tag:theconversation.com,2011:/us/topics/talking-therapy-21622/articlesTalking therapy – The Conversation2023-03-08T19:07:00Ztag:theconversation.com,2011:article/1991972023-03-08T19:07:00Z2023-03-08T19:07:00ZI think I need therapy. Here are 5 types of psychotherapy to help with almost any mental health problem<figure><img src="https://images.theconversation.com/files/513579/original/file-20230306-22-3pj7o2.jpg?ixlib=rb-1.1.0&rect=0%2C230%2C5863%2C3566&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/person-in-black-pants-and-black-shoes-sitting-on-brown-wooden-chair-4101143/">Pexels/cottonbro studio</a></span></figcaption></figure><p>You have made a momentous decision: you will seek psychological treatment for your depression, anxiety, substance abuse, or other mental health issue. </p>
<p>Your mind then may turn to the question of what type of treatment would best suit you. To even ask this sophisticated question, you need to realise there are various types of psychological treatment. To make a wise choice, you must understand what each type of therapy provides. </p>
<p>Let’s look at several types of psychotherapy (also known as talking therapy) that have the potential to help with almost any mental health problem. </p>
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Read more:
<a href="https://theconversation.com/think-therapy-is-navel-gazing-think-again-173312">Think therapy is navel-gazing? Think again</a>
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<h2>1. Cognitive behaviour therapy</h2>
<p>Cognitive behaviour therapy (<a href="https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral">CBT</a>) is a common type of therapy where the therapist explores the thoughts and behaviours that relate to your therapy goal. </p>
<p>Let’s suppose you have been feeling depressed for months. Relevant thoughts might be that no one likes you and that you are worthless. Relevant behaviours might include staying in your home and avoiding contact with others. </p>
<p>The therapist would likely help you challenge the accuracy and usefulness of those thoughts and find replacement thoughts. The therapist might encourage you to do more for fun and to interact more with others.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">Explainer: what is cognitive behaviour therapy?</a>
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<h2>2. Acceptance and commitment therapy</h2>
<p>In <a href="https://www.racgp.org.au/afp/2012/september/acceptance-and-commitment-therapy">acceptance and commitment therapy</a>, you would instead be asked to accept your negative thoughts as yours (regardless of whether they are accurate) and also accept your negative emotions. </p>
<p>The therapist would encourage you to look at your thoughts and emotions as separate from you so you can examine them more objectively. Acceptance might reduce your negative feelings about yourself. </p>
<p>The therapist would explore your values and encourage you to commit to acting according to them. If you value kindness, for instance, the therapist might encourage you to show kindness to others. </p>
<h2>3. Psychodynamic therapy</h2>
<p>A <a href="https://psychcentral.com/lib/psychodynamic-therapy#your-therapists-role">psychodynamic</a> therapist would help you explore your childhood, searching for traumas and difficulties with your parents. </p>
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<img alt="Woman writing in notebook" src="https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=838&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=838&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=838&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1054&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1054&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513577/original/file-20230306-14-pelyme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1054&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some therapies look deep into your past.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/ewRSEBHyO_c">Kateryna Hliznitsova/Unsplash</a></span>
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<p>If you felt unloved by your parents as a child, you would consider whether your parents provide a fair representation of the entire world. </p>
<p>You might consider to what extent you deserve love now as an adult. You might also gain insight into how your early experiences colour your current expectations, and affect your emotions and behaviour. </p>
<p>You might find yourself transferring to the therapist your feelings toward your parents and then realise that others are not your parents and you are no longer an unloved child.</p>
<h2>4. Narrative therapy</h2>
<p>In <a href="https://www.verywellmind.com/narrative-therapy-4172956">narrative therapy</a>, you would explore the stories of your life, particularly the stories that seem to persist. </p>
<p>If you were an outsider in school, reluctant to join in social activities, you may think of yourself as a loner. As an adult, even though you engage fully and successfully in social interactions at work, you may continue to think of yourself as a loner. </p>
<p>In other words, the story you tell yourself remains unchanged despite your social success at work, and you feel depressed about being alone. </p>
<p>In becoming aware of the story of your life, you create distance from the story and you may find ways to change the story (the narrative). In essence, you rewrite the story in a realistic way to develop toward being the person you want to be. </p>
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Read more:
<a href="https://theconversation.com/psychologists-are-starting-to-talk-publicly-about-their-own-mental-illnesses-and-patients-can-benefit-177716">Psychologists are starting to talk publicly about their own mental illnesses – and patients can benefit</a>
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<h2>5. Person-centred therapy</h2>
<p>In <a href="https://www.goodtherapy.org/learn-about-therapy/types/person-centered">person-centered therapy</a>, sometimes called supportive counselling, the therapist would listen attentively, try hard to understand life as you experience it and try to understand and even feel your emotions. </p>
<p>The therapist would show caring and an interest in helping you, in the expectation that you can find your own way to overcome feeling depressed. </p>
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<img alt="" src="https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/513586/original/file-20230306-16-jjlxae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Supportive therapists listen attentively and try to understand and feel your emotions.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-woman-talking-at-a-couple-s-therapy-session-5217833/">Antoni Shkraba/Pexels</a></span>
