Major depression is a prevalent psychological disorder around the world. Worldwide, 121 million people suffer from depression ("Global Depression Statistics," 2011); in the United States, approximately 6.6% of the population suffers from this debilitating disorder, with numbers steadily climbing each year (Centers for Disease Control and Prevention, 2010). Generally, several factors are thought to contribute to depressive episodes. These factors include genetics—individuals with a family history of depression have a greater chance to suffer from depression, changes in brain chemistry, and the inability to cope with stress National Alliance on Mental Illness, 2012). Clinicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) to classify an individual as depressed. A diagnosis of major depression requires that a patient show 5 of the listed symptoms during a single 2-week period. These symptoms can include changes in sleeping patterns (hypersomnia or insomnia), feelings of worthlessness, trouble concentrating, changes in weight (significant weight loss or gain), and suicidal ideations (American Psychological Association, 2000). Since depression can lead to diverse physiological and emotional symptoms, it is important to choose a treatment that will significantly reduce both types of symptoms.
One psychotherapeutic treatment approach to major depression is cognitive therapy. Cognitive therapy addresses how an individual’s thoughts affect his or her behavioral, physiological, and emotional responses. Cognitive therapy is used to modify thoughts by teaching an individual the methods to evaluate the accuracy of each thought (Oakley, 2013). There are several variations of cognitive therapy used by clinicians; however, cognitive-behavioral therapy (CBT) is the best suited to address the diverse symptoms of depression. CBT is an interactive therapy that engages both the patient and therapist, and often requires the patient to complete assignments outside of the session (Freedman, 2012). By challenging negative, automatic thoughts and encouraging the patient to practice identifying these thoughts, the patients not only become aware of negative thought patterns, but also learn to re-interpret their world in a less negative manner. Negative thoughts, like “I am worthless,” can cause a depressed patient to become socially withdrawn (behavioral response) and sad (emotional response), leading to changes in eating habits (physiological response). By conquering the negative thought, the depressed patient can reduce or even avoid the more harmful symptoms of depression.
Where CBT attempts to address the global impact of depression, psychoanalysis concentrates on delving into the unconscious mind and identifying and dealing with issues that are repressed. Psychoanalysis examines the ways in which these unconscious factors influence behaviors, emotions, and thoughts by determining their origin, exploring how these factors developed over time, and allowing patients to cope with these factors (American Psychoanalytic Association, 2009). While the patient explores the underlying factor leading to their depression, for example, the therapist also participates in experiencing this factor and the patient is able to freely express his or her feelings. By using psychoanalysis to address a complex disorder, like major depression, the therapist assumes there is an identifiable life event that precipitated the depressive episode. Since depression can be caused by several different factors—genetics, stress, and changes in brain chemistry—that can be unrelated to specific life events, this therapeutic approach would not alleviate the depressive symptoms. Psychoanalysis also requires the patient to play an active role in their therapy. Each session is patient directed: the patient determines what is discussed, while the therapist generally listens and does not participate in the discussion. Depressed patients can be withdrawn, so unless the therapist is actively engaged in the therapy, the patient would receive no benefits.
Major depression is a complex psychological disorder that affects many people worldwide. While the causes and symptoms of depression can vary from person to person, psychotherapeutic approaches attempt to address both aspects of the disorder. Cognitive-behavioral therapy provides the patient with a method for identifying negative thoughts and restructuring those thoughts to alleviate the behavioral, emotional, and physiological symptoms of depression. This therapy forces the patient to practice and apply the skills learned in therapy sessions to the real-world. Due to the hands-on approach of this therapy and its ability to address an array of depression-related symptoms, CBT is a useful tool for combating this disorder. Psychoanalysis, on the other hand, relies solely on patient participation and the ability of the patient to identify a particular life-event that underlies the onset of the depressive episode. Although this therapy would be useful for individuals whose depression was solely precipitated by a specific life event, it would fail to alleviate symptoms for individuals where this is not the case. The best treatment strategy for major depression examines not only the causes of the disorder, but also the underlying assumptions or thoughts made by the patient that leads to the harmful symptomology. Currently, CBT provides the most effective treatment for major depression.
References
American Psychological Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR): American Psychiatric Publishing, Incorporated.
American Psychoanalytical Association. (2009). About Psychoanalysis Retrieved March 22, 2013, from http://www.apsa.org/About_Psychoanalysis.aspx
Centers for Disease Control and Prevention. (2010). Current Depression Among Adults--United States, 2006 and 2008 Morbidity and Mortality Weekly Report (Vol. 59, pp. 1229-1258).
Freedman, K. D. a. J. L. (2012). Cognitive Behavioral Therapy (CBT)? Retrieved March 22, 2013, from http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&Template=/ContentManagement/ContentDisplay.cfm&ContentID=141590
Global Depression Statistics. (2011) Retrieved March 22, 2013, from http://www.sciencedaily.com/releases/2011/07/110725202240.htm
Mark E. Oakley, P. D. (2013). Center for Cognitive Therapy 2013. Retrieved March 22, 2013, from http://www.cognitivetherapyla.com/CognitiveTherapy.php
National Institutes on Mental Health. (2012). Depression Retrieved March 22, 2013, from http://www.nimh.nih.gov/health/publications/depression-easy-to-read/complete-index.shtml
