As well as medication, psychological treatment is another core pillar of depression treatment.
Psychotherapy is the most common form of psychological treatment. Psychotherapy involves two main features: talking and cooperation. There are several different types of validated psychotherapy, including cognitive behaviour therapy, psychodynamic psychotherapy, supportive counselling, and mindfulness-based approaches.
Cognitive Behaviour Therapy
Cognitive behaviour therapy (CBT) is a type of behaviour therapy, which has been proven to be effective in treating depression. It is based on the idea that negative feelings arise from unhelpful thoughts and can lead to negative behaviours in a kind of "downward spiral". CBT can start with exercises to educate on how to structure your days and increase daily activity. Later on, CBT teaches how to identify unhelpful thoughts, to challenge them, and replace them with ones that are more helpful. Another important part of the therapy is learning more about the disorder (psychoeducation). Such changes have a knock-on positive effect on mood and make external life events easier to manage. In CBT, the client and therapist work actively together and learn from each other. Normally, there are about one to two sessions a week. Altogether, the treatment takes about 25 to a maximum of 80 sessions (about 3 months to a year).
Psychodynamic psychotherapy is based on knowledge from psychoanalysis. It makes similar assumptions about the causes of psychiatric disorders, namely that they are the result of emotional problems in the unconscious mind. In contrast to psychoanalysis, this type of psychotherapy will preferably deal with current internal conflicts, and with the client's relationships with others. The treatment is done in a sitting position and the therapist and client have eye contact. The therapist's approach can range from passive to participating and providing structure. Normally there are one to two sessions per week. Overall the treatment can either be brief from 16-24 sessions or more prolonged, taking up to more than 50-100 sessions, or even more.
Some psychotherapists may use a supportive, non-directive counselling approach, either alone or in combination with other therapy approaches. Supportive counselling is also regularly used by other health care professionals and volunteers. This type of counselling is intended to provide a supportive atmosphere for the client to resolve their problems. This is achieved by the therapist listening attentively and encouraging the person to speak about their situation and explore possible solutions in a caring and respectful way. This type of counselling can help to reassure and empower the client, but its long-term effectiveness in treating depression has not yet been shown.
While CBT and psychodynamic approaches focus on changing the patterns associated with depression, mindfulness-based approaches help a person to develop a more observant and non-reactive approach to their thoughts and feelings. Examples of such approaches include mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR). Like CBT, mindfulness-based approaches teach about the automatic nature of negative thoughts and feelings in depression, and seek to interrupt these. Unlike CBT, the focus is on developing skills to allow distressing thoughts and feelings to come and go, without having to react to them. MBCT has been shown to work particularly well for people who suffer from recurrent depression.