Integration of Cognitive-Behavioral and Interpersonal Therapies in Treating Depression With Concurrent Relational Distress and Chronic Pain

Abstract

This is a single-case study of a middle-aged man presenting with relationship distress and simultaneous major depressive disorder with chronic back pain and a physical tic. Treatment was informed by cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and psychodynamic principles. Over the course of treatment, a variety of techniques were utilized, including progressive muscle relaxation training, behavioral monitoring, cognitive restructuring, and interpersonal principles to address somatic complaints and underlying feelings of helplessness and inadequacy. Symptoms including general distress, frustration, back pain, worry about his wife's mental illness, and amount of negative thinking were tracked on a daily basis over three assessment periods. In addition, clinically significant change was assessed using a comparison of baseline and follow-up results from the patient's Outcome Questionnaire-45 (OQ-45.2). Evidence for symptomatic and characterological change is outlined, and treatment implications are discussed. Keywords case study, integrative treatment, time series, major depressive disorder, chronic pain 1 Theoretical and Research Basis for Treatment Many individuals seek psychological treatment with a number of complaints that may seem unrelated. It is often the work of therapy to understand how and why disparate symptoms occur simultaneously. The following case study is an example of conducting therapy with an individual who reported several areas of concern but denied intense suffering from any one area. In this case, the initial, seemingly unrelated problems were depression, relationship distress, back pain, and eyebrow rubbing. This article first outlines the theory and research behind several treatment approaches used in an integrative fashion at the beginning of therapy. Then, we discuss changes to the original treatment plan, results from outcome data, as well as an integrative formulation that might link these seemingly distinct presenting complaints.

Interpersonal Psychotherapy and Mindfulness for Treatment of Major Depression With Anxious Distress

“…Evidence supports the successful treatment of social anxiety as well as eating disorders and substance use disorders using IPT (Cuijpers et al, 2016). Furthermore, IPT has been modified and integrated with various approaches, such as the integration of IPT, CBT, and psychodynamic principles used by Wischkaemper and Gordon (2015) in the treatment of depression with relational distress and chronic pain in a middle-aged male. Evidence from case studies suggests that IPT has also been integrated with other treatment modalities in effectively treating comorbid conditions, such as IPT combined with CBT to treat bipolar I disorder and social anxiety disorder (Queen, Donaldson, & Luiselli, 2015), IPT combined with assertiveness skills training to treat avoidant personality disorder with depression (Gilbert & Gordon, 2013), and IPT combined with CBT to treat geriatric depression and bereavement (Wyman-Chick, 2012).…”

Acceptance and Commitment Therapy for the Treatment of Chronic Pain and Coexisting Depression: A Single-Case Study

“…Historically, cognitive-behavioral therapy (CBT) has been viewed as the “gold standard” psychological treatment for chronic pain management and reduction (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012), in addition to the suffering from comorbid depression accompanying CMCs (Wischkaemper & Gordon, 2014). However, there is a growing body of literature indicating that ACT is an efficacious treatment for chronic pain and is a promising alternative approach for patients who do not respond to CBT (Gutiérrez, Luciano, Rodríguez, & Fink, 2004; Hughes, Clark, Colclough, Dale, & McMillan, 2017; McCracken & Vowles, 2014; Veehof, Trompetter, Bohlmeijer, & Schruers, 2016).…”