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<h2>A mix of styles to suit you</h2>
<p>You can ask potential therapists what type of therapy they provide. Many will say they are <a href="https://www.verywellmind.com/eclectic-therapy-2671584">eclectic</a>, meaning they try to choose methods to suit each client and specific problem. They may combine methods of different therapy types. </p>
<p>They may also use popular methods such as <a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/mindfulness-exercises/art-20046356">mindfulness training</a> that do not fit any specific therapy type. Mindfulness training involves focusing on your breathing and being aware of the here and now. </p>
<p>You can request an eclectic therapist to provide a certain type of therapy or certain therapy methods. Once the therapist gets to know you, you can discuss your preferences and decide on the therapy methods to use.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/meditation-and-mindfulness-offer-an-abundance-of-health-benefits-and-may-be-as-effective-as-medication-for-treating-certain-conditions-195276">Meditation and mindfulness offer an abundance of health benefits and may be as effective as medication for treating certain conditions</a>
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<h2>How can you decide which one?</h2>
<p>You might wonder which type of therapy usually works best. The answer is unclear. Much depends on the specific client, the problem and the therapist. </p>
<p>Most types of therapy work <a href="https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/is-psychotherapy-effective-a-reanalysis-of-treatments-for-depression/5D8EC85B6FA35B5CEE124381F18E51B9">moderately well</a> for treating people with depression. Psychotherapy also appears to be <a href="https://onlinelibrary.wiley.com/doi/10.1002/wps.20941">reasonably effective</a> for other types of psychological problems.</p>
<p>CBT has the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797481/">strongest evidence</a> for treating a broad range of psychological problems (including <a href="https://www.sciencedirect.com/science/article/abs/pii/S0272735817302271">post-traumatic stress disorder</a>). However, CBT has the most evidence in part because it is heavily studied (for example to treat <a href="https://www.sciencedirect.com/science/article/abs/pii/S0005796722001747">specific phobias</a>).</p>
<p>Acceptance and commitment therapy is also backed by <a href="https://www.sciencedirect.com/science/article/pii/S0005796714001211">substantial evidence</a>, as is <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0018378">psychodynamic therapy</a>.</p>
<p>The effects of narrative therapy and person-centred therapy have not been studied so much.</p>
<p>Some people, including those with depression or psychosis, can benefit by receiving psychotherapy and taking medication <a href="https://www.nimh.nih.gov/health/topics/mental-health-medications">prescribed</a> by a GP or psychiatrist.</p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/199197/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Malouff does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>So you want to start therapy for your anxiety, depression or other mental health issue. What type of therapist should you choose? Here’s a quick guide to get you started.John Malouff, Associate Professor, School of Behavioural, Cognitive and Social Sciences, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1225792019-10-01T11:28:43Z2019-10-01T11:28:43ZWhen should my child start speaking?<figure><img src="https://images.theconversation.com/files/292851/original/file-20190917-19076-52bl52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cheerful-mother-teaching-her-male-toddler-297400199?src=Tm6tNablsZ8A9BOqPgPfSA-1-4">Shutterstock/OlenaYakobchuk</a></span></figcaption></figure><p>Children develop at varying rates in all sorts of ways, from when they take their first steps to when they understand that their own perspective might be different to someone else’s. Language is no different <a href="http://modules.ilabs.uw.edu/module/language-development-listening-speaking/variability-language-acquisition/">so there is no set age at which a child should start talking.</a></p>
<p>There are, of course, <a href="https://www.nidcd.nih.gov/health/speech-and-language">certain milestones</a> which most children achieve in their communication at certain ages and it can be a daunting time for parents who see their friend’s children begin speaking earlier than their own. For most children, this is likely just the natural variation in when children achieve their own milestones. For others, this could be a temporary language delay <a href="https://www.asha.org/public/speech/disorders/Late-Blooming-or-Language-Problem/">which will eventually see them</a> catch up without any intervention. </p>
<p>But for some children a delay in early language milestones might be the first sign of a long-term disorder of language development. So <a href="https://www.speechpathways.ca/2018/04/11/when-should-i-worry-about-my-childs-speech-language-development/">what should parents look for</a> if they are concerned about their child’s language development?</p>
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<p>
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Read more:
<a href="https://theconversation.com/surprising-facts-about-how-we-talk-to-babies-85277">Surprising facts about how we talk to babies</a>
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</p>
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<h2>It’s not all about speech</h2>
<p>Generally, children begin to babble from around the age of six months and say their first words between ten and 15 months (most start speaking at about 12 months). They then begin to pick up increasing numbers of words and start to combine them into simple sentences after around 18 months. </p>
<p>It is important to note that language is not just the sounds we make with our voice. The idea that language is only speech is a huge misconception. We take it for granted, but understanding the language used by those around us is a very complex task. We need to have knowledge of the words being used, have a concept of what those words mean in different contexts and understand the meaning of a sentence based on the order of the words. These are called receptive language skills.</p>
