4.1. Discuss psychological approaches in the management of an identified mental health condition

This guide will help you answer 4.1. Discuss psychological approaches in the management of an identified mental health condition.

Depression is a common mental health condition that affects millions of people globally. Its impacts can be emotional, such as persistent sadness, as well as physical, such as fatigue or difficulty concentrating. Psychological approaches are widely used to manage the symptoms of depression, either alone or alongside medication. These approaches involve structured therapies based on psychological theories to address the underlying cause of the individual’s condition, helping them develop healthier thought patterns and behaviours. Understanding mental health is crucial in effectively managing depression. It is important for individuals to recognize that depression is not a sign of weakness, but rather a medical condition that requires proper treatment and support. Through therapy and education, individuals can learn coping strategies and develop a better understanding of their mental health, leading to improved overall well-being.

This discussion focuses on three key psychological approaches: Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT), and Psychodynamic Therapy. Each of these can help individuals with depression in unique ways.

Cognitive Behavioural Therapy (CBT)

CBT is a structured, short-term therapy that focuses on helping individuals identify and challenge negative thought patterns. It is based on the principle that thoughts, feelings, and behaviours are interconnected. Negative thinking can contribute to how a person feels and acts, reinforcing depression.

How CBT works:

• CBT encourages individuals to become aware of automatic negative thoughts, such as “I’m useless” or “No one cares about me.”
• These thoughts often aren’t based on reality, but because they feel convincing, they worsen how a person feels.
• CBT challenges these thoughts and encourages more balanced thinking.

Techniques used within CBT include:

• Cognitive restructuring: Identifying negative thoughts, testing their accuracy, and replacing them with more realistic ones.
• Behavioural activation: Helping individuals schedule positive activities that bring them a sense of accomplishment and enjoyment.
• Problem-solving skills: Guiding them to deal with everyday challenges in a structured way.

CBT is often delivered over 6-12 weeks. It can be delivered face-to-face, in groups, or via online platforms. The NHS commonly offers CBT for depression because it has strong evidence supporting its effectiveness. It is especially useful for individuals with mild to moderate depression. However, people with severe depression may need additional support, such as medication, before engaging with therapy.

Strengths of CBT in managing depression:

• Research shows CBT significantly reduces symptoms in many people.
• The approach teaches lifelong skills, enabling individuals to manage future episodes of depression.
• It is well-structured, making it easier for individuals to engage in the process.

Limitations of CBT:

• CBT requires active participation. Individuals lacking motivation, a common symptom of depression, may initially struggle to engage.
• Sessions are time-limited, which may not suit individuals with complex or long-standing issues.

Interpersonal Therapy (IPT)

IPT is a short-term therapy focused on improving relationships and social functioning. Depression often impacts personal relationships, and strained relationships can worsen depression. IPT helps individuals understand how their mood and relationships affect each other.

How IPT works:

• The therapist identifies specific relationship issues that may be contributing to depression.
• IPT may focus on one of four areas: grief following a loss, conflict in relationships, role transitions (such as becoming a parent), or difficulties in forming and maintaining relationships.
• The therapy provides individuals with strategies to manage these challenges more effectively.

For example, a person who recently lost a loved one (grief) may experience intense feelings of guilt or anger, which fuel depression. IPT helps them process these feelings and adapt to life without the person. On the other hand, if someone struggles with role transitions (e.g., entering a new job), IPT helps them adjust and cope with associated stresses.

Strengths of IPT in managing depression:

• IPT is practical for individuals who believe their depression stems from relational issues.
• It focuses on specific, real-life challenges, providing targeted support.
• It addresses social isolation, which is a major factor in depression.

Limitations of IPT:

• IPT may not be effective for individuals whose depression isn’t linked to their relationships.
• Like CBT, it requires effort and engagement from the individual, which may be difficult if their depression is severe.

Psychodynamic Therapy

Psychodynamic therapy is rooted in the idea that unresolved conflicts from past experiences influence feelings and behaviour. Therapy explores these unconscious conflicts, aiming to make them conscious so the individual can process them and move forward.

