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Other Forms of Psychotherapy for Major Depression - Behavior Therapy

Rashmi Nemade, Ph.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

CBT and IPT are empirically-based forms of therapy; however, they are not the only forms of psychotherapy out there. Other therapies besides CBT and IPT have been used to treat depression and may be useful options for people who do not respond to empirically-valid treatments, or who cannot access such treatments in their community. Individuals suffering from depression may also turn to behavior therapy, psychodynamic therapy, support groups, and to various forms of supportive or growth oriented group therapy.

Behavior Therapy

Behavior therapists help depressed patients to examine their behaviors so as to determine exactly what is decreasing their mood or keeping them from achieving their goals. When depressed patients don't have enough positives (i.e., positive reinforcement or rewards) in their lives, the therapist will help devise strategies for helping patients to increase the number of pleasant experiences they have across a week. The behavior therapist will also carefully look for any behavior skills or deficits that might play a role in maintaining a patient's depressed mood or behavior.

For example, if a person wishes to have more friends, but lacks the necessary social skills to seek out and meet new people, a behavior therapist may offer role plays (practice sessions occurring during therapy) and homework assignments (practice sessions occurring outside of therapy) both designed to enhance social skills. If a depressed person stays in bed in the morning in order to avoid the pain of getting up, going to work, and facing failure, a behaviorist might help that person look at the consequences of staying in bed, and make suggestions to for trying out a new behavior (such as getting out of bed for a certain number of hours per day) that may likely positively impact mood. The behavior therapist may also point out the negative consequences of staying in bed (e.g., staying in bed may cause the depressed person to lose his job and to feel even more like a failure), and troubleshoot different ways to handle the problem (e.g., a person who stays in bed and avoids going to work because he is ignored at work might benefit from assertiveness training). Finally, a behavioral therapist often examines the function of a specific behavior. A depressed person might find that the attention he or she receives during a depressive episode is reinforcing (rewarding). Should this be the case, the behavior therapist will help depressed clients to find new and more adaptive ways of obtaining the attention they craves.

A key aspect of behavior therapy involves monitoring and measuring behavior and using this data to help motivate patients to make positive behavioral changes. For example, a given patient's homework might involve engaging in a pleasant activity or new skill at least once a day, and then recording the subsequent change in mood. The goal of this sort of intervention is to increase mood directly (by increasing positives and decreasing negatives), and also to concretely demonstrate to patients how particular changes in their behavior will cause them to feel better.

Behavior therapy is typically conducted in individual therapy sessions, however, a behavioral approach can also be used in group therapy. Although behavior therapy is typically used in outpatient settings, a person receiving inpatient psychiatric care may also work with a behavioral therapist. Because behavior therapy is symptom-focused, it is usually a short-term therapy lasting only a few weeks or months duration. However, the length of treatment depends on an individual's needs, on available resources (mental health insurance or ability to pay for therapy sessions), and on the therapist's recommendation. Most people attend weekly sessions for the first several months and thereafter increase the time between sessions as they start feeling less depressed.

Behavior therapy is appropriate for people who want fast symptom relief rather than spending lots of time uncovering the reason(s) why they are depressed. Patients typically learn valuable new skills that help them stay in better control of their moods. Behavior therapy is not appropriate for people who do not want to take an active role in their therapy both inside and outside of sessions. People who are not willing to practice new skills, or engage in extensive monitoring and recording of their mood and behavior will not see relief from depressive symptoms.