<p>Parents should be aware that from the earliest stages of language development, children understand more than they can communicate themselves. Indeed, it is through children’s understanding of the language surrounding them – in other words, what parents, siblings and caregivers are saying – that they build their own language skills. </p>
<p>Some conditions affecting speech, such as a stutter, are highly noticeable. In contrast, the problems children have when they are not developing language in the typical fashion can sometimes be hidden. Sometimes seemingly complex instructions can be readily understood due to the overall context. For example, telling your child to “go and get your coat and boots on” may be understood due to the context of getting ready to leave the house and understanding the words “coat” and “boots”.</p>
<p>Other instructions with a less clear context, such as “get the blue and black book that is under the blanket on the chair”, require a better understanding of the language itself and might be harder for children with language difficulties. It is often difficult to identify an underlying language problem in many children, particularly when they are good at using the social context. </p>
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Read more:
<a href="https://theconversation.com/before-babies-understand-words-they-understand-tones-of-voice-81978">Before babies understand words, they understand tones of voice</a>
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<h2>When to seek help</h2>
<p>For the children themselves, it can be very frustrating when they are unable to express their thoughts or when they don’t fully understand what is going on around them. A child that has temper tantrums but finds it hard to say why they are distressed may have an underlying language difficulty. This might signal <a href="https://www.asha.org/public/speech/disorders/Late-Blooming-or-Language-Problem/">language delay</a>, which is not uncommon. If you notice that your child finds it hard to follow simple instructions this could be due to a difficulty in understanding language, which may indicate a more persistent problem. </p>
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<p>About <a href="http://www.hanen.org/Helpful-Info/Articles/A-Closer-Look-at-the-Late-Talker-Study--Why-Parent.aspx">70-80% of children</a> with expressive delays catch up with their language by the age of four. For others this might highlight <a href="https://radld.org/about/dld/">developmental language disorder</a> (DLD), a long-term impairment of language skills. Even experts find it difficult to tell language delay and disorder apart before primary school. DLD is thought to affect 7.6%, or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.12573">one in 15 children</a>. DLD can affect expressive and receptive language skills and it lasts into adulthood.</p>
<p>All children have the capacity to thrive, but children with DLD may need extra support to achieve their full potential. Rather than “wait and see” it is a good idea to seek professional advice, particularly if your child is between 18 and 30 months and appears to have problems understanding language, uses very few gestures to communicate and is slow at learning new words. The first step is to contact a local speech and language therapy service. </p>
<h2>Boosting language skills</h2>
<p>Language is flexible and there is no such thing as too much language input. Whatever level of language development your child has, there are always things that you can do to boost their language skills further. </p>
<p>For example, when you are playing with your toddler, watch where their eyes are going and label the things they see. If they say “horse running”, you can build on this with: “Yes, the horse is running! Where is he running to?” This helps children to learn new words and concepts as well as learn about how better to structure sentences. </p>
<p>Reading books together is great for building language skills, as you can find new words in books for things not often seen in real life, such as zoo animals. It is also valuable in promoting attention and listening skills. Be sure to ask lots of “why” and “how” questions to get more language out of your child, rather than questions which can be answered with a “yes” or “no”. Watching videos or children’s television can be similar, but only if you are watching and discussing the videos or shows together.</p>
<p>It sounds simple but having back and forth conversations with your child can help enormously. Not only can this be incredibly rewarding socially, but it can help build and expand their language and wider social communication skills. Try to build this into regular activities, such as talking with your child while doing the supermarket shop.</p><img src="https://counter.theconversation.com/content/122579/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here’s what parents should look out for if they are worried about their baby’s language development.Michelle St Clair, Lecturer in Psychology, University of BathVanessa Lloyd-Esenkaya, PhD Candidate in Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/644132016-08-30T11:13:30Z2016-08-30T11:13:30ZWe may be able to treat depression with anti-inflammatory drugs – here’s why<figure><img src="https://images.theconversation.com/files/135499/original/image-20160825-6618-1yo56u3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-381189358/stock-photo-sad-woman-hug-her-knee-and-cry.html?src=dx3ir4r9m7ze4OqLrvX_fg-1-42">Shayneppl/Shutterstock</a></span></figcaption></figure><p>There is growing evidence that inflammation – already known to be a cause of many whole-body diseases – is also involved in diseases of the brain, including psychiatric conditions like depression.</p>
<p>Depression is a common and crippling disease affecting over 350m people worldwide. Around 20% of the UK population will suffer from depression at some point in their lives, with symptoms varying from feelings of sadness and hopelessness through to suicidal thoughts. The disease may be a response to bereavement or other life events or emerge without any obvious cause. All too often it persists, sometimes for life. </p>
<p>Despite its high prevalence, the disease is poorly understood. It is often put down to a disturbance in brain chemistry and treated in a trial-and-error manner with talking therapies and drugs that are designed to re-balance brain chemistry. For many, these approaches eventually work, but all agree that better treatments are needed and these require a better understanding of the disease.</p>
<h2>Beating two disorders with one pill</h2>
<p>Inflammation is the body’s response to injury or infection. Cells and proteins are mobilised to deal with the injury, do their job and then are demobilised. However, inflammation, when not properly controlled, can cause damage and disease, such as rheumatoid arthritis. These types of diseases are often controlled with anti-inflammatory drugs.</p>
