Depression Treatment (Adult)

ACT is a contextually focused form of cognitive behavioral psychotherapy that uses mindfulness and behavioral activation to increase a client’s psychological flexibility—their ability to engage in values-based, positive behaviors while experiencing difficult thoughts, emotions, or sensations. ACT establishes this through six core processes: Acceptance of private experiences; cognitive defusion (i.e., alter the undesirable functions of thoughts and other private events); being present, a perspective-taking sense of self; identification of values; and commitment to action. The first four processes define the ACT approach to mindfulness, and the last two define the ACT approach to behavioral activation.

ACT is delivered to clients in one-on-one sessions, in small groups or larger workshops, or in books or other media, through the presentation of information, dialogue, and the use of metaphors, visualization exercises, and behavioral homework. The number, frequency, and length of the sessions and overall duration of the intervention can vary depending on the needs of the client or treatment provider.

CBASP has been developed solely for the treatment of the chronic depressive adults. Most patients present with maltreatment developmental histories that impede normal cognitive-emotive growth in the ability to related socially with others. Hence, patients begin treatment functioning in a primitive manner meaning their thought and feeling patterns are not very organized, self-centered, and prelogical, and they talk to therapists in a monologic manner. Chronic depression is essentially a chronic mood disorder and does not fit the typical description of major depression that comes and goes as a "thinking disorder."

At the outset of psychotherapy, the patient is interpersonally detached and withdrawn and is perceptually disconnected from the actual consequences of their own behavior. The general fiction they live out is "it doesn't matter what I do, nothing will change." Three techniques are administered to demonstrate to patients that the way they behave with others has consequences (Situational Analysis); to help patients discriminate the psychotherapist from toxic Significant Others who have hurt them (Interpersonal Discrimination Exercise); and to modify in-session maladaptive behavior that precludes the therapist from administering treatment (Contingent Personal Responsivity). The CBASP therapist role is interpersonally active and administered in a disciplined personal involved manner.

CBT is a skills-based, present-focused, and goal-oriented treatment approach that targets the thinking styles and behavioral patterns that cause and maintain depression-like behavior and mood. Depression in adults is commonly associated with thinking styles that are unrealistically negative, self-focused and critical, and hopeless in nature. Ruminative thinking processes are also typical. Cognitive skills are used to identify the typical "thinking traps" (cognitive distortions) that clients commit and challenge them to consider the evidence more fairly. Depressed adults also demonstrate increased isolation, withdrawal, simultaneous rejection of others and sensitivity to rejection, and decreased activity and enjoyment in activities. They typically experience a number of functional impairments including disrupted sleep cycles, eating and appetite issues, and increased thoughts of death and dying. Behavioral interventions can often help these interpersonal and functional impairments. Behavioral interventions include problem solving, behavioral activation, and graded activation or exposure. Treatment is generally time-limited and can be conducted in individual or group formats.

Cognitive Therapy (CT) is a form of psychotherapy used for a wide variety of disorders. The therapist and client work together as a team to identify and solve problems. Therapists aim to help clients overcome their difficulties by changing their thinking, behavior, and emotional responses. CT and Cognitive Behavioral Therapy (CBT) are often used interchangeably. There are, however, numerous subsets of CBT that are narrower in scope than CT such as problem-solving therapy, stress-inoculation therapy, motivational interviewing, dialectical behavior therapy, behavioral modification, exposure, response prevention, etc. CT uses techniques from all these subsets at times, within a cognitive framework.

The basic ISTDP understanding of many psychological disorders is based on attachment and the emotional effects of broken attachments. Interruptions and trauma to human attachments may cause a cascade of complex emotions which may become blocked and avoided. When later life events stir up these feelings, anxiety and emotional defenses may be activated. These reactions may be totally unconscious to the person having them, and the result is ruined relationships, physical symptoms, anxiety, depression, substance abuse, eating disorders, work dysfunction and a range of psychiatric symptoms. A proportion of all patients with anxiety, depression, substance use, and interpersonal problems have this emotional blockage problem. ISTDP is designed to focus on emotional awareness and the ability to feel these emotions in order to heal and overcome these behavioral and psychiatric symptoms.

IPT is a time-limited and manual-specified psychotherapy developed initially for patients with major depressive disorder, but later adapted for other disorders and tested in numerous clinical trials. Designed for administration by trained mental health professionals, it can also be taught, with adaptations, to less trained health workers. IPT has been used with and without medication. IPT is based on the idea that the symptoms of depression have multiple causes. The onset of depressive symptoms is usually associated with a trigger in the patient's current personal life. IPT helps the patient to identify and learn how to deal with those personal problems and to understand their relationship to the onset of symptoms. There are three phases:

• The diagnostic and problem identification phase where a formulation and treatment contract are made
• Identification of the problem area(s): grief, disputes, transition, or deficits, which is the focus of the middle phase
• Termination

MBCT is based on Jon Kabat Zinn's Stress Reduction program at the University of Massachusetts Medical Center, which was developed to help people suffering with chronic physical pain and disease. It includes simple meditation techniques to help participants become more aware of their experience in the present moment, by tuning in to moment-to-moment changes in the mind and the body. Participants learn the practice of mindfulness meditation through a course of eight weekly classes (the atmosphere is that of a class, rather than a therapy group) and through daily practice of meditation skills while listening to tapes at home. MBCT also includes basic education about depression and suicidality, and a number of exercises derived from cognitive therapy. These exercises demonstrate the links between thinking and feeling and demonstrate ways that participants can care for themselves when they notice their mood changing or a crisis threatens to overwhelm them.

The BATD program's primary goal is to reduce depressive symptoms. It is aimed at helping clients reconnect with their values across several life areas. It begins with behavioral monitoring of daily activities with an examination of the extent to which the client currently is living according to these values. In moving the client towards this more valued life, BATD uses a structured approach aimed at identifying activities that fit within the client's values on a daily basis. The program also uses contracts to recruit social support for these efforts. BATD can be conducted individually or in groups. It was designed to be a 10-12 session treatment, but has been shown to be efficacious in shorter durations.

Mom Power®: A Strong Roots™ Curriculum is an integrated mental health and attachment-based parenting program that incorporates a manualized intervention delivered by 2 facilitators across 13-sessions (3 individual and 10 group sessions), with corresponding parent- and child-group curricula. Mom Power® is intended for, but not limited to, mothers with young children (ages 0-6) and histories of adversity and/or trauma who may also present with depression, anxiety, posttraumatic stress, and/or high levels of distress. Mom Power® utilizes a multigenerational approach and applies attachment theory, cognitive-behavioral and dialectical behavioral strategies to facilitate growth and new skills. The group format is designed to facilitate social support, and the nurturing environment and individual sessions are designed to enhance access to care. The program seeks to nurture resilience through strengthening protective factors, improving mental health, and promoting sensitivity and responsive parenting. Although the CEBC has not yet reviewed these, there are adaptations of the Mom Power® curriculum specifically tailored for military families, fathers, and families involved in the child welfare system.