Psychotherapy – Evidence-Based Treatments for Major Depression

Brindusa Vanta, MD, DHMHS
Medical editor

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It's crucial to seek help when dealing with depression, a serious mental health condition that extends beyond mere sadness. Early intervention can help increase the success of outcomes, so seeking assistance sooner rather than later is better.


Therapy serves as a fundamental part of this process, offering a structured and supportive environment to address the root causes of depression. Through therapy, individuals learn coping strategies and gain insights that pave the way for recovery and improved mental well-being.

What Is Psychotherapy?

Psychotherapy is a talk therapy that involves people working with trained professional therapists to discuss their problems and learn new skills. Psychotherapy can help depressed individuals talk about experiences while:

  • Feeling listened to
  • Gaining insight into (and often some measure of control over) thinking processes 
  • Exploring the contribution of past experiences to present-day distress
  • Learning practical coping skills that can help decrease the likelihood of developing future depressive episodes

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Psychotherapists may be psychologists, social workers, trained nurses, psychiatrists, counselors, psychoanalysts, or even professionals from other disciplines. Each profession brings something different to the psychotherapy table. 

Psychiatrists who offer psychotherapy are able to prescribe medication, unlike most other professional therapists. Therapists often align themselves with doctors who can prescribe for patients when that is necessary. 

Psychologists have special training in mental health assessment as well as psychotherapy. Social workers can also offer mental health assessments (although not as broadly or comprehensively as psychologists) and talk therapy, as well as link people to community and institutional resources.

Psychotherapy isn't a unified field. Accordingly, psychotherapists may employ any of a number of approaches and techniques. The major schools of thought that dominate current psychotherapy thinking include psychodynamic, cognitive-behavioral, family systems, and humanistic schools. Each has a unique perspective on what causes people to experience mental illnesses and how best to address those problems. 

However, all types of psychotherapy aim to teach individuals about their depression, help individuals understand, express, and control their feelings more effectively, and transform negative thoughts, attitudes, behaviors, and relationships for the better.

What Are Evidence-Based Treatments?

Historically, psychotherapy was not an evidence-driven field. Therapists trained in a particular school or approach to mental health and learned from practical experience what worked and what didn't. With the exception of behavioral approaches, which are founded on scientific principles, most older forms of psychotherapy have not been subjected to rigorous scientific tests to see how well they work.

Thankfully, a growing interest in the development of evidence-based therapies (EBTs) has developed in the last 25 years or so. EBTs are standardized psychotherapy treatments subjected to scientific clinical studies that have shown substantial evidence of efficacy. 

Efficacy refers to how well an intervention helps people recover during a clinical study. It's not the same thing as effectiveness, which refers to how well a therapy works under real-world conditions. 

Unfortunately, true effectiveness is much harder to study than efficacy. Though they are not perfect therapies by any means, modern evidenced-based therapies are typically the best therapy options professionals currently have to offer. If you're depressed and have the opportunity to receive an evidence-based form of psychotherapy that has been specifically designed to help you overcome your depression, you may feel comfortable deciding to participate in that therapy.

Psychotherapies that fit the definition of evidence-based must:

  • Have a specified focus (e.g., they target depression)
  • Be intended for a defined treatment population (e.g., African American women between the ages of 20 and 50)
  • Follow a well-defined treatment protocol

Typically, clinicians follow a treatment manual, which specifies the number of sessions to be offered, what to talk about and teach during those sessions, and what techniques are to be employed during those sessions.

Evidence-based therapies are highly structured for a reason: They aim to teach specific skills to specific clients who will benefit from them.  Clients generally appreciate the no-nonsense approach to treatment involved with many EBTs, but some benefit from a more traditional open-ended and free-form mode of therapy. It's also an option to follow a more structured EBT therapy with more traditional supportive psychotherapy or to participate in both EBT and supportive forms of therapy at the same time if these options prove helpful or useful to patients.

EBTs are increasingly becoming a gold standard for mental health care for a few different reasons. Healthcare companies like EBTs because they have scientific data that support their use and are short-term in nature. Health insurance and managed care companies are interested in having clinicians be able to justify the number of treatment sessions necessary to treat particular disorders, and EBTs offer a science-based way to do that. Many clients like the shortness and focus of EBTs as well.

Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are two EBT psychotherapies that have documented success in treating groups of people with depression in clinical trials. 

Dr. Brindusa Vanta, MD, says, "While both cognitive behavioral therapy and interpersonal therapy show effectiveness in managing symptoms of depression, some research found that cognitive behavioral therapy may be particularly effective in treating some cases of major depressive disorder."

As with medication therapy, not all people with depression will be helped by evidence-based therapies. Dr. Brindusa Vanta, MD, says, "Some research found that IPT and CBT  work as well as antidepressants in the first stage of depression, with up to 60% of individuals responding to these therapies." 

Understanding the Therapy Journey

Engaging in therapy often involves a structured and transformative journey. Here's what you can typically expect:

  • Initial assessment: The first few sessions are often dedicated to understanding your background, symptoms, and goals. This phase is crucial for tailoring therapy to your specific needs.
  • Setting objectives: Together with your therapist, you'll identify key areas of focus and set achievable objectives.
  • Regular sessions: Therapy usually involves weekly sessions, each lasting about 45-60 minutes. During these sessions, you'll work through various strategies and exercises tailored to your objectives.
  • Progress evaluation: Periodically, your therapist will review your progress and adjust the approach if necessary.
  • Duration: The total duration of therapy can vary. EBTs like CBT or IPT typically range from 12-20 sessions, but this can be shorter or longer depending on your progress and needs.

Integrating Complementary Therapies

In addition to traditional psychotherapy and medication, incorporating adjunctive or complementary therapies can play a significant role in the holistic treatment of depression. These therapies are not stand-alone treatments and aren't approved by health authorities to treat depression, but they can be used alongside standard treatments to enhance emotional well-being.

  • Art therapy: This form of therapy uses the creative process of art-making to improve mental health and emotional well-being. It can help individuals express themselves non-verbally, explore emotions, and reduce anxiety, which can be particularly beneficial for those who find it difficult to articulate their feelings.
  • Music therapy: This therapeutic approach involves using music to address physical, emotional, cognitive, and social needs. It can include activities like listening to music, singing, and playing instruments. Music therapy has been found to reduce symptoms of depression, alleviate stress, and improve mood.
  • Animal-assisted therapy (AAT): Involving animals like dogs, horses, or even dolphins, AAT can significantly boost mood, reduce feelings of loneliness and isolation, and provide comfort. The presence of an animal during therapy sessions can create a sense of calm, encourage positive social interactions, and enhance the therapeutic experience.

Each of these complementary therapies can be tailored to individual needs and preferences, offering a diverse range of options for those seeking a more comprehensive approach to managing depression. It's important to consult with a healthcare professional to determine the most appropriate combination of treatments for your specific situation.

Additional Resources

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