<p>Recently, it has been suggested that depression is also an <a href="http://www.ncbi.nlm.nih.gov/pubmed/26711676">inflammatory disease</a>. The first evidence came from people with diseases like rheumatoid arthritis and psoriasis who were also severely depressed. When these people were treated with anti-inflammatories, both their arthritis and their depression improved, suggesting that <a href="http://www.ncbi.nlm.nih.gov/pubmed/18652795">inflammation in the body was affecting the brain</a> to cause depression. </p>
<p>Of course, their depression may have improved because their other physical conditions had cleared up, but the evidence strengthened when it was shown that some people with depression, and no other disease, had increased levels of <a href="http://www.ncbi.nlm.nih.gov/pubmed/24838302">blood markers of inflammation</a>. When their brains were looked at in the latest imaging machines, <a href="http://www.ncbi.nlm.nih.gov/pubmed/25629589">tell-tale signs of inflammation were present</a>.</p>
<p>All of this evidence has led scientists to think of depression in a different way: as a disease of the whole person in which the symptoms are most evident in the brain, and where treatments targeting inflammation in the body might resolve the brain problems. However, it is likely that inflammation is not always the cause of depression, and we know that inflammation comes in different types that require different treatments. So, the current problem is how to identify which of the many patients with depression have inflammation as an underlying cause and exactly what type of inflammation they have. If we can develop simple blood tests to analyse inflammation in depressed patients we would be better placed to choose the best drugs to treat individual patients.</p>
<h2>Stratified medicine</h2>
<p>A group of UK scientists have teamed up with researchers from several pharmaceutical companies to investigate whether mood disorders, such as depression, and neurodegenerative diseases, such as Alzheimer’s disease, could be treated by targeting the immune system. The group is called NIMA (Neuroimmunology of Mood Disorders and Alzheimer’s Disease). </p>
<p>The first stage of NIMA’s work (currently ongoing) is to develop blood tests and brain imaging tests that can precisely identify those people who have depression associated with whole-body and brain inflammation. The final blood test will likely look at multiple markers of inflammation in the blood and give information that not only tells the clinician that the patient has inflammation but also what sort of inflammation it is. It will then be possible to select the best possible anti-inflammatory drug for that patient, improving the chance of a successful treatment. </p>
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<img alt="" src="https://images.theconversation.com/files/135501/original/image-20160825-6622-ljtgj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/135501/original/image-20160825-6622-ljtgj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=465&fit=crop&dpr=1 600w, https://images.theconversation.com/files/135501/original/image-20160825-6622-ljtgj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=465&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/135501/original/image-20160825-6622-ljtgj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=465&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/135501/original/image-20160825-6622-ljtgj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=584&fit=crop&dpr=1 754w, https://images.theconversation.com/files/135501/original/image-20160825-6622-ljtgj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=584&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/135501/original/image-20160825-6622-ljtgj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=584&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Anti-inflammatory drugs might treat some cases of depression.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-390373792/stock-photo-boxes-of-prescription-painkillers-ibuprofen-and-paracetamol-on-a-shelf-at-home.html?src=pTWQeC7bOpY2kzkFLren6g-1-0">Mr Doomits/Shutterstock.com</a></span>
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<p>And here’s where the clever part of NIMA comes in: to make a new drug costs a huge amount and takes years, but the partner pharmaceutical companies already have many anti-inflammatory drugs in their lockers which have been tested and shown to be safe in patients but are not yet available on the market. NIMA scientists will be able to select drugs from this resource, test them to confirm that they have the desired activity and then take them into small, fast clinical trials in highly selected patients with the right sort of disease. </p>
<p>The new approach of identifying the right patients to treat with the right drugs – called “stratified medicine” – is being used in many areas of medicine, but the work of NIMA means that one of its early successes might be in one of the most difficult diseases to treat: depression. While reaching for the ibuprofen will not resolve depression in everyone, there is the real prospect that many with depression associated with inflammation will soon benefit from individually tailored anti-inflammatory treatments.</p><img src="https://counter.theconversation.com/content/64413/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Morgan receives funding from Alzheimer's Research UK and The Wellcome Trust. He is affiliated with the UK Labour Party. </span></em></p>And the good news is that the treatments may already exist.Bryan Paul Morgan, Professor, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/525142016-01-06T10:16:21Z2016-01-06T10:16:21ZPsychodynamic therapy – there’s more to it than lying on a couch talking about your childhood<figure><img src="https://images.theconversation.com/files/107176/original/image-20160104-29000-79vble.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tell me about your childhood</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=FBrMZflCqeECqdPh4rxP5Q&searchterm=therapists%20couch&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=136749077">www.shutterstock.com</a></span></figcaption></figure><p>Some people think psychodynamic psychotherapy is mumbo jumbo. The therapy, which grew out of the Freudian school of psychoanalysis, is often portrayed as elitist, expensive, old-fashioned and ineffective. Cognitive behavioural therapy (CBT), by contrast, is portrayed as modern, evidence-based, quick and affordable. </p>
