| Psychological therapies
Cognitive-behavioural therapy
The principle of cognitive-behavioural therapy is that irrational
beliefs and distorted attitudes towards the self, the environment
and the future perpetuate depressed mood. Treatment aims to help
patients become aware of these beliefs, and so become more able to
realistically appraise themselves and their life experiences.
Case example
A 50-year-old doctor presented with a five-year history of
depression precipitated by work and financial difficulties.
Assessment of his premorbid personality style revealed marked
perfectionist traits and very high self-expectations. He viewed
minor failings as a severe indictment of his capacities and
self-worth. Treatment of his depression therefore incorporated
both antidepressants (to treat the symptoms) and
cognitive-behavioural therapy (to help him recognise his damaging
thought patterns and modify them to interpret his own behaviour and
experiences more realistically).
Interpersonal therapy
Interpersonal therapy seeks to identify interpersonal losses, role
disputes and transitions, social isolation, or deficits in social
skills that may lead to depression. It works on the principle that
losses must be mourned, role disputes and transitions must be
recognised and resolved, and that deficits in social skills must be
overcome to permit the acquisition of social supports.28
Case example
A middle-aged businessman presented with depression
occurring in the context of difficulties in a work partnership. On
further questioning it became apparent that he had always had
difficulties with asserting himself appropriately and could not
cope with conflict or anger. He was a quiet person who preferred to
please others, "bottling up" his feelings rather than dealing openly
with disagreements. His treatment program therefore included
assertiveness and social skills training, in addition to marital
therapy and antidepressants.
Problem solving
The principle underlying problem solving is that depression is
caused by problems in life circumstances, and that if problems are
dealt with symptoms may improve. Problems are identified, listed and
dealt with one-by-one.
Case example
A teacher in his forties presented with persistent low-grade
depression despite a number of adequate courses of antidepressants.
After taking the patient's history, it was clear that he was a markedly
obsessional person who was highly distressed by his work with
developmentally disabled pupils. An excellent teacher, he would set
high standards for himself, and had difficulty coping with the
behavioural disturbance of some of the pupils. After discussion, he
recognised that his work context was a significant contributor to his
depression and decided to leave face-to-face teaching. He took up a
position coordinating correspondence courses, which resulted in a
marked resolution in his levels of stress and depression.
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