Depression cannot be treated without psychotherapy and patients themselves seek this form of medical and psychological help. For a long time they do not dare to resort to taking medications and, having started taking antidepressants, they often quickly stop drug treatment. Due to helplessness and constant doubts, patients are usually suggestible and, reading the annotations on certain drugs, they easily find side effects in themselves in the first days of treatment. In addition, patients suffering from depression have functional disorders of the internal organs and, therefore, are really sensitive to the side effects of drugs. Many sufferers experience false alarms about constant dependence on antidepressants. A significant proportion of patients suffering from depression belong to placebo – reactors, i.e. people who easily react to taking even “empty pills” that do not contain any active medicinal substance at all. All of the above determines the increased interest of such patients in psychotherapy.
Experimental data suggesting the importance of psychological factors in the formation of the therapeutic resistance of depression to drugs are a serious argument for the role of psychotherapy in the treatment of depression. An effective course of psychotherapy is arguably more beneficial in the long term than pharmacotherapy because it educates the patient. The latter acquires the skills to overcome depression, learns to recognize its approach, to prevent the development of its relapse. As the results of many studies have shown, the normalization of endocrine parameters in the course of depression therapy is achieved not only in the course of treatment with antidepressants, but also in psychotherapy. Moreover, the effect of psychotherapy on endocrine indicators is observed both in the case of its combination with psychopharmacological therapy, and in the case of using it as the only method of treatment.
In some cases, psychotherapy enables patients to adapt to real life with persistent disorders of the affective sphere, thinking and attitudes. Possessing an independent therapeutic effect, psychotherapy promotes optimal cooperation between the patient and the doctor, increases the effectiveness of drug treatment, improves family relations and the patient’s professional status.
The frequent onset of depression after an acute trauma or prolonged state of stress leads to a persistent search for the psychological causes of its occurrence. This circumstance enhances the desire of patients for psychological help. However, an excessive overestimation of its capabilities, unfortunately, can lead to a complete rejection of psychotropic drugs, the formation of resistant and protracted variants of the course of depression, the emergence of its early exacerbations.
From the point of view of the doctor, psychotherapy for depression should be primarily aimed at eliminating its symptoms. Some of them are more sensitive to psychotherapy, others are relatively difficult to respond to its influence. It is generally accepted that in severe depression, the possibilities of psychotherapy are more limited than in mild cases of the disease.
Disorders of mood, thinking, behavior, motivational and physiological symptoms are identified as targets of psychotherapeutic influence in depression. Among the affective symptoms – sadness, guilt and shame, and especially anxiety are especially sensitive to psychotherapeutic effects.
A number of general principles of the work of a psychotherapist with a patient suffering from depression can be distinguished. Here, the doctor’s control over his own feelings in relation to the patient is important, since a feeling of emptiness, irritation, excessive sympathy and fatigue may appear. The psychotherapist not only sympathizes with the patient, but also carefully observes him, maintaining a certain distance. In the course of therapy, it is necessary to strictly regulate the time of communication with the patient, to maintain the structure of the forward movement towards recovery. Actively asking targeted questions, being confident in the diagnosis, and providing real hope are among the basic rules for treating depression. Studies have shown that the hope received from the doctor is retrospectively assessed by patients as an important aid in the process of overcoming depression.
A feature of the work of a psychotherapist with a patient with depression is not so much empathy as understanding the state and, in particular, the possibility of episodes of negative mood changes. Often the patient seeks to “paralyze” the psychotherapist with his endless expectation of help, and the latter makes the mistake of getting into theoretical explanations and searching for the psychological causes of depression. In fact, the psychotherapist should strive to ensure that the patient pays attention to himself and looks for ways to adequately perceive his situation. It is especially undesirable to talk with the patient about the symptoms of his condition, it is much more important to emphasize the dependence of their severity on various situations, to talk about the characteristics of the character and relationships with people around him. The therapist’s compassion usually increases the patient’s expectation of help, an attempt to weaken the severity of symptoms leads to their intensification, and consolation leads to inconsolability. It is important to lead the patient to the need for self-help, and not to console him, to show him the importance of accepting himself as he is.
Various psychotherapy methods have been proposed to treat depression :
- Client-centered therapy.
- Existential therapy.
- Interpersonal therapy.
- Cognitive therapy.
- Memory therapy.
- Change of projection in time.
- Relaxation training.
- Social problem solving therapy and other psychotherapy methods, including mixed or eclectic versions.
According to most researchers, the most effective in the treatment of depression is cognitive therapy, which focuses on correcting the mental characteristics of patients with depression.