Of all mental health disorders, depression is the single most common with almost 17% of the U.S. population suffering from a major depressive disorder in their lifetime, according to the most recent National Comorbidity Study. A major depression is a period of two weeks or longer during which a person experiences a depressed mood or loss of interest in nearly all life activities. Given the prevalence of depression and its potential negative consequences in terms of loss of productivity, health problems, partner relationship strain, and impaired parenting, it’s important to know the most effective treatments.
Medication has become a popular approach, mainly due to the marketing efforts of pharmaceutical companies and indeed, ten percent of the U.S. population is now on antidepressants. But what about psychotherapy?
Although it may take longer than medication to take effect, psychotherapy deals with the circumstances of the person’s life that may have given rise to the depression. It also may help people find ways to cope with depression and make a better adjustment. The question then becomes, are there certain psychotherapies that may be more effective than others?
This question was undertaken in a recent meta-analysis performed by Barth and colleagues. A meta-analysis involves a systematic and comprehensive synthesis of all the available studies that have been done on a certain topic. Barth et al. found a number of studies, representing the following types of therapy:
1) Cognitive-Behavioral Therapy (CBT) involves behavioral models that focus on the development of coping skills, especially social skills and ensuring that a person puts pleasant activities into their daily lives. CBT also involves cognitive models that include assessing and changing the distorted thinking that people with depression often show (e.g., “everybody hates me,” “I would be better off dead.” Although typically delivered as a package of interventions, some of the techniques have been used as stand-alone treatment so these are listed separately (they were also handled as separate treatmentsin Barth’s study).
2) Behavioral activation treatment centers on activity scheduling and increasing pleasant activities.
3) Problem-solving therapy focuses on behaviorally defining specific problems, brainstorming ideas to solve them, and deciding upon and implementing solutions.
4) Interpersonal Therapy (IPT) is a brief psychodynamic intervention (about 12 sessions) focusing on how current interpersonal relationships have contributed to the person’s depression. This perspective considers interpersonal conflicts to be a major source of depression. The therapist’s goal is to help the client repair these conflicts.
5) Psychodynamic treatment is typically delivered longer-term than the briefer models that have been described so far. There are different types of psychodynamic treatment, but they are united by the premise that depression has its origins in the early childhood experiences and the way these have become internalized within the person. The relationship between the therapist and the client is a key part of the change process.
6) Supportive treatment involves any unstructured therapy that offers empathy and helps people talk about their life experiences and emotions.
Generally, the researchers found that the psychotherapies were comparable to each other. This means that people suffering from depression don’t necessarily need to seek out a particular approach. CBT has been studied more than any other therapy. However, it does not seem to be more or less effective than any other approach. The authors found that none of the treatments were appreciably more efficacious than others, except for IPT (which was superior to others at a small effect size) and nondirective, supportive therapy (which was less effective than the others at a very small effect). Therefore, it appears that people seeking psychotherapy for depression need not worry about the practitioner’s particular method and may benefit in any case.
Citation: Barth J, Munder T, Gerger H, Nüesch E, Trelle S, et al. (2013) Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis. PLoS Med 10(5): e1001454. doi:10.1371/journal.pmed.1001454.