<p>Plenty of research shows that CBT can help people with mild or moderate depression or anxiety. As a result, CBT has become a bit like paracetamol for psychological problems. </p>
<p>However, when it comes to more deep-seated psychological problems, <a href="http://onlinelibrary.wiley.com/doi/10.1002/wps.20267/full">new research suggests</a> that psychodynamic psychotherapy – in which the therapist and patient form a therapeutic relationship where the patient can begin to think about and understand their past and present relationships with others and consider new ways to relate to people – can be effective. Mumbo jumbo it isn’t.</p>
<h2>Quick fix</h2>
<p>Since 2008, thousands of new cognitive behavioural therapists have been trained to provide treatment to hundreds of thousands of people. These <a href="http://www.iapt.nhs.uk/">services</a> are now usually the first port of call for anyone who goes to their doctor complaining of psychological problems. </p>
<p>There are said to be more than <a href="http://www.scientificamerican.com/article/are-all-psychotherapies-created-equal/">500 different types of talking therapy</a> which might suit different people at different times for different reasons. There is an argument that having put CBT on a pedestal, patient choice is much diminished.</p>
<p>CBT tends to be provided in six to 12 week doses and is offered either face-to-face, by telephone or through a computer program. This reminds me of “<a href="http://www.imdb.com/title/tt0578587/">gourmet night</a>” at Fawlty Towers when there were only three options on the menu: duck with orange, duck with cherries or “duck surprise”. Basil Fawlty famously pointed out: “If you don’t like duck, you’re rather stuck!”</p>
<p>Some services have now expanded their menu to include other quick-fix therapies. This includes a brief version of psychodynamic psychotherapy called <a href="http://www.d-i-t.org/">dynamic interpersonal therapy</a> which involves 16 one-to-one sessions to treat mood disorders, such as depression. But when people have very complex problems, they probably need a form of therapy which takes a lot longer. </p>
<h2>Not good enough for NICE</h2>
<p>Psychodynamic psychotherapy is available on the NHS at the <a href="http://tavistockandportman.uk/">Tavistock Clinic</a> in London where patients can be seen for a year or sometimes longer. In other areas, availability is relatively sparse and <a href="http://www.nhs.uk/Conditions/Psychotherapy/Pages/Introduction.aspx">waiting lists tend to be long</a>. </p>
<p>The reason why this and other types of talking therapy have not been considered to work as well as CBT is because, although there has been research, it has been the wrong type of research for NICE (the agency responsible for deciding whether new drugs and treatments should be funded by the NHS).</p>
<p>NICE prioritises research in the form of randomised controlled trials which compare how well one type of therapy works compared with a current standard treatment. However, research which compares therapies with each other or examines one type of therapy over time is not valued by NICE, even though this hierarchical approach to evaluating research has its <a href="http://onlinelibrary.wiley.com/doi/10.1002/cpp.1942/abstract">critics</a> both inside and outside the field of psychotherapy. </p>
<h2>A gold-standard study</h2>
<p>The new research is the first <a href="http://onlinelibrary.wiley.com/doi/10.1002/wps.20267/full">randomised controlled trial of psychodynamic psychotherapy</a> in the NHS (partly funded by the Tavistock Clinic Charitable Foundation) for adults with severe long-lasting depression. </p>
<p>The 129 patients who agreed to take part in the study had already found antidepressants – and in some cases CBT – unhelpful. This type of depression is sometimes called “treatment resistant”. </p>
<p>The patients were randomly assigned to receive psychodynamic psychotherapy or treatment-as-usual. The patients were treated for 18 months and then followed up for two years.</p>
<p>The results showed that when therapy ended after 18 months, patients were no more likely to have improved in the treatment group than the control group. Two years later, however, significantly more people had improved in the treatment group than in the control group. </p>
<p>Most psychotherapy research fails to follow patients for this long. A recent <a href="http://tinyurl.com/at8qpop">randomised controlled trial</a> of CBT for treatment resistant depression also found CBT to be helpful for this type of depression. However, the CBT in this trial was unusually long (18 sessions), the depression severity was slightly lower than in the psychodynamic psychotherapy study, and patients were followed up for one year only. </p>
<p>Because treatment resistant depression is a long-term – sometimes life-long – condition which is likely to return, longer term follow-up periods in trials are critical to understand what impact different therapies have, not just while the patient is in therapy but in the years that follow. </p>
<p>Psychodynamic psychotherapy is not a quick fix. It can take time after therapy finishes for the patient to put into practice what they have learned, so we might expect to see patients’ lives improving gradually, after therapy ends. If psychodynamic psychotherapy leads to improvements two years after the end of therapy instead of during therapy as the results of the new study suggest, then its potential as a therapy which might deliver long lasting as opposed to transient change should be of interest to patients seeking help. </p>
<h2>End the caricature</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/107212/original/image-20160104-28997-5ostc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/107212/original/image-20160104-28997-5ostc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=516&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107212/original/image-20160104-28997-5ostc3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=516&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107212/original/image-20160104-28997-5ostc3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=516&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107212/original/image-20160104-28997-5ostc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=648&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107212/original/image-20160104-28997-5ostc3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=648&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107212/original/image-20160104-28997-5ostc3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=648&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The evidence is mounting.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=VCxKbGMaYNDnYgGduDlUgg&searchterm=stack%20of%20documents&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=133106732">www.shutterstock.com</a></span>
