Treatment for Unipolar Depression

There are three major psychological approaches for the treatment of unipolar depression. They are psychodynamic, behavioral, and cognitive/cognitive behavioral. Psychodynamic approaches result from the unconscious grief over real or imagined loss. People can have extreme dependence on other people which results in underlying problems. For example an adult child’s grandmother dies and they have relied on the grandmother to provide them with a car to commute back and forth from work. Upon her death the child has a problem because the car went into her estate. Then other siblings placed claim to the car and took the adult child’s transportation away. Subsequently he lost his job. A therapist could bring this problem to the surface and work through it with the client by the use of free association. Free association is when a person describes thoughts and feelings that come to their mind regardless of the significance of that thought at the time. The therapist would examine the person’s reaction through free association. The therapist would then suggest interpretations of the client’s associations, dreams, and displays of resistance and transference that occurred during the therapy. The therapists would review past event of his loss and the feelings about that event. In this case the loss of his grandmother, her car and his job. It has been noted that the most helpful psychodynamic sessions were with clients who have experienced childhood loss and trauma, long lasting emptiness, perfectionism, and extreme self criticism.

The behavioral treatment approach approaches a person’s depression that is connected to their negative mood. A person could have experienced loss of rewards in their life causing mood changes into depression. The therapist would approach the treatment in three areas. The therapist would help reintroduce clients to pleasurable events and activities, reinforce depressive and non-depressive behavior, and help to improve social skills. Studies have proven that positive activities added to a person’s life can lead to a better mood. The therapist would set up for the person a weekly schedule of social events in an attempt to engage the person. The depressed person would monitor their negative behavior and try to change their behavior in a more positive way. Therapists use the cognitive management approach which is ignoring the client’s depressive behavior and praising /rewarding constructive statements and behaviors. Often times the depressed person is encouraged to participate in group therapy where they learn to improve their eye contact, facial expressions, posture, and other behaviors that send positive social messages.

Cognitive therapy has an approach to maladaptive attitudes using a cognitive triad. This triad consists of a person’s negative thoughts about themselves, their environment and their future. This theory supports that a depressed person developed their depression by continued negative thinking. The therapy includes four basic steps used by a therapist. These steps include increasing the depressed person’s activities and therefore improve their mood, challenge the person’s constant negative thoughts, point out the negative thinking and opinion, change attitudes that the person thinks contributed to their depression. The first step is to increase activities and elevate mood. The therapist will write up a detailed schedule of hourly activities for the upcoming week. They will become more active and confident. This provides some emotional relief. The second step is to challenge automatic thoughts. They have to recognize and record their automatic thoughts and then show them to the therapist at the next session. The third step is to identify the negative thinking and opinions. They guide the client to recognize almost all the interpretations of events that have negative results and to change the style of their interpretation. The last step is to change the primary attitude.

Cognitive/behavioral therapy is a combination of both styles and treatment of a depressed person. Research has indicated that by combining these two styles of therapy the outcome is more effective.