![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Racer on December 14, 2008, at 13:43:45
http://www.physorg.com/news147336598.html
This is an article about a psychotherapeutic intervention trial, comparing it to maintenance medications for preventing relapse in depression. I thought it might be interesting for a lot of people here.
Two things I'd like to point out from the beginning:
1. At no point does this article suggest that this treatment is as effective as medication for treating an active depressive episode. It only says that it performed well -- outperformed meds, actually -- at the end of 15 months IN PREVENTING RELAPSE.
2. The article also notes that the study subjects from the experimental group reported improved quality of life. That's a subjective report -- and I know I would far rather experience a subjective improvement in quality of life than a coldly objective rating by an outside observer.
I frankly proclaim my own bias: I believe that psychotherapy is beneficial for many people. I believe that there are things many of us can do behaviorally which will improve our long term experience of quality of life. I also believe, very strongly, that medications are necessary for most people who experience a moderate to severe depressive episode. My own personal pet theory is that behavioral efforts improve subjective quality of life partly by helping combat feelings of helplessness. If we feel that we can have a positive impact on our lives, we feel a little more powerful, and that certainly improves my sense of my QoL.
I thought others might be interested in this, too. It might be helpful for someone -- especially those in the UK who may not have access to an individual psychotherapist, but still want psychological treatment.
Peace.
Posted by bleauberry on December 14, 2008, at 17:27:49
In reply to Interesting article about non-med maintenance tx, posted by Racer on December 14, 2008, at 13:43:45
I think outside therapy is almost always helpful. As you said, it helps battle the feeling of helplessness. I went to therapy every week for 6 months. Whether intended or not, my counselor became to me my coach, my cheerleading squad, my trusted friend, the one person who made me feel good about myself and sent me back out into the world to do good at whatever I do.
A major part of depression is the withdrawal from society, the loneliness, the isolation, and the blank stares of family and friends. A good counselor can bridge that gap so that you are not so withdrawn, not so isolated, not so lonely, and so you can better interact with friends and family without spilling all your medical woes on them. You can talk all your suffering and woes with the counselor and spare your loved ones, who quite frankly have no idea how to deal with it and eventually become scared of it and turned off by it, often leading to adultries and divorces, and then of course much worsened depression and isolation. The counselor can prevent all that from happening by working with you every step of the way.
I like counselors. But it needs to be someone you have a good chemistry with, and it needs to somehow be something you can afford economically.
Posted by Quintal on December 16, 2008, at 1:54:55
In reply to Interesting article about non-med maintenance tx, posted by Racer on December 14, 2008, at 13:43:45
Wow, thanks Racer! Great article. I haven't had much luck with standard CBT. These new mindfulness techniques may be just up my street. I asked my CBT therapist in the first session if she used any Buddhist/mindfulness techniques, but it was all 5-year plans and setting goals, which I found depressing. MBCT sounds as if it has great potential. I was told a new psychotherapy group is being set up in my area. I think it was primarily CBT based, but there may be other groups. I'll ask around. Thanks again.
Q
Posted by desolationrower on December 16, 2008, at 21:06:45
In reply to Re: Interesting article about non-med maintenance tx » Racer, posted by Quintal on December 16, 2008, at 1:54:55
I think there are various modalities of human culture that are important. Therapy traditionally has helped with analytic self-reflection, as well as being a positive relationship. Meditation has traditionally been part of the religious branch of culture along with things like moral codes and ritual worship, but because of the decline in hte last few hundred years in western spiritual practice, and high quality of dharmic religion's meditation, we have to import it to the west; and since western religion has become quite conservative it is unable to be part of the integration. Psychology is more liberal and able to be a part of the importation of high quality techniques. I think it is a very important part of life that benefits everyone and am glad it is being spread. I do see some risk it in it become a commercialised thing, but it is good it isn't beeing seen as an elite thign only some people can do.
-d/r
Posted by desolationrower on December 16, 2008, at 22:54:08
In reply to Re: Interesting article about non-med maintenance tx, posted by desolationrower on December 16, 2008, at 21:06:45
I hope noone is offended by my take on religion, I was trying to make a point about the ways human get their needs fulfilled in our culture; unfulfilled needs i think is a broad way of describing the stress that causes genetically vulnerable to succumb to mental illness, and that need to be fixed for drug-induced remission to really stick.
-d/r
Posted by SLS on December 17, 2008, at 5:52:24
In reply to Interesting article about non-med maintenance tx, posted by Racer on December 14, 2008, at 13:43:45
Hi.
I like the concept of "depressive pressure". It is something I came up with in a post I submitted a few years ago. As I see it, depressive pressure can be the presence of a chronic psychosocial stress for which psychotherapy and/or environmental change are the best alternatives to reduce. Depressive pressure can take a toll on the brain such that it causes it to malfunction in biologically vulnerable individuals. For some people whom respond adequately to antidepressants, future relapses despite continued treatment (known as medication break-through) becomes likely if the depressive pressure created by psychosocial stress remains unmitigated. Psychotherapy here would go a long way to help prevent this from happening, although it is no guarantee. However, the removal of the depressive pressure through psychotherapy is often a well-designed strategy. Unfortunately, the more depressive episodes one experiences, the deeper the biological illness digs into the brain. Subsequent recurrences often occur even in the absence of psychosocial stress. For these people, medical treatment might be both necessary and sufficient.
Another good use of psychotherapy is to clean up the mess left in the wake of an extended depressive episode. Biological depression warps thoughts and feelings. It changes the way people think and behave. It can lead to erroneous perceptions and conclusions about the self and the outside world that psychotherapy can often address.
A proactive use of psychotherapy is to help prevent too much of a mess from developing in the first place and allowing the depressed individual to function as well as the biological illness permits. However, when appropriate, it is most helpful that the psychotherapist acknowledge and actually *believe* that the depression is biological. To proceed otherwise can sabotage the efforts of the sufferer to work with the depression as the therapist may convey upon them unreasonable expectations and neglect insights targeted at the reality of the illness. When used properly, psychotherapy can help the sufferer of a biological depression better understand the dynamics of the illness, accept their temporary limitations, reduce anxiety and stress, and prevent suicide.
- Scott
Posted by SLS on December 17, 2008, at 5:59:16
In reply to Re: Interesting article about non-med maintenance tx, posted by bleauberry on December 14, 2008, at 17:27:49
The thing about Major Depressive Disorder (MDD) is that it is monumentally more difficult to process psychotherapy and internalize changes in thinking while in the midst of the depressive episode. Sometimes, the most one can expect from psychotherapy is to provide survival coping mechanism until the biological depression is resolved. The goal is to improve the biological function of the brain and reduce the severity of the depressive state, and then begin to work on psychosocial issues in a way that was nearly impossible before somatic treatment was introduced.
- Scott
Posted by SLS on December 17, 2008, at 6:02:41
In reply to Re: Interesting article about non-med maintenance tx, posted by desolationrower on December 16, 2008, at 21:06:45
Nice.
I never considered the importance of culture-specificity when psychotherapeutic modalities are employed.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.