Talk Therapy Can Ease Depression, But No Single Type Deemed 'Best'

Experts say choice depends on individual patient, treatment availability

Tuesday, May 28, 2013

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Depression

TUESDAY, May 28 (HealthDay News) -- Various forms of "talk therapy" can help people with depression, but no single type stands out as better than the rest, according to a new analysis.
Experts said the results confirm what is generally thought: Psychotherapy can help lift depression, and there is no one form that is best for everyone.
Instead, a person's therapy choice may come down to the nature of the depression, and practical matters -- like finding a therapist you're comfortable with, and being able to pay.
In the study, published online May 28 in PLoS Medicine, Swiss researchers from the University of Bern analyzed nearly 200 clinical trials testing seven different types of psychotherapy for major depression. Overall, they found that all of the therapies were better than no treatment. The typical effect was "moderate to large," they say -- which means that the average patient who received the therapy was doing better than half of the patients in the untreated, comparison group.
"This study is reassuring, because it shows all of these therapies can work," said Dr. Bryan Bruno, acting chair of psychiatry at Lenox Hill Hospital, in New York City, who was not involved with the analysis. "I'd encourage people to get educated about the different types of therapy that are out there."
Most of the studies in the review (70 percent) tested cognitive-behavioral therapy -- which aims to change the dysfunctional thinking and behavior that feed a person's depression. In the United States, it's the most widely available talk therapy for depression.
Another approach is known as interpersonal therapy, which focuses on improving a patient's relationships and social skills.
Interpersonal therapy is well-studied, but it's harder to find than cognitive behavioral therapy, said Steven Hollon, a professor of psychology at Vanderbilt University in Nashville, Tenn., who was not involved in the review.
Both cognitive behavioral and interpersonal therapies are attractive, in part, because they are fairly short-term -- typically lasting for 10 to 20 sessions over a few months.
Some other therapies, like an approach known as supportive counseling, are longer term, Bruno noted. So your ability to pay may be an obstacle, even if the therapy is available to you.
"Most insurers do not dictate the type of psychotherapy they'll pay for," Bruno said. "But they may dictate the number of sessions."
The nature of depression varies widely from person to person, so ideally psychotherapy would be individualized. Bruno said that a person who has suffered a trauma, for example, might benefit from short-term "psychodynamic therapy" -- where the therapist tries to help you figure out how past experiences, from childhood onward, may be affecting your mental health now.
"Or sometimes a therapist will use a combination of therapies, depending on what seems best for the patient," Bruno said.
The various forms of talk therapy do have "overlapping features," said James Maddux, university professor emeritus of psychology at George Mason University in Fairfax, Va.
So it's not surprising that the review found no clear differences in effectiveness, on average, according to Maddux, who did not work on the study.
Whatever the name, all psychotherapies offer certain basic things -- like support, empathy and a sense of hope, Maddux noted. And the nuts and bolts have similarities, too -- cognitive behavioral therapy, for instance, puts some focus on a patient's relationships, as interpersonal therapy does.
"I think the take-home message is that, if you're depressed, it's better to get into one of these well-established types of therapies than no therapy at all," Maddux said.
The review excluded trials that compared talk therapy with antidepressant medication. But there has been a good amount of research comparing cognitive behavioral therapy with drugs.
"The results are complex," Maddux said, "but the primary finding is that cognitive therapy works just as well for many people as medication without therapy. For some people, both is probably better than either alone."
For his part, Bruno agreed that a combination of talk therapy and medication may be best for some people. But what the current review emphasizes, he said, is that talk therapy plays a vital role in depression treatment.
"There's often so much emphasis on medication in depression treatment," Bruno said. "This reminds us how important psychotherapy is."
Hollon noted that in the UK, the government is putting 700 million pounds into training providers in research-supported talk therapies. "In the U.S," he said, "we are increasingly relying on primary care physicians to prescribe medications."

SOURCES: Bryan Bruno, M.D., acting chair, psychiatry, Lenox Hill Hospital, New York; James Maddux, Ph.D., university professor emeritus, department of psychology, George Mason University, Fairfax, Va.; Steven Hollon, Ph.D., professor, psychology and psychiatry, Vanderbilt University, Nashville, Tenn.; May 28, 2013, PLoS Medicine, online

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