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<p>A <a href="http://onlinelibrary.wiley.com/doi/10.1002/wps.20235/full">recent review</a> which examined all relevant research on psychodynamic psychotherapy also supports the idea that this type of therapy could help people with a range of psychological difficulties including depression, anxiety and eating disorders.</p>
<p>This does not mean psychodynamic psychotherapy should now be offered to everyone. Because it’s a longer and more complex treatment, it may never fit into the mainstream NHS model which is based on providing brief therapies for the mass market which are delivered by therapists whose training and therefore time costs much less than a psychodynamic psychotherapist. But it does mean that some of the traditional caricatures of psychodynamic psychotherapy need to be reconsidered, especially the idea that it does not work. </p>
<p>It is important that patients are offered a real choice of therapy at the right time, particularly for people whose difficulties are long standing, complex and severe and where a quick fix approach is less likely to work and may even put people off seeking help.</p><img src="https://counter.theconversation.com/content/52514/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan McPherson has an honorary (unpaid) research affiliation with the Tavistock & Portman NHS Foundation Trust and is also employed by the University of Essex as a research tutor on the Essex-Tavistock Doctorate in Clinical Psychology which is a training programme run in partnership between the University of Essex and the Tavistock & Portman NHS Foundation Trust.</span></em></p>A new study has found that psychodynamic therapy is useful for treating depression, and the positive effects are longer lasting.Susan McPherson, Senior Lecturer in Clinical Psychology, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/505692015-12-15T10:53:56Z2015-12-15T10:53:56ZFeeling SAD? Talk therapy gets better long-term results than light boxes<figure><img src="https://images.theconversation.com/files/102710/original/image-20151122-420-yt9r2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Feeling SAD?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-235862692/stock-photo-lonesome-woman-drinking-cup-of-coffee-by-the-window-of-her-living-room-while-the-snow-is-falling.html?src=cCMFqNFmUwx_RpFIvXRYBg-1-28">Woman holding mug via www.shutterstock.com</a></span></figcaption></figure><p>As the days get shorter and the nights grow longer, sometimes it can seem like we barely get a chance to see the sun. For most people, this can be frustrating; and for others, the slide into winter can actually lead to a subset of depression called seasonal affective disorder, or SAD. </p>
<p>SAD is a form of clinical depression that follows a seasonal pattern. The symptoms are present during the fall and winter months and resolve in the spring and summer. Common SAD symptoms include: depressed mood, loss of interest, fatigue, sleep changes (usually sleeping more), significant appetite changes (usually craving more starches and sweets), difficulty concentrating and sometimes thoughts of death or suicide. </p>
<p>SAD can be tough, but it is treatable. Some people might use daily therapy with a light box, but antidepressants are also used. My lab at the University of Vermont wanted to test another kind of treatment – cognitive-behavioral therapy. We wanted to see if using this talking-based therapy could deliver more lasting results than light therapy does. </p>
<h2>Who gets SAD and how it is different from depression?</h2>
<p>One popular misconception about SAD is that it affects everyone at northern locations, though it’s true that most people at high latitudes experience SAD symptoms to a certain extent. In the United States, the farther north you go, the more cases of SAD you find. SAD prevalence has been estimated to range from <a href="http://www.ncbi.nlm.nih.gov/pubmed/2326393">1% in Florida to 10% in Alaska</a>. While it is more common the farther north you go, only a minority of people living in these places actually have the number and severity of symptoms it takes to count as winter depression. </p>
<p>Everyone can experience some changes in behavior or outlook with the shift of the seasons, and many of these are normal. When it is cold, you might not want to go out as often. When the nights are longer and the days are shorter, your sleep patterns may change. </p>
<p>But SAD is different from these typical changes because the symptoms can make it difficult to function at work or school or in relationships and cause great distress. We can think of seasonal changes as on a continuum, ranging from no symptoms at all to seasonal affective disorder on the extreme end. In northern locations, most people fall in the middle, with mild changes in energy, sleep and food preferences in winter versus summer.</p>
<p>We don’t know why short days can lead to SAD, but several hypotheses have been proposed. For instance, a person’s biological clock may run slow, delaying circadian rhythms. Perhaps longer nights mean a longer period of release for melatonin, the “hormone of darkness” that signals sleep, which leads to a longer “biological night.” Both of these scenarios would lead to a mismatch between sleep and wake cycle and the light-dark cycle.</p>
<h2>Treating SAD</h2>
<p>One popular treatment for SAD is light therapy, which involves daily exposure to a device that produces 10,000 lux of full-spectrum light, minus the harmful ultraviolet rays. The idea is that it mimics sunlight. Light therapy usually takes place first thing in the morning to simulate a summer dawn and jump-start the circadian clock. It is an established, effective SAD treatment. Across studies, <a href="http://www.ncbi.nlm.nih.gov/pubmed/2679625">53% of SAD patients</a> experience complete relief from their symptoms with light therapy. </p>
<p>My laboratory has been conducting clinical trials to test an alternative treatment: cognitive-behavioral talk therapy (CBT). CBT is not a new treatment – it has been used and researched for nonseasonal depression for over 40 years. But, until now, it hasn’t been tested for SAD in clinical trials.</p>
<p>CBT involves recognizing and changing negative thoughts that feed sad moods and engaging in pleasurable activities that counteract depressed moods. In SAD specifically, a lot of these negative thoughts are gloomy thoughts about the winter season, short days and winter weather. </p>
