Therapy

Background:

People had mental illnesses well before any medications were available to treat the symptoms. Other means needed to be explored to provide relief. Therapy is well documented and well studied to be effective in treating depression. Just like there are many types of medications, there are also many types of therapy. All types can provide benefit, but it may be best to stick to the more developed and proven types as a beginner.

It can be a daunting task to begin therapy with all the therapists and types of therapy out there. Psychology Today’s website can be a great resource. First, a location can be selected to narrow down options. Then, other filters can be applied such as picking a gender of the therapist or picking what they specialize in. Then, each person’s bio can be explored on the website to see if they sound right for you. Finally, many therapists offer a “get to know each other” session or half session that can be a good tool to try it out before you pay for a session.

Therapy is very important in the treatment of depression. This is one of the few non-medicine options that is frequently offered by medical providers. One of the biggest issues is that many people don’t want to do therapy! Many people comment on the cost or the amount of time spent in therapy. Getting someone to start is usually the hardest. Once a good match with a therapist is found, people have no problem going back to therapy after seeing the very apparent benefits.

Effectiveness:

(1) A study was conducted to compare long-term psychodynamic psychotherapy, fluoxetine and their combination in the treatment of depression. 272 patients were treated. All treatments showed significant improvements.  The Beck Depression Inventory scale was used to track improvement. Scores decreased by 22.08 in the therapy group, 22.04 in the combination group and by 12.53 in the fluoxetine group. Patients can easily decrease their symptoms of depression by adding therapy to their medication regimen.

(2) 52 trials with 3,623 patients were included in a meta-analysis that compared pharmacotherapy only against pharmacotherapy and psychotherapy. The overall improvement when psychotherapy was added was deemed to be moderately large. These effects remain up to 2 years after treatment. The results also suggest that the effects of pharmacotherapy and those of psychotherapy are largely independent from each other, with both contributing equally to the effects of combined treatment.

My experience: 

I was trained in Cognitive Processing Therapy (CPT) while I lived in Denver. I was working on a PTSD unit at the VA hospital at the time. The first session started with a group of 4 veterans, the therapist and me. The veterans had been instructed to write an “impact statement” the night before. An impact statement is a vivid description of what event the veteran’s attributed their PTSD to the most. The amount of emotional tension and anger in this first session was intimidating to be a part of. Adrenaline was clearly coursing through the veterans. I was scared. Then over the next few weeks, I watched the veterans get less and less on edge as they discussed what they had been through. The final session was to have the veterans read the impact statement again. They were able to do it without spiking their adrenal. The amount of improvement that I saw in a short period of time was remarkable.

I am a strong advocate of therapy because I have seen the improvements first hand. The medical literature also clearly shows the benefits.

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References:

1. Bastos A, Guimaraes L, Trentini C, et al. The efficacy of long-term psychodynamic psychotherapy, fluoxetine and their combination in the outpatient treatment of depression. Psychother Res. 2015;25(5):612-24.

2. Cujipers P, Sijbrandij M, Koole S, et al. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014 Feb; 13(1): 56–67.

 

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