Psychotherapy of Mood Disorders

Abstract

In the last decades, psychotherapy has gained increasing acceptance as a major treatment option for mood disorders. Empirically supported treatments for major depression include cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT), behavioural therapy and, to a lesser extent, short-term psychodynamic psychotherapy. Meta-analytic evidence suggests that psychotherapy has a significant and clinically relevant, though not large, effect on chronic forms of depression. Psychotherapy with chronic patients should take into account several important differences between patients with chronic and acute depression (identification with their depressive illness, more severe social skill deficits, persistent sense of hopelessness, need of more time to adapt to better circumstances). Regarding adolescent depression, the effectiveness of IPT and CBT is empirically supported. Adolescents require appropriate modifications of treatment (developmental approach to psychotherapy, involvement of parents in therapy). The combination of psychotherapy and medication has recently attracted substantial interest; the available evidence suggests that combined treatment has small but significant advantages over each treatment modality alone, and may have a protective effect against depression relapse or recurrence. Psychobiological models overcoming a rigid brain-mind dichotomy may help the clinician give patients a clear rationale for the combination of psychological and pharmacological treatment. In recent years, evidence has accumulated regarding the effectiveness of psychological therapies (CBT, family-focused therapy, interpersonal and social rhythm therapy, psychoeducation) as an adjunct to medication in bipolar disorder. These therapies share several common elements and there is considerable overlap in their actual targets. Psychological interventions were found to be useful not only in the treatment of bipolar depressive episodes, but in all phases of the disorder.

A positive psychology intervention for patients with bipolar depression: a randomized pilot trial

“…Psychotherapy is an appealing alternative or adjunctive treatment to pharmacotherapy for bipolar depression. Psychotherapies like cognitive behavioral therapy have been associated with improved mental health outcomes-including improved functioning, greater life satisfaction, and reduced rates of relapse-in this population (Deckersbach et al, 2016;Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012;Picardi & Gaetano, 2014;Swartz & Swanson, 2014;Thase, 2007). However, these therapies are intensive (Thase, 2007), may not be available or appeal to all patients, and require specialized provider training (Dorflinger, Fortin, & Foran-Tuller, 2016).…”

Examining the competency of Filipino mental health professionals in psychodynamic psychotherapy

“…Viewing psychotherapy as either supportive or expressive, they unintentionally belie the contemporary notion that supportive and expressive interventions exist within a spectrum, and that supportiveness facilitates expressiveness. (Picardi & Gaetano, 2014). Many of the respondents in this study believed that the therapist could relate with the patient as a friend.…”

“…The therapeutic relationship, the vehicle for change in psychodynamic psychotherapy, provides a venue for the patient to discuss and re‐experience with the therapist, his or her difficulties in past and current relationships (Gomez, 1986). This relationship facilitates the healing process as it allows the patient to achieve a refined understanding of self and others, develop fulfilling relationships, give up self‐defeating behavioral patterns, improve decision‐making, use one's abilities effectively and efficiently, tolerate a wide range of emotions, develop autonomy, and respond to challenges with greater flexibility (Kay & Kay, 2003; Picardi & Gaetano, 2014; Rueve & Correll, 2006). Current derivative forms of psychodynamic psychotherapy such as short‐term psychodynamic psychotherapy (STPP), long‐term psychodynamic psychotherapy (LTPP) intensive short‐term dynamic psychotherapy, short‐term psychodynamic supportive psychotherapy, and supportive‐expressive psychotherapy apply the basic principles through the lens of the relational perspective.…”

The Application of the Polyvagal Theory to High Conflict Co‐Parenting Cases

“…Individual family members, sensing the dysregulation, often respond with a survival response and state change of their own. Utilizing cognitive skills from dialectical or cognitive behavioral therapy, can lead to awareness of triggers and identification of the cues of danger that drive dysregulation (Picardi & Gaetano, ; Fassbinder, Schweiger, Martius, Brand‐de Wilde, & Arntz, ). Providing specific skills that each family member can use to manage their own physiological response to threat offers a pathway to emotional regulation and a sense of safety.…”