<p>Dwelling on these negative thoughts and going into “hibernation mode” by withdrawing to the couch or bed breeds depression. In CBT for SAD, we try to get people to be proactive by questioning and reframing these negative thoughts and engaging in behaviors that make them approach winter rather than avoiding it, especially through increased social activities and keeping up hobbies and interests in the winter. </p>
<p>The basic idea is to tweak negative, helpless attitudes about winter (“Winter is a dreaded season to endure”) to be more positive and empowering (“I prefer summer to winter, but winter also offers opportunities for enjoyment if I take control of my mood rather than letting the season dictate how I feel”). </p>
<h2>Comparing talk therapy and light therapy</h2>
<p>We just finished a clinical trial at the University of Vermont where 177 adults with SAD were treated with either light therapy or CBT across six weeks in the winter and then followed for two years. </p>
<p>Initially, <a href="http://dx.doi.org/10.1176/appi.ajp.2015.15060773">we found</a> that light therapy and CBT were both effective SAD treatments. Both were associated with large improvements in SAD symptoms during treatment in the winter. However, by two winters later, there was a clear advantage of initial treatment with CBT over light therapy. </p>
<p>People who were treated with CBT had fewer relapses of their SAD: slightly less than one-half of the people in the light therapy group relapsed as compared to slightly more than one-quarter in the CBT group. The people treated with CBT also had less severe winter symptoms overall than those treated with light therapy. </p>
<h2>Why does the CBT seem to have a longer-lasting effect?</h2>
<p>These results suggest that the effect of CBT is more durable in the long run. </p>
<p>It might be that long-term compliance with light therapy – sitting in front of a light box for at least 30 minutes a day, every day during winter – is part of the problem. We found that slightly less than one-third of the people we treated with light therapy reported any light therapy use one or two winters later. This is an issue because light therapy is intended as a daily treatment during the fall and winter months that is continued until spring – with its increase in sunshine – arrives. </p>
<p>Although CBT involves effort to attend sessions, work with a therapist to change winter habits and “homework” to practice skills, it seems to pay off in the long run with better outcomes. It might be that teaching people to reframe their thoughts about winter can help them overcome SAD year after year.</p><img src="https://counter.theconversation.com/content/50569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kelly Rohan receives funding from the National Institutes of Mental Health. Dr. Rohan receives book royalties from Oxford University Press for the treatment manual for the cognitive-behavioral therapy for SAD intervention.</span></em></p>It might be that teaching people to reframe their thoughts about winter can help them overcome seasonal affective disorder year after year.Kelly Rohan, Professor of Psychology, University of VermontLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/449762015-10-15T05:08:13Z2015-10-15T05:08:13ZYou’ve been diagnosed with depression, now what?<figure><img src="https://images.theconversation.com/files/98488/original/image-20151015-27925-1qedpdk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Therapy, drugs or exercise? The depression treatment journey can be difficult to navigate. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/edumillo/5044131348/">Eduardo Millo/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>So you’re depressed. You know this because a health professional has told you so, or you’ve been depressed before and there is no mistaking the symptoms. Or perhaps you just suspect that you’re depressed – you’ve used an <a href="https://www.beyondblue.org.au/the-facts/depression/signs-and-symptoms/anxiety-and-depression-checklist-k10">online screening questionnaire</a> that suggests the diagnosis, and just need to see a health professional to confirm it. What now?</p>
<h2>First stop: talking therapies</h2>
<p>Psychotherapy remains the cornerstone of treatment. <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">Cognitive behavioural therapy</a> (CBT) is the most studied of the therapies, but other forms are effective too. CBT works by addressing the thoughts and behaviours that act to entrench depression. </p>
<p>When people are depressed they tend to withdraw from their social networks. They no longer enjoy social interactions and think they’re unappealing company. By spending more time alone, and less time around people whose company they would usually enjoy, the depression gets worse, leading to even more time spent alone, and so on. </p>
<p>CBT and most other therapies act to break this feedback loop by challenging the thoughts and behaviours that reinforce social isolation, and getting people engaged again.</p>
<p>How do you find a therapist? </p>
<p>Your GP should be able to recommend one, or you can find names in the directories at the <a href="http://www.psychology.org.au/FindaPsychologist">Australian Psychological Society</a> and <a href="https://www.ranzcp.org/Mental-health-advice/find-a-psychiatrist.aspx">Royal Australian and New Zealand College of Psychiatrists</a>. If you’re between 12 and 25, <a href="http://headspace.org.au">headspace</a> is a good option. </p>
<p>Most therapists are psychologists or psychiatrists, but some have backgrounds in occupational therapy and social work. There is actually no need for a formal qualification to work as a therapist; my five-year-old daughter could put up her shingle. But it becomes important for claiming rebates, as well as feeling confident you’re seeing someone with a degree of competence. </p>
<p>The <a href="https://health.gov.au/internet/main/publishing.nsf/Content/mental-ba-fact-pat">Medicare Better Access</a> scheme provides rebates for up to ten sessions of therapy a year to see a psychologist, social worker, or occupational therapist. </p>
<p>To access it you need a GP referral, and the amount of the rebate you get will depend on the qualification of the therapist. It might cover all of the therapist’s fee, or there might be a gap. </p>
