Depression Management and Psychotherapy

Below are methods and approaches used to manage depression and includes the basis of psychotherapy used in clinical depression. They are widely accepted and scientifically proven to ease the symptoms of depression.

Psychotherapy:

Reassurance and listening

A. Instill hope

B. Consider Cork Analogy

1. Think of self as cork under water

2. No matter how much people or events push you under

3. Eventually you will pop up

Reinforce Positive Behaviors

A. Exercise (Increases Energy and Self Esteem)

1. Comparable effect to Antidepressants

B. Healthy Diet

C. Attending Counseling

D. Antidepressant Compliance

1. Reassure that these are not habit forming

2. Reassure that these are not forever

3. Establish a therapeutic alliance

E. Schedule pleasurable activities (esp. with people)

F. Repair relationships with family and friends

G. Consider keeping a journal

Discourage Negative Behaviors

A. Challenge negative thoughts

B. Sleep disturbance

C. Stress in relationships and work

D. Poor diet or nutrition

E. Alcohol use or Alcohol Abuse

F. Medications that worsen depression

Cognitive Behavioral Therapy:

A. Efficacy

1. At least as effect as pharmacotherapy

B. Summary of Process

1. Recognize that some perceptions of reality are false

2. False perceptions lead to negative thoughts

3. Learn to identify negative thoughts as they occur

4. Replace distorted thoughts with alternatives

5. Reframe central beliefs about world and self-image

C. Techniques

1. Keep a Thought Journal

a. Identify specific stressful situations

i. Example: Meeting a new person

b. Characterize associated mood and automatic reaction

i. Example: I am anxious - they will hate me

c. Identify reasons for negative thoughts

i. Example: Noone speaks with me at parties

d. Identify counter-arguments

i. Example: I have close friends who care about me

e. Substitute negative thought with alternative

i. Example: I am likeable - be myself

2. Set goals and activities (example follows)

a. Goal: Exercise every day, this improves self-esteem

b. Start: Next thursday, before work

c. Obstacles: Early wake-up

d. Strategies to overcome obstacles

i. Be in bed by 10 pm, with clothes set out for AM

3. Progress (example)

i. Jan 4: Arrived gym 20 minutes late, short jog

ii. Jan 5: Overslept, missed workout, bad day

iii. Jan 6: Swam for 40 minutes, feel great

References

Rupke (2006) Am Fam Physician 73(1):83-86 [PubMed]

Scott (1996) J Affect Disord 37:1-11 [PubMed]