Psychological Therapies For Depression
The Psychodynamic Interpersonal Therapy
PIT was first developed by Robert Hobson (1985) as an attempt to move away from the traditional psychoanalytic approach of a one-sided relationship between therapist and client. It was originally called the ‘conversational model’ to emphasise the fact that the mutual task of therapist and client was to engage in a therapeutic ‘conversation’. In this ‘conversation’ problems are not only talked about as past events, but are also actively relived in the present and resolved within the therapeutic relationship. Hobson believed that the symptoms of depression arise from disturbances in the interpersonal relationships. These disturbances can only be explored and modified effectively from within another relationship - the therapeutic one. The quality of the relationship is therefore crucial.
Components of PIT-
Exploratory rationale- interpersonal difficulties in the individual’s life are identified, and the therapist tries to find a rationale for the individual that links their current symptoms with these difficulties.
Shared Understanding- the therapist tries to understand what the individual is really experiencing or feeling.
Focus on difficult feelings- the individual may express an emotion (i.e. anger) of which they are unaware, or may not display appropriate emotion.
Gaining insight- the therapist points out patterns in different types of relationship
Sequencing of Interventions- different aspects of the model must be used in a coherent manner.
Change- the therapist acknowledges and encourages changes made during therapy.
Effectiveness of PIT
Paley et al (2008) have shown that as a treatment for depression, outcomes for PIT are at least equivalent to those achieved with CBT. However, they acknowledge that changes in significant life-events were not monitored during the study, therefore any observable clinical gains (or lack of them) could not be attributed solely to the therapeutic intervention.
NHS psychotherapy patients were randomly allocated to receive 12 weeks PIT or to remain as a waiting list controls for that period. 54 patients entered the study, of which 33 completed. Significant improvement was observed in patients that completed the therapy, suggesting that even a brief treatment by inexperienced therapists can be effective in alleviating the symptoms of depression.
The Cognitive Behavioural Therapy
CBT emphasises the role of maladaptive thoughts and beliefs in the origins and maintenance of depression. When people think negatively about themselves and their lives, they become depressed. The aim of CBT is to identify and alter these maladaptive cognitions as well as any dysfunctional behaviour that might be contributing to depression. CBT is intended to be relatively brief (16-20 sessions) and is focused on current problems and current dysfunctional thinking
Thought Catching- individuals are taught how to see the link between their thoughts and the way they feel. By challenging these dysfunctional thoughts, and replacing them with more constructive ones, clients are trying out new ways of behaving.
Behavioural Activation- this is based on the common sense idea that being active leads to rewards that act as an antidote to depression
Effectiveness of PIT
Robinson et al (1990) meta-analysis found that CBT was superior to no-treatment control groups. However, when these control groups were subdivided into waiting lists and placebo groups, CBT was not significantly more effective than the placebo condition.
CBT appears to be less suitable for people who have high levels of dysfunctional beliefs that are both rigid and resistant to change.- (Elkin et al 1985)