<p>You can get a higher rebate still if you see a psychiatrist, who can offer up to 50 sessions of therapy a year. Their fees are likely to be higher, though, meaning a bigger gap between what you pay and the rebate you get. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98489/original/image-20151015-27962-iqjsgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98489/original/image-20151015-27962-iqjsgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98489/original/image-20151015-27962-iqjsgd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98489/original/image-20151015-27962-iqjsgd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98489/original/image-20151015-27962-iqjsgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98489/original/image-20151015-27962-iqjsgd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98489/original/image-20151015-27962-iqjsgd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">CBT aims to break unhelpful thinking patterns.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-247411348/stock-photo-girl-telling-about-her-problems-on-therapy.html?src=pp-photo-312038324-zt2AG5pKJJwf0-6_KPZwuQ-1&ws=1">Photographee.eu/Shutterstock</a></span>
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<p>The funding for ten sessions per calendar year for non-medical therapists introduces an oddity to the process. If you start seeing a therapist towards the end of the year you can get 20 continuous sessions (ten in one year and ten in the next). But if your depression hits at the beginning of a calendar year you will be cut off after ten. </p>
<p>There are other options, though: you might be eligible for rebates from your health insurance fund and of course, if you can afford to, you can pay for the sessions yourself. </p>
<p>Then there is online therapy, which research suggests is very effective. There are a number of options available in Australia, including <a href="https://moodgym.anu.edu.au">MoodGYM</a>, <a href="https://ecouch.anu.edu.au">e-couch</a> and <a href="https://thiswayup.org.au/clinic">This Way Up</a>. They are worth investigating.</p>
<h2>Antidepressants</h2>
<p>Medications for depression have got a lot of bad press in the past few years, with suggestions that pharmaceutical companies have exaggerated their effectiveness by <a href="http://www.nytimes.com/2008/01/17/health/16cnd-depress.html">burying equivocal or negative results</a>. </p>
<p>A fair assessment of the evidence suggests that overall they are effective: only modestly so, but taking an antidepressant medication is, on average, more effective than taking a sugar tablet. </p>
<p>Antidepressant medications might be considered when therapy hasn’t been effective, when it isn’t wanted (not everyone wants to see a therapist), or when the depression is severe. </p>
<p>One of the problems with antidepressant medications is they’re often <a href="http://ps.psychiatryonline.org/doi/10.1176/appi.ps.54.9.1233">not well-managed</a>. Too often doctors write a script and the person stays on a low and ineffective dose of the medication without review for many months, even years. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98490/original/image-20151015-27925-508kvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98490/original/image-20151015-27925-508kvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98490/original/image-20151015-27925-508kvq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98490/original/image-20151015-27925-508kvq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98490/original/image-20151015-27925-508kvq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98490/original/image-20151015-27925-508kvq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98490/original/image-20151015-27925-508kvq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Antidepressant use should be closely managed.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-176088170/stock-photo-man-in-middle-age-taking-a-white-pill.html?src=mMhJ7v41n2gGpiSehIkPfA-1-7">Photographee.eu/Shutterstock</a></span>
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<p>Antidepressant medications take four to six weeks before they start working. If there hasn’t been any effect by then, something needs to happen. In the first instance that is usually a dose increase. </p>
<p>But if the medication still hasn’t had any positive effect after another six to eight weeks, another medication should be considered. You need to get to this point before you can determine that a medication hasn’t been effective, but beyond this point there seems little sense in staying on a medication that hasn’t helped. </p>
<p>Any decisions about stopping medication, or changing dose, should be made in consultation with a doctor. Not only can they discuss the options, but they can also monitor your mood while changes are made.</p>
<h2>Diet and exercise</h2>
<p>People with depression are increasingly told that <a href="http://well.blogs.nytimes.com/2011/08/31/prescribing-exercise-to-treat-depression">doing more exercise</a> and <a href="http://www.independent.co.uk/life-style/health-and-families/features/how-to-beat-depression-with-the-right-diet-1817675.html">eating better</a> – the contemporary version of pulling their socks up – will alleviate their symptoms. </p>
<p>The science shows people who eat well and exercise regularly have lower levels of depression. Good physical health is associated with good mental health.
Whether or not interventions that aim to improve diet or increase physical fitness are effective treatments for depression is, however, <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004366.pub6/abstract">less certain</a>. </p>
<p>The main problem with these prescriptions, as anyone who has been on a diet or joined a gym will know, is that filling them is hard. </p>
<p>It is always good to be fit and eat well, and doctors <a href="https://www.mja.com.au/journal/2013/199/6/depression-diet-and-exercise">should more often recommend</a> that these can help depression. But at this stage, while we work out how best exercise and diet can work as interventions, they should be seen as adjuncts to the more established treatments: pursue them, but in addition to psychotherapy, not instead of it.</p>
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<p><em>Christopher will be on hand for an Author Q&A between noon and 1pm AEDT on Friday, October 16, 2015. Post your questions in the comments section below.</em></p><img src="https://counter.theconversation.com/content/44976/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Davey receives funding from the National Health and Medical Research Council.</span></em></p>So you’re depressed. You know this because a health profession has told you so, or because there is no mistaking the symptoms. Perhaps you’ve been depressed before. What now?Christopher Davey, Consultant psychiatrist and head of mood disorders research at Orygen, The National Centre of Excellence in Youth Mental Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.