeeded in overcoming problems very similar to what they are going through. Also, by imitating the examples provided by the therapist and other group members, they can learn to understand themselves better and develop real alternatives that can make coping easier.
46. What can parents do to help children who are depressed?
It seems almost inevitable that parents blame themselves whenever one of their children develops a mood disorder. Not only do they wonder if their parenting was somehow responsible for it but they may also feel guilty over missing warning signs that might have alerted them sooner that something was wrong. Unfortunately, many parents may choose to ignore these symptoms for as long as possible in the hope that their child might “snap out of it.” But depression doesn’t go away if it is ignored.
For any parent who wants to find the right help for a depressed child, the first step is always to recognize that something is wrong and become willing to take action. This means accepting a child’s mood problems as a challenge that needs to be overcome. It also means educating themselves about depression, its causes, and possible treatment options. Just as importantly, they need to be realistic about any expectations they might have about how quickly a treatment will work. Overcoming depression isn’t something that can happen overnight, and parents need to work together with their child’s therapist to ensure the best possible care.
Parents also need to set clear boundaries for their depressed child, but again, these have to be reasonable boundaries. This includes a willingness to get tough whenever their child acts out in any way and laying down ground rules that even depressed children should be expected to follow. Injecting a sense of structure into a child’s life can teach them to monitor their own behavior.
Since people who are depressed often feel moody and unloved, making certain that they know that their parents care about them can be an essential part of providing the right kind of support. This includes avoiding blanket statements such as “I know how you feel” (chances are, you don’t). Be prepared to sit down with them and simply listen to what they have to say.
Parents also need to avoid giving advice (which, admittedly, is a hard habit for mothers and fathers to break). While people with depression may want honest feedback at times, advice shouldn’t be forced onto them. If they are prepared to listen, they will.
Once a depressed child begins treatment, the first few weeks are going to be especially crucial. Parents need to provide encouragement and to be patient. For many people in treatment, whether as adults or adolescents, the temptation to simply give up is going to be particularly strong at first. Progress isn’t going to come as fast as they might have originally hoped, and as a result, they may assume that the treatment isn’t working and that the depression won’t go away.
At the same time, parents need to monitor their children to ensure that they keep taking medication or attend treatment as needed. All too frequently, particularly for people experiencing depression for the first time, many who find their mood lifting may decide that they have recovered and no longer need treatment. Parents and therapists need to work together to reinforce the importance of continuing the treatment and be willing to be a part of the treatment process.
Simply knowing that their parents are supportive and accepting may play a critical role in patients learning how to deal with depression.
47. Can online support groups help with depression?
For many depressed people who want to attend treatment, the problem of finding treatment programs can be difficult, especially if they live in a small community where certain programs may not be available. Anyone attending treatment for the first time may also feel reluctant to become part of a treatment group where they would be expected to talk about their emotional problems and share many of their most intimate secrets with people they have never met before.
As a result, many people with depression may be tempted to go online and take advantage of one of the numerous Internet support groups already available. Not only would this allow them to stay anonymous but these groups are usually free and can be accessed at any time of the day or night.
But how effective are these online groups when compared to in-person treatment programs when it comes to treating depression? Research looking at Internet-based cognitive behavioral therapy (iCBT) suggests that it can be as effective as traditional in-person treatment programs in treating depression. Still, much of this research is in the very early stage, and many more studies need to be done to determine whether this kind of online help can become more widely used.
Despite the appeal of online, often anonymous treatment programming, there are drawbacks as well. Since online groups often allow people to participate without revealing their identity, this removes much of the emotional connection that those participating in face-to-face meetings would experience. Meeting in-person also allows depressed patients to relearn how to communicate honestly and avoid the impulse to lie when being asked uncomfortable questions. In-person group members also learn to form strong emotional bonds with fellow group members and their therapist, something that can be extremely important for people who want to open up about secre
ts they might not otherwise share. With online counseling, on the other hand, many of the benefits of in-person treatment are often lacking.
Despite the disadvantages of online treatment programs, there is no disputing that they are becoming much more popular. Not only are there far more options available online than most people are likely to find in their own community, but joining an online group is far easier than finding an in-person treatment program. Considering that many programs may not be covered by standard health plans or receive government support, that also adds to its appeal.
Though online treatment is becoming increasingly popular, in-person treatment will continue to be available for people who need something more comprehensive to overcome depression. People seeking treatment should be able to investigate a wide range of treatment options. This can mean using online resources in supplementing the help that can come from conventional treatment, though it should never replace it completely.
If you are considering online treatment groups, make sure you do your homework to ensure that such treatment is the right choice for you. Most reputable treatment programs are affiliated with national or international organizations that also provide access to local resources as well as other resources that can help. Check the appendix section for some possible online sites to contact.
48. Does the risk of depression ever go away?
In a real sense, this is a loaded question. As we’ve already seen in previous section, there are always going to be times when we start “feeling the blues.” Whether due to grief, disappointment, or the inevitable setbacks that are a part of being human, nobody is going to be happy all the time. For people who have already experienced the often- crippling symptoms of true depression, it’s perfectly natural to worry that the depression will return someday and that what seems like an ordinary case of the blues might become something far worse.
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