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Depression
Is Group Therapy an Antidote for Antidepressants?
Group Treatment Is Good Medicine For Depression
Posted June 23, 2015
Although there are many effective forms of psychotherapy and anti-depressant medications for depression, nearly eighty percent of those who have recovered eventually relapse without ongoing treatment. According to the World Health Organization this fact contributes to making depression one of the leading causes of disability worldwide.
Research published in the medical journal, The Lancet, in April 2015, examined the effectiveness of group treatment as a primary intervention compared to antidepressant medicine. The study found that Mindfulness-Based Cognitive Therapy (MBCT), a blend of an ancient Buddhist meditation practice and cognitive behavioral therapy (CBT), works just as well as medication at preventing depression relapse.
Many of the 350 million people affected rely on antidepressant medication as part of their ongoing treatment regimen. Although medicine is effective only about two thirds of the time—it remains the typical go-to choice for maintenance. The main difficulties with the medicines when they do work, is that they have side effects such as nausea, vomiting, insomnia, sleepiness, increased anxiety, weight gain, diarrhea, lack of libido, headaches, or weight loss. These and other side effects are the main reason people stop taking the medicine—and consequently, the main reason for relapse.
MBCT was developed to help people initiate a constructive response from an awareness of their depressive thoughts and feelings. The goal is to recognize, respond, and reverse a potential downward spiral of depression.
The research studied 424 adults whose relapse prevention for depression was maintained through the use of antidepressant drugs. Half were randomly assigned to gradually come off medication and receive MBCT through eight group therapy sessions along with daily homework assignments. They were also given the option to have four follow-up sessions throughout the year. The other half stayed on their medication as prescribed. Two years later the relapse rated for both groups were essentially the same: 44 percent of the MBCT relapsed compared to 47 