Cognitive Therapy

The goal of cognitive therapy is to help patients recognize their negative cognitive processes and to help them change those processes in order to improve their moods and behaviors.  According to Beck’s cognitive model, there are four phases for this treatment.  In the first phase, the patient is instructed to increase his amount of activities in order to elevate his mood.  The therapist may sit down with the patient and literally plan every waking hour of the day.  During the second phase of treatment, the therapist works to challenge automatic thoughts by instructing the patient to list the automatic thoughts he experiences and to then bring his list to a therapy session, where the therapist and patient will discuss it together.  In the third phase of treatment, the therapist will try to point out to the patient which of his thoughts are unhealthy and biased toward the negative.  The final phase of the process is helping the patient change his thought process so those negative thoughts do not recur over and over in his mind.  This type of therapy may be defined as a cognitive-behavioral approach because it involves scheduling activities into the patient’s days.  Research has shown that it is one of the more effective treatment options.

Sociocultural Approaches

Interpersonal Psychotherapy (IPT)

Interpersonal psychotherapy targets depression brought on by: interpersonal loss, role dispute, role transition, and interpersonal deficits.  Interpersonal loss is defined as the loss of a loved one.  Role dispute is a case in which the patient and someone close to him do not understand how to define their relationship.  An example of a role dispute may be between a father and son who are having trouble defining amount of authority that each has in the relationship.  A role transition may occur when a person is making a big change such as moving away to college or getting married.  Depression may result from her inability to cope with the changes taking place.  Finally, interpersonal deficits are defined as problems the patient may be having relating to others and in forming relationships.  

In the case depression induced by the loss of a loved one, the patient is instructed to think about his relationship with his loved one and try to find new ways of remembering that person.  The patient is also given instructions on how to make new relationships. For an interpersonal role dispute, the therapist and the patient work together to think of role disputes and then both think of ways to solve the problems. In the case of depression brought on by interpersonal role transition, the therapist helps the patient to develop new skills and a solid social support structure so that the patient may cope with the changes he is experiencing. For the patients with interpersonal deficits, they are assisted in recognizing their social deficits and taught how to overcome them by social skills training.  The different sociocultural treatment techniques have shown be effective methods of overcoming depression.

Couple Therapy

Couple therapists believe that it is more difficult for most people to recover from depression if they do not receive support from their spouses.  Therefore, during couple therapy sessions, the clients are taught problem solving and communication skills to help them change their destructive marital behavior.  An important part of coming out of depression is strong social support. 

Biological Approaches 

One biological approach is electroconvulsive therapy (ECT), which is a treatment for depression in which electrodes attached to a patient’s head send an electrical current through the brain which causes a convulsion, which is said to “reset” the brain.  This treatment is particularly effective for severe depression, causing improvement 60-70% of patients who undergo it. 

Another approach is antidepressant drugs such as MAO inhibitors, tricyclics, and selective serotonin reuptake inhibitors (SSRIs). MAO inhibitors prevent the action of the enzyme monoamine oxidase. Tricyclics (such as imipramine) have a three-ringed molecular structure and work to inhibit the reabsorption of neurotransmitters into the presynaptic terminal.  By inhibiting reabsorption, neurotransmitters will stay within the synapse for the longer period of time and will be given more time to bind with the postsynaptic neuron.  They do not specifically target any one particular neurotransmitter.  Conversely, SSRIs, a group of second-generation antidepressant drugs, increase serotonin activity specifically without affecting other neurotransmitters.  Like tricyclics, SSRIs also work to prevent neurotransmitter reuptake by the presynaptic terminal.  Biological treatments are some of the most common and the most reliable treatment options for depression.