Aaron Beck, M.D. at the University of Pennsylvania developed a type of therapy for depression called Cognitive Therapy, which is often referred to as Cognitive-behavioral Therapy or CBT. He noted that people with depression have consistent patterns of negative thinking. For example, a person who had dinner plans with a friend who cancelled might think, “my friend doesn’t like me anymore.” This negative thinking creates a spiral that leads to negative emotions and behaviors such as withdrawal or avoidance. CBT helps people by helping them to identify their negative views of themselves, others and their future. In the example above, the therapist might help the person to find alternatives to their automatic assumption that their friend doesn’t like them anymore. They would search together to find other, more balanced explanations, such as “maybe she had to work late or was sick.”
CBT is an active, collaborative approach that often involves the use of homework or experimenting with new activities, communication patterns, alternative thinking, and problem-solving for difficult life problems. Typically, the therapy lasts from 8 to 20 sessions, although it may last longer depending on the individual needs of the patient. Learning to consistently think in newer, more adaptive, and helpful ways can help to reduce symptoms of depression. Many people report that these changes lead to increased meaning, satisfaction, and happiness in their lives and relationships. There is strong evidence from research that CBT helps to prevent the relapse of depression by helping people learn new coping, problem-solving, and thinking strategies.
Interpersonal Therapy (IPT) is a focused, short-term psychotherapy developed specifically for depression. People play a large part in our lives, even when we tend to think that we face life alone. Although the causes of depression are unknown, its onset is frequently associated with problems in personal relationships, including dealings with one’s spouse, children, family, or colleagues. Problems in relating to others or the loss of loved ones may bring on depression in some people, while for others the symptoms of depression prevent them from dealing with others as successfully as they usually do. Depression is often triggered by interpersonal stressors such as unresolved grief, interpersonal role disputes with significant others, role transitions such as leaving a job, divorce or relocating, or interpersonal deficits such as loneliness or isolation. IPT focuses on reducing depressive symptoms and dealing with the social and interpersonal problems associated with the onset of the symptoms. The patient and therapist work together to understand the onset of the depressive symptoms and to identify the specific interpersonal stressor that needs to be focused on in therapy. For example, a woman struggling with depression during a divorce might need to focus on the loss of the marriage (grief), and adjusting to being single (role transition).
Behavioral activation (BA) can be used alone or in conjunction with other evidence-based psychotherapies. The aim of BA is to change a person’s mood by enhancing their activities and behaviors. Depressed people often become trapped in a vicious cycle in which they withdraw or avoid previously pleasurable activities or no longer participate in activities that give them a sense of accomplishment. The more they withdraw the less they feel their life is rewarding, and they may sink lower into a depression. BA “activates” people to help them break out of this vicious cycle. The goal to is to enhance a person’s daily activities, structure, sense of accomplishment, and ultimately mood. For example, a person with depression may avoid going out to lunch with friends, leaving them more isolated and less able to experience social contact, warmth and support. BA helps patients recognize what activities have fallen away, and helps them re-establish a pattern of more rewarding activities. As they experience more rewarding activities their depression begins to lift.
Dialectical Behavior Therapy (DBT) was developed by psychologist Marsha M. Linehan to treat problems in emotion regulation. Although DBT was originally designed to treat chronically suicidal and self-injurious behavior, it has since been adapted to treat a variety of other problems and is useful for people struggling with mood disorders and anxiety. DBT combines techniques from cognitive-behavioral therapy with mindfulness and acceptance techniques. In DBT, clients are taught more skillful ways to regulate their emotions, deal with the distressing situations in their lives, and improve relationships with the people around them. These skills are taught group and individual therapy and offer pragmatic methods for creating a "life worth living".
Mindfulness Based Cognitive Therapy (MBCT) for Relapse Prevention
Mindfulness is a term that means paying attention, in a particular way: on purpose, in the present moment, and non-judgmentally, therefore interfering with patterns of thinking that lead to a spiral of depressive thoughts and behaviors. Mindfulness techniques and practice may be woven into a specific evidenced-based treatment as one component of an intervention or individuals may participate in a group format for relapse prevention. In addition to becoming better acquainted with internal and external triggers for mood symptoms, participants will learn the benefits of taking action and engaging in self-care in the real world where they are likely to feel their most vulnerable. Core aims of the relapse prevention program will be to prevent future depressive episodes as well as to assist individuals to change their fundamental relationship with old, inaccurate or negative thinking patterns. Mindfulness Based Cognitive Therapy techniques serve as a method of empowering individuals through awareness, acceptance, and being present.