An integrative approach to treatment of depression.

Abstract

Despite promising advances in medication and psychotherapy, most patients with depression are vulnerable to relapse and will feel the effects of the condition in their lives permanently. It seems responsible to view depression as a chronic disease and help patients plan their lives accordingly. A biopsychosocial model of depression is proposed, emphasizing the circular nature of the disease. An important element of circularity is that it encourages intervention simultaneously at multiple levels. The author presents an active treatment model, emphasizing a high degree of emotional engagement, the link between life experience and mood changes, a skills-based approach to behavior change, appropriate use of medication, and flexibility in using the therapist's own experience. This model fits in the tradition of efforts toward assimilative integration of psychotherapy.This article is meant for mental health professionals who treat patients with depression. I am a therapist who suffers from depression myself. I want to convey something that will be practical and helpful to therapists, physicians, and pharmacologists who are trying to help patients who do not respond quickly or easily to the standard prescribed treatments. Unfortunately, research is confirming that these are the majority of people suffering from depression. A careful review of the literature suggests that most care for depression is superficial, inadequate, and based on false information. Many assumptions commonly held in the professional communitythat newer antidepressants are reliably safe and effective, that short-term cognitive and interpersonal psychotherapy help most patients, that many people with depression can be effectively treated in primary care, that most patients can recover from an episode of depression without lasting dam-

The GIFT Program for Major Depression: Integrating Group, Individual, and Family Treatment.

“…Further, we suggest that, for many individuals, depression is a chronic or recurrent condition. Thus, similar to previous integrative models of depression treatment (McCullough, 2003;O'Connor, 2003), we encourage patients to take a more long-term approach; depression is a chronic but controllable condition that can be effectively selfmanaged over time.…”

“…We feel that the particular way we have integrated treatment in the GIFT program allows for a particularly transportable treatment, easily adopted by patients and therapists. First, to our knowledge, although previous programs have emphasized the importance of repeated practice of skills (e.g., O'Connor, 2003), the GIFT program is the first to explicate an emotional fitness model. In contrast to the work of McCullough (2003), which we consider a more theoretical integration (Arkowitz, 1989), the emotional fitness model is a common factors approach.…”

Problemas enfrentados por terapeutas analítico-comportamentais em sua prática clínica

“…A consulta à literatura sobre psicoterapia indica que muitas das situações de difícil manejo na clínica requerem intervenções emergenciais por parte do terapeuta, as quais, muitas vezes, são atípicas. O manejo de risco de suicídio, da exposição da própria vida do paciente ou de outras pessoas, assim como do uso abusivo de substâncias pode requerer o envolvimento de agências, ou de pessoas que costumeiramente não participam em tratamentos psicológicos convencionais (Futterman, Lorente, & Silverman, 2005;Meichenbaum, 2005;O'Connor, 2003;Thomas, 2005). A identificação de eventos ambientais que se constituem fatores de proteção para a ocorrência de eventos indesejáveis ao paciente é também uma medida comumente adotada pelos clínicos nas situações de difícil manejo.…”

“…Por fim, vale mencionar os artigos que focam a integração em psicoterapia. De certo modo, esses documentos auxiliam a identificação de intervenções comuns a diversas abordagens em psicoterapia diante de problemas clínicos usuais e de difícil tratamento, como a depressão (O'Connor, 2003). Mayfield, Kardash e Kivlighan Jr. (1999), sugerem que terapeutas experientes são mais parcimoniosos nas descrições dos dados obtidos, são mais rápidos para detectar informações e para planejar tratamentos.…”