How psychodynamic therapy works:

• The therapy explores how early childhood experiences or relationships influence current patterns of thinking, feeling, and behaving.
• The individual is encouraged to reflect on past experiences, dream analysis, and recurring patterns in their life.
• There isn’t a structured “homework” element like in CBT; instead, the therapy focuses on deep reflection and insight.

For example, someone whose depression stems from feelings of rejection or abandonment may not realise these feelings are linked to being neglected as a child. Psychodynamic therapy helps them uncover this and consider how it might affect current relationships or their self-image.

Although psychodynamic therapy tends to be longer-term, shorter versions called brief psychodynamic therapy exist. This therapy can be useful for individuals whose depression might not have an apparent external cause, helping them connect feelings to past patterns.

Strengths of psychodynamic therapy:

• It addresses deep-seated issues and emotional patterns that might not be apparent at first.
• It can help individuals understand themselves better, leading to long-term emotional growth.
• It provides individuals with a “safe space” to explore unresolved conflicts.

Limitations of psychodynamic therapy:

• It often takes longer than CBT or IPT, which might discourage some individuals.
• Its effectiveness depends heavily on the therapist’s skill and their relationship with the individual being supported.
• It is less structured, which might not suit people looking for practical tools or immediate symptom relief.

Alternative Psychological Approaches

In addition to CBT, IPT, and psychodynamic therapy, other psychological approaches may suit certain individuals:

• Mindfulness-Based Cognitive Therapy (MBCT): Combines CBT with mindfulness techniques like meditation to help individuals stay present and avoid ruminating on negative thoughts. This approach is particularly effective in preventing depression relapse.
• Dialectical Behaviour Therapy (DBT): While originally designed for borderline personality disorder, DBT also includes strategies to manage intense emotions, which can be helpful for some individuals with depression.
• Humanistic Therapy: Focuses on an individual’s personal growth and self-actualisation. It emphasises empathy and self-esteem.

Factors to Consider in Treatment

Treatment isn’t a one-size-fits-all process. Individuals with depression have unique symptoms, experiences, and preferences. For example:

• Some may prefer the structured, skills-based approach of CBT.
• Others might need to explore the deeper emotional roots of depression through psychodynamic therapy.
• Someone struggling with social isolation might benefit more from IPT.

External factors, such as access to services, waiting times within the NHS, and financial constraints for private therapy, may also influence the choice of treatment.

Combining Psychological Approaches with Other Treatments

For many individuals, psychological approaches alone aren’t enough. Combining therapy with other treatments may improve outcomes, especially for moderate to severe forms of depression. This can include:

• Medication: Antidepressants like SSRIs (Selective Serotonin Reuptake Inhibitors) are commonly prescribed to help regulate brain chemicals that influence mood.
• Lifestyle Changes: Regular exercise, a healthy diet, and regular sleep patterns can complement therapy by creating stability and improving mood.
• Social Support: Joining support groups or reaching out to family and friends often helps individuals feel less isolated.

The Role of the Therapist

A skilled therapist plays a key role in supporting individuals through depression. They:

• Create a safe, non-judgemental environment for clients to discuss their feelings.
• Help individuals set realistic goals and track progress throughout therapy.
• Adjust the therapeutic approach if one method is not working effectively.

The therapist-client relationship is one of the most important elements of successful therapy. If this relationship feels supportive and trusting, individuals are more likely to stay engaged with treatment.

Conclusion

Psychological approaches like CBT, IPT, and psychodynamic therapy are effective, evidence-based options for managing depression. Each offers unique benefits and is chosen based on the individual’s symptoms, preferences, and past experiences. By addressing negative thoughts, improving relationships, and processing unresolved emotional issues, these therapies give individuals the tools to cope with depression and prevent its recurrence. Working closely with a trained therapist further supports individuals in their recovery and helps them maintain long-term mental wellbeing.