- [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.