Types of Psychotherapy for Depression

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Psychotherapy is often called "talk therapy" because it involves an individual and a psychotherapist sitting in a room talking, but it is much more than that. Psychotherapists have training in a variety of techniques that may be employed in order to help people to recover from mental illness, resolve personal issues, and create desired changes in their lives.

Psychotherapy can be an effective treatment for depression because it can help you delve into the underlying reasons for your depression and learn new coping skills.

Many of the therapeutic modalities described below have evidence supporting their benefit in treating depression. Several studies suggest, however, that the combination of an antidepressant and psychotherapy is the best approach, because of the biopsychosocial origins of most mood disorders.

Types of Therapy Used for Depression

There are many different types of therapy that can be effective in treating depression. The kind that is right for you can depend on a variety of factors including the severity of your symptoms, your own personal preferences, and your therapy goals.

Cognitive Therapy

At the heart of cognitive therapy is the idea that our thoughts can affect our emotions. For example, if we choose to look for the silver lining in every experience, we will be more likely to feel good as opposed to if we only focus on the negative.

Negative thoughts can contribute to and exacerbate depression. It is hard to feel good when you are stuck in a constant loop of negative thoughts. Cognitive therapy helps people learn to identify common patterns of negative thinking (known as cognitive distortions) and to turn those negative thought patterns into more positive ones, thus improving your mood.

Cognitive therapy is usually short-term and goal-focused. Therapy sessions are structured with a specific plan for each session, and you will be expected to do "homework" practice outside of therapy. Cognitive therapy usually lasts between 6 to 18 weeks.

Behavioral Therapy

Where cognitive therapy is focused on the negative thoughts that contribute to depression, behavior therapy is centered on changing behaviors.

Behavioral therapy is a type of psychotherapy that focuses on changing undesired behaviors. It uses the principles of classical and operant conditioning in order to reinforce wanted behaviors while eliminating unwanted behaviors.

Specific techniques that may be used include:

  • Aversion therapy: This approach involves pairing unhealthy behaviors with negative outcomes. If someone uses unhealthy coping techniques such as drinking alcohol, the use of such substances may be paired with feelings of illness. 
  • Systemic desensitization: Situations that provoke feelings of sadness or anxiety are paired with relaxations techniques. The goal is that after repeated pairings, the trigger will no longer provoke negative feelings and you will be able to remain calm and relaxed.

Cognitive-Behavioral Therapy 

Because cognitive therapy and behavioral therapy work well together to help depression and anxiety disorders, the two are often combined in an approach called cognitive-behavioral therapy (CBT).

CBT focuses on addressing both the negative thought patterns as well as the behaviors that contribute to depression.

Your therapist may ask you to keep a journal to track the events that happen in the week and any self-defeating and negative reactions to those events. Habitual negative responses to events (known as automatic negative reactions) are just one pattern of thinking you might address over the course of CBT. Other common response patterns include all-or-nothing thinking and overgeneralization. 

Once you have learned how to identify this kind of response, you will work with your therapist to learn new thinking patterns and ways of responding. You might also practice positive self-talk.

Like cognitive and behavioral therapy, CBT is usually brief and goal-oriented. It involves between 5 to 20 structured sessions centered around addressing specific concerns.

CBT sessions are often accompanied by "homework," which may include keeping a journal, practicing relaxation activities, completing readings, and using worksheets focused on specific goals.

Research suggests that CBT can be effective in the treatment of depression and that it may have lasting effects that prevent future relapse of depressive symptoms.

Dialectical Behavior Therapy

Dialectical behavior therapy is a type of CBT. Its main goal is to teach people with depression skills to cope with stress, regulate emotions, and improve relationships with others.

Dialectical behavior therapy is derived from a philosophical process called dialectics. Dialectics is based on the concept that everything is composed of opposites, and that change occurs when one opposing force is stronger than the other.

This type of psychotherapy also incorporates mindfulness practices from Buddhist traditions.

This approach also incorporates the use of crisis coaching in which an individual can call the therapist to receive guidance on how to handle difficult situations. As the person practices these new skills more and more, they will become better at handling these challenging situations on their own.

The National Alliance on Mental Health states that DBT has been shown to be effective in the treatment of mental illnesses, including depression. 

Psychodynamic Therapy

Psychodynamic therapy is based on the assumption that depression can occur because of unresolved—usually unconscious—conflicts, often originating from childhood. The goals of this type of therapy are for the patient to become more aware of their full range of emotions, including contradictory and troubling ones, and to help the patient more effectively bear these feelings and put them in a more useful perspective.

Unlike some of the other treatment approaches for depression, psychodynamic therapy tends to be less focused and longer-term. This approach can be useful for finding connections in past experiences and seeing how those events might contribute to feelings of depression. This approach can also be helpful for building your self-awareness, which is important for gaining insight.

Interpersonal Therapy 

Interpersonal conflict and poor social support can also contribute to feelings of depression. Interpersonal therapy is a type of therapy that focuses on these issues by addressing past and present social roles and interpersonal interactions.

During treatment, the therapist generally chooses one or two problem areas in the patient's current life to focus on.

This type of therapy is usually brief and involves examining social relationships with important people in your life. This can include your relationships with your partner, friends, family, and co-workers. The goal is to identify the role these relationships play in your life and find ways of resolving conflicts that exist. 

Your therapist might ask you to role-play different scenarios in order to practice and improve communication. By doing this, the hope is that you will be able to implement these strategies in your relationships and build a stronger social support system.

Psychotherapy Formats

Psychotherapy can also be delivered in a number of different ways. In some cases, your treatment may incorporate two or more forms, such as meeting individually with your therapist followed by the occasional group session where you can practice new skills.

Common psychotherapy formats include:

  • Individual Therapy: This modality involves one-on-one work between patient and therapist. It allows the patient to have the full attention of the therapist but is limited in that it does not allow the therapist an opportunity to observe the patient within social or family relationships.
  • Family Therapy: This approach is most useful when it is necessary to work on dynamics within the family group.
  • Group Therapy: Group therapy generally involves anywhere from three to fifteen people. It offers everyone the opportunity to give and receive group support in coping with their particular issues and gives therapists the chance to observe how they interact in group settings. It may also be a less expensive alternative to individual therapy.
  • Couples Therapy: This type of therapy is geared toward married couples and those in committed relationships who desire to improve their functioning as a couple.

How to Choose a Technique and Therapist

Recommendations from others can often be the best way to find a good therapist but, in the end, it's up to you to decide whether or not the two of you click. It's well within your rights to "interview" a new therapist and, if you feel that things are not working, to try a new one.

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