Talking Therapies to treat Mood Disorders by J.E.

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Psychotherapy involves “talking therapy” where the patient sees a therapist. There are several types of psychotherapy in which you will talk with a professional person e.g., a psychologist, psychiatrist, or mental health care worker. It can be used to treat mood disorders and other problems. The person carrying out the treatment is usually called a therapist. Therapy can be individual or in groups. In group psychotherapy, the individuals in the group have similar problems. It is useful to know you are not alone and you may get help from group members or be able to offer help to members. The group is usually supervised by a psychotherapist. There are some useful online therapy sites your GP may guide you to.

Therapists use scientific based procedures that aid the patient to develop healthier and more effective habits. The aim is for the patient to understand their feelings and what is making them depressed, anxious, or stressed. It helps the patient feel more positive and allows them to cope better with situations using techniques learned from their therapist.

COGNITIVE BEHAVIOURAL THERAPY(CBT)

CBT is a talking therapy that helps you manage your problems by changing the way you think and behave. It may take from 6 weeks to up to 6 months or longer and is most commonly used to treat depression and anxiety. A key part of change is the client testing out their beliefs and experimenting with different behaviours.

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CBT recognises the fact that thoughts, feelings, physical sensations, and actions are interconnected. Negative thoughts and feelings can result in you getting trapped in a vicious cycle of events.

CBT is a way of talking about:

1. How you think about yourself, the world, and other people.

2. How what you do affects your thoughts and feelings

CBT aims to help you cope with problems in a more positive way. You will be guided through how to change negative patterns of thought. CBT focuses on the “here and now” and not necessarily issues from the past. It looks for practical ways to improve your state of mind on a daily basis. In CBT, problems are broken down into 5 main areas:

  1. Situations
  2. Thoughts
  3. Emotions
  4. Physical feelings
  5. Actions

These features can all interact and what happens in one can affect all the others. CBT can help break vicious cycles of altered thinking, feelings, and behaviour. It is not a “quick fix”. The therapist advises and encourages you; but cannot “do” it for you. It isn’t for everyone. It can work for some forms of depression and anxiety as well as antidepressants. Severe depression may require antidepressants alongside CBT. After working out what you can change in your life, your therapist will ask you to practice these changes and discuss how you are getting on in your next session. The final aim is that you can manage your problems using the CBT techniques you have learnt during your treatments. This should help you manage your problems and prevent them having a negative influence on your life.

INTERPERSONAL PSYCHOTHERAPY (IPT)

This is mainly used to treat depression and is a brief (12-16 weeks) form of psychotherapy that uses a structured model to treat mental health issues. It is designed to help current concerns and is aimed to help you understand how your problems, or a solution to them, may be connected to the way your relationships work. How to strengthen these relationships will probably be discussed with the aim of being able to find better ways of coping.

Interpersonal psychotherapy is a brief, attachment-focused psychotherapy that centres on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks.

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COUNSELLING

This is often provided at your GP’s surgery. The aim is to support, empathise and understand the client’s difficulties and/or distress. It is usually a fairly short period of sessions and helps you be clearer about your problems, especially recent events you have found difficult. By being clearer about your problem, you may come up with your own answers to that problem. Counselling does not aim to change you as a person.

PSYCHODYNAMIC PSYCHOTHERAPY

This type of therapy seeks to understand current distress in terms of inner conflicts that are the legacy of past experiences, often from childhood.

This is an approach that emphasises the study of human behaviour, feelings, and emotions, and how they may be related to early life experiences. Meetings explore the patient’s feelings and emotions and often last up to an hour. They are usually weekly sessions and can last for months if the problems are complicated. Internal defence mechanisms can develop to protect an individual from painful experiences, and these may be unconscious. Over time these defence mechanisms can cause difficulties and maintain inner conflicts. Therapy seeks to identify and resolve conflicts through the relationship with the therapist.

It gives you a regular time to talk about your feelings with the therapist. This can include:

1. What is happening in your life at the moment - the part you play in things going right or wrong for you.

2. What has happened in the past

3. How the past may be making you feel think and behave currently.

Connections between the past and present are discussed with your therapist. Your therapist may comment on how some of your thoughts and feelings are not driven by conscious thoughts and feelings, but from feelings from your past. The aim is for you to understand why you feel as you feel currently and what you want or need now, not what past experiences are driving you to do.

DIALECTIC BEHAVIOUR THERAPY (DBT)

A full course of DBT is a combination of intensive 1-2-1 support from a therapist and group-based skills. The skills, such as “affect regulation” are intended to equip clients with ways of managing difficult experiences in their daily life, such as self-soothing and mindful awareness. It involves regular sessions of therapy over a 12-18 month period and aims to help patients with complex emotional issues. It can help depression, although it is mostly aimed at helping people with borderline personality disorders.

COGNITIVE ANALYTICAL THERAPY (CAT)

The main focus of CAT is identifying relational patterns that can lead to recurring traps, snags or dilemmas in daily life. The relationship with the therapist is one way in which these patterns are identified. The client and therapist explore ways in which the client can un-snag by relating differently to others.

This involves talking to a therapist for about 16 sessions, so is fairly short. The therapist helps you:

1. To describe your problems and how they have developed from current life events and past life experiences.

2. To look at coping strategies that you have been using to deal with these problems

3. To think of ways of changing your coping strategies so that you can feel better and cope more easily.

The therapist records these details in writing and at the end of the treatment, you may be given a letter summarising your difficulties and the ways you have worked out how to cope with them.

EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR)

EMDR is specifically used to treat post-traumatic stress disorder (PTSD) and is carried out by a specially trained therapist. EMDR is increasingly available in the NHS as a treatment for trauma and PTSD.

A full history must be taken and then the therapist will develop a treatment plan that defines the targets on which to base the EMDR . These targets include events from the past and present situations that are causing distress.

A relationship of trust between the therapist and patient is essential. The therapist identifies the targets to be processed and eye movements are used during desensitization. The therapist leads the patient in a set of eye movements. Eye movements are used to create bilateral stimulation in the brain while the client re-processes distressing memories and images. The patient focusses on the disturbing emotions measured on a scale of 1 to 10. Following the eye movements, the aim is the variations and changes of focus occur until the levels are reduced to a 0, 1 or 2. The goal is to install and increase the strength of the positive belief that replaces the original negative belief. An EMDR session isn’t considered complete until the patient can bring up the original target image without any body tension. It is very important to note that EMDR can make the patient feel psychologically worse before they feel better. Careful selection of the patient to receive the treatment is therefore essential.

WHERE DO I GET TALKING THERAPY FROM?

Your GP may have mental health workers and counsellors working in their surgeries or may direct you to self-help material from books or online sources.

Books may inform cognitive therapy; but it is not a therapy on their own. Cognitive Behavioural Therapy can be carried out by oneself using self-help books.

You may be referred to a community mental health team, a specialist psychotherapy service, or a consultant psychiatrist in psychotherapy.

You may be able to refer yourself to part of your local mental health services provided by a local NHS trust.

Private therapists – it is vital that any private psychologist or psychotherapist is properly qualified. You may be able to see one quicker than on the NHS and your GP may be able to recommend such a qualified therapist. To be properly qualified, the therapist must have a degree in psychology. To practice as an adult psychotherapist, you'll need to undertake appropriate recognised training. You'll usually need an undergraduate degree in a relevant subject and/or be a qualified and experienced healthcare practitioner, such as a psychiatrist, psychologist, mental health nurse or social worker.