Although MDD is treated with drugs and medication, there are times when your symptoms are not totally cured or treated. Thus, there is a need to add another mode of therapy, such as psychotherapy.
Interpersonal psychotherapy (IPT) is a method of treating you through an interaction with your therapist, be it a medical doctor or a psychologist. It is a one on one engagement where the therapist talks to you and will try to uncover the root of your problem. This method is time limited—that is, it will run a certain length of time, usually 12-16 weeks, and it is a present-focused treatment which encourages you to regain control of your mood and functioning. It is a treatment alliance between your therapist and you. He emphatically engages you and helps you feel that you are being understood. He arouses your emotions so that again you will start to feel things.
Based on the preceding, IPT generates two basic principles:
- That depression is a medical illness and it is not the patient’s fault or defect. Furthermore, it is highly treatable.
- That mood and life situations are related and that IPT connects your mood. Also that any disturbing events in your life that either trigger or follow from the onset of the mood disorder.
Research results showed that depression usually comes after any disturbing situation in your life, such as the death of a loved one, changes in career, marital separation, or illness. Once you become depressed, your symptoms compromise your interpersonal skills. Worse, you may start to blame yourself for the situation and completely ignore your environment.
Whether life events follow or precede your mood changes, your task in therapy is to resolve your disturbing life event(s) by building social skills and learning to organize your life. If you can solve your life problem then your depressive symptoms will subsequently disappear. Your therapist will help you on how to achieve your goal.
Cognitive-behavioral therapy (CBT) is another form of “talk therapy” where a one on one engagement and encounter is done with the therapist facing and talking to you. The main assumption of CBT is that your mood is very much determined by the way you think—specifically termed as your pattern of thinking. If you think negatively about yourself, then that will adversely affect your mood, sense of self, behavior, and even physical state. The main purpose of CBT is to help you recognize your negative patterns of thought, assess their validity, and replace them with healthier ways of thinking.
The way you think determines the way you behave. If you think negatively, then you will behave in a very inappropriate manner. To remedy this, CBT aims to change your behavior which arises from a negative thinking. Thus, CBT helps you change your thoughts and behavior. All of these are done because dysfunctional thoughts and behavior predispose you to suffer from depression. When negative thoughts and behavior are changed to healthier ones, your mood will correspondingly change for the better.
Problem-solving therapy (PST) is a form of treatment where a therapist engages you on one on one conversation and teaches you how to effectively manage the negative effects of stressful events that take place in your life. The stressors in your life vary in form, intensity, and duration. In terms of intensity, it could be large or small. Even with small, if it happens most of the time in your life, it could transform itself into a big stressor. When a stressful situation creates and generates other serious problems, be it psychological or medical, then PST could be utilized. This can be done either using it as the sole intervention method or in combination with other modes of psychotherapy.
PST helps you develop problem-solving skills so that you could resolve and cope with whatever stressful problems cross your way. Such skills include: making effective decisions, generating creative means of dealing with your problem, and accurately identifying barriers to reaching your goals.
In general, PST aims to do the following:
· To identify which stressors tend to trigger emotions, such as sadness, tension, and anger
· To better understand and manage negative emotions
· To become more hopeful about your abilities to deal with difficult problems in your life
· To be more accepting of problems that are unsolvable
· To be more keen in planning and systematic in solving stressful situations
· To be not evasive in facing and confronting problems
· To be less impulsive in choosing “quick fix” solutions to your problems
So far, PST is considered a very effective approach because it equips you with skills to deal more effectively with wide range of difficulties and stressful problems in your life. Scientific research results revealed that negative stressful events in your life could exact a toll on your health—specifically mental health disorders. Thus, PST is developed to assist you in coping more effectively with stressful life problems and can, therefore, decrease psychological and emotional difficulties. This, in turn, leads to the improvement in the quality of your life.
Behavioral activation (BA) is one of the methods in psychotherapy wherein your good behavior is reinforced by the therapist so that your bad behavior is gradually and ultimately replaced by it. This method has been found to be very effective, even for those who experienced failure in the other methods or approaches. Researchers have determined that BA is at par with the use of medications and it is slightly superior to cognitive therapy in the treatment of depression. It shifts away from cognitions and feelings and it concentrates on your behavior and environment.
BA contends that giving importance to negative life events, such as grief, trauma, daily stressors, or genetic predispositions to depression provides no space for you to have positive reinforcement. In fact, by allowing you to look at the negative sides of your life, you might even resort to unhealthy behaviors such as drug use, sleeping late in the afternoon, social withdrawal, and much more—so that you will avoid the negative feelings. Initially, these changes in your behavior provide temporary relief, but in due time they will lead to more negative outcomes and worsening depression.
When you submit yourself to behavioral activation psychotherapy, your clinician will intervene on your behalf in two primary ways:
- He increases positive reinforcement for your good behavior that needs to be sustained and
- He ends negative behavior patterns that cause depression to worsen. Rewarding new and good behavior increases your positive reinforcement and reduces negative reinforcement.
Seemingly, the goal of BA is simple: just replace negative behaviors with positive alternatives. However, when it is implemented in your real life, there are a lot of challenges to meet and overcome. Firstly, the good effect of BA is not immediate; it will take some time before you will reap it. Therefore, before starting BA, you need to be educated about it. This is the first challenge. Secondly, there are unhealthy avoidant behaviors that you will be tempted to avail of while waiting for the good effect of BA. However, your clinician needs to discourage them. This is another challenge.
As mentioned in the preceding, you need to be educated about the nature of BA so you are motivated to follow through. Considering that the good effects of BA will not be immediately realized, you may be tempted to return to your avoidant behavior. It is the work of your clinician to help you recognize how avoidant behavior is worsening your depression. Thus, your clinician needs to listen, pinpoint negative behavior patterns, and collaborate with you to figure out how your avoidant behavior could be damaging to you. After you have been educated about BA and your clinician has identified some of your negative behavior patterns, the next step is for your clinician to come up with some positive replacement behaviors, which are both easy and rewarding.