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Treatments for depression - Psychological therapies

Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any Khan Academy video. Created by Brooke Miller.

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Video transcript

- [Voiceover] When you picture someone treating depression, and maybe when you think about therapy more generally, you might picture something like the scene here. Someone lying on a couch discussing their problems while a bearded serious therapist, who happens to look a lot like Freud, listens and takes notes and maybe occasionally gives the patient some kind of insight. But this is an overly simplistic picture of psychological therapies, which can actually be really diverse. But before I talk about specific ones, I want to note two things about all psychological therapies. The first is that therapists go through years of training to get where they are, so chances are they have helped individuals with depression in the past. The second thing is that the therapist doesn't know you. They aren't personally invested in you or your problems. Both of these things making talking to a therapist very different from talking with a family member or a friend. The first type of therapy I want to talk about here is also the oldest, and that's psychodynamic therapy. This is the type of therapy that looks most like that couch picture from before. It is based on the idea that depression is caused by a loss in a person's life, either a real one or a symbolic one. This loss could also be conscious or unconscious. The goal of this type of therapy is to give a person insight into their thoughts and behaviors. In doing so they can help them find the root of their depression, the symbolic loss in their life that lead to their current depressive state. They do this by talking, not necessarily about their problems, but about anything that comes to their mind at that moment. The job of the therapist is to guide that discussion, to focus their attention on certain details. This therapy is meant to be continued long term, because as it turns out it can take a long time to shift through and identify unconscious causes. But unfortunately this type of therapy is generally not effective in treating depression. Another thing that I want to focus on is the term "psychotherapy," because we have Freudian psychotherapy, that's what we've been talking about here, but these days the term psychotherapy is generally used as an umbrella term for many different therapies, some of them really effective. Although these may look different from traditional psychotherapy, they all do use it as a base. One example of a modern form of psychotherapy is called "inter-personal therapy," it's also known as IPT. The idea behind this type of psychotherapy is that social networks and social support can kind of act as a buffer against depression. IPT focuses on helping people be more aware of their social networks. Specifically it's goal is to help people be more aware of the ways that their actions might be preventing them from maintaining close social relationships with those around them. The goal is to help the individual with depression improve these social relationships as a means to decrease their depressive symptoms. Unlike traditional psychotherapy, this type of therapy is meant to be short term. It focuses on strategies rather than discussing the past and looking for insights. Instead of lying on a couch and talking about their relationship with their mother, they might talk about ways to reconnect with their mother. It's much more action oriented. The next therapy that I want to talk about is behavioral therapy, and behaviorism in general does away with hidden concepts like the unconscious. Instead it focuses on people's behaviors. As it relates to depression, the ideas is that depression stops a person's energy and makes them withdraw from their social contexts. A combination of these two things reduces a person's access to pleasurable activities, so all of the things that they once enjoyed doing. Because they are no longer going out and having fun, this reinforces their negative mood. The goal of behavioral therapy is to focus on strategies instead of thinking about the past. But rather than focusing on ways to fix relationships like IPT, the goal of behavioral therapy is to get the person out of the house and back to the activities that they once enjoyed. By increasing social contact with friends and family and by forcing the individual to engage in activities that they once found pleasurable, even if they don't find them pleasurable now, they will eventually feel better. Through repetition they will eventually begin to enjoy them again. This therapy, which is short term, let me write that down, this therapy is actually quite effective. It turns out that going through the motions really does make people feel better over time. But one problem with this style of therapy is that people find it really hard. People with depression might find taking part in these activities to be really stressful and really intimidating. Another problem is that people don't start feeling better right away, it isn't spontaneous. In fact, it can be a few weeks before they see improvement, before they start enjoying these activities again. Because of this, some individuals might have a hard time sticking with it. If behavioral therapy is more focused on changing people's behaviors, cognitive therapy is about changing people's thoughts. The idea behind this theory is that how we feel is largely a factor of how we think about the world and how we interpret the world around us. Over time people develop automatic negative thoughts and irrational assumptions. Imagine a person going around thinking to themselves, "I am worthless." Think about how thinking about that statement and repeating it over and over might contribute to depression. Think about how it might affect how this person acts, how they perceive the world. Both of these things, both automatic thoughts and irrational assumptions, drive our behavior and shape our experiences, even if we're not consciously aware of it. In practice, cognitive therapy has two parts. The first is to challenge these automatic thoughts and irrational assumptions, and the next is to change them. More specifically, to show the individual that they have the ability to change them, to show them that these thoughts are actually under their control. Because it's action-oriented, this type of therapy tends to be short term. There are some problems with this style of therapy. The main one is that depends a lot on the individual with depression. The therapist can act as a guide, but it is really the individual with depression who needs to make it work. That can be somewhat challenging for individuals who believe that their symptoms are a part of them and who don't believe that they have the power to do anything about them. But that said, cognitive therapy can be really effective for individuals who are active participants. The last kind of therapy I want to talk about in this video is cognitive behavioral therapy. As you can probably tell by the name, this therapy is a combination of cognitive therapies and behavioral therapies. It's based on the idea that there is a reciprocal relationship between our thoughts, our feelings, and our behaviors. Notice that I have drawn all of these arrows as being two-sided. Here we're saying someone has a negative thought, "I am worthless," and this might lead them to not study for a test since they believe it's hopeless anyway, and then they feel upset when they fail. Or maybe they forget when an assignment was due and this leads them to think, "I'm stupid," which then leads to a depressed mood, which then leads to them canceling plans with their friends and causes them to think, "I am a terrible friend." This could go on forever, and that's the main point here. CBT holds that all of these things are interconnected, and you can't really piece them apart. So if anything is really going to help an individual with depression, it needs to address both cognitions and behaviors. The goal of this therapy is to challenge people's negative schemas and change them while at the same time also encouraging them to be mindful of their behaviors and go back to being active participants in their life. Of the therapies that I've mentioned here, IPT and CBT are generally considered to be the most effective. Sometimes just as effective as medication. But I want to point out that this isn't an either/or kind of deal. In general the best outcomes tends to come from a combination of medicine and therapy.