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Taking Depression Seriously: Types of talk therapy

In this fifth post in the Taking Depression Seriously series, Sophia Xiao and physician Randall Stafford outline the different types of talk therapy.

To really feel better, most people with depression benefit from both medication and talk therapy. There are numerous types of talk therapy, however, so it may take time and experimentation to find one that works best for you.

Here are some of the different forms:

Cognitive behavior therapy (CBT)

The cognitive theory of depression suggests that depressed individuals tend to interpret events in an unrealistically negative and defeatist manner, which can cause depression to begin and persist. However, this can often be confronted in cognitive behavior therapy.

CBT aims to change the underlying belief systems that cause this thinking. During treatment, individuals are taught how to recognize harmful and irrational thoughts and replace them with more constructive ones. It is geared towards solving immediate problems and is highly structured, with lesson plans for each session and usually work between sessions.

CBT can involve weekly sessions and typically lasts 16 weeks or less.

Behavioral activation

Depression is often associated with a decrease in energy and a general disinterest in daily activities. This can cause depressed individuals to disengage from their routines and their environment, which can make depressed moods worse over time.

Behavioral activation seeks to increase an individual's engagement with their surroundings to increase their exposure to positive experiences so they feel more motivated to further participate in daily life.

Behavioral activation therapy usually lasts 20-24 sessions. A shorter version, called brief behavioral activation treatment for depression, lasts 8-15 sessions.

Interpersonal therapy

If lack of social support or difficult relationships are a key part of an individual's depression, then interpersonal therapy might be a good place to start.

In interpersonal therapy, individuals have the space to closely examine their relationships with family, friends, coworkers, and others. The goal is to improve interpersonal relationships, and as a result, increase the amount of social support depressed individuals have.

Like CBT, interpersonal therapy is focused and involves shorter and fewer sessions.

Mindfulness-based cognitive therapy

Mindfulness-based cognitive therapy strives to change the relationship between an individual and their emotions through mindfulness exercises. By developing these practices, individuals gain new ways to manage their negative emotions whenever they become too overwhelming.

During these group sessions, individuals learn meditation techniques, basic principles of cognition, like the relationship between thought and feeling, and more about the depressive condition.

This form of therapy is usually weekly for eight weeks in two-hours sessions.

Client-centered or person-centered therapy

Client-centered therapy emphasizes the importance of a person's self-direction when it comes to their own treatment. The therapist takes a non-directive role and encourages the patient using positive feedback and empathy.  

The goals of client-centered therapy are to decrease feelings of guilt and insecurity and increase a patient's capacity to establish more comfortable relationships and effective relationships with others.

There are no strict guidelines about the frequency or time span of client-centered therapy. Sessions are usually once a week for an hour, and therapy often ends when the client feels they are ready.

Counseling

Counseling is the easiest form of talk therapy to access. Counseling targets specific issues/problems, like addiction or stress management. It can also focus on problem solving or learning techniques for coping with or avoiding problem areas.

Because counselors do not require a specific therapist license, seeing a counselor can also be cheaper. However, since not all counselors are licensed, try to do your research ahead of time before trusting one with the intimate details of your life.

The number of counseling sessions can vary, but it is often short-term.

Other forms of therapy also show promise as treatments for depression, including short-term psychodynamic therapy and somatic therapies that focus on body and mind.

While there are many types of therapy available to choose from, access to care is still a very real issue despite laws and policies mandating equal treatment of mental health and physical health problems.  

Randall Stafford, MD, PhD, a researcher and physician at Stanford, recommends that patients look for low-cost, local alternatives if affordable traditional talk therapy is hard to find. Some therapists provide free or reduced-cost individual and group therapy. Some universities have counseling centers serving the community, often staffed by graduate students. Local health departments also provide crisis care services over the phone or in person if necessary.

Finally, primary care physicians are great resources for referral to psychiatry or talk therapy; they can also diagnose and prescribe some mental health medications themselves.

This is the fifth in a series of blog posts, Taking Depression Seriously, that aims to help patients and family members better understand depression as a chronic disease and more successfully navigate the health care system. The next blog will explain the different types of caregivers who work with those with depression.

Sophia Xiao is a masters degree student in Community Health and Prevention Research at Stanford University. She studies barriers to health care and the role of public health education in improving access to care. Stanford professor and primary care physician Randall Stafford, MD, PhD, studies strategies to improve chronic disease treatment, including increasing the role of patients in their health care.

Photo by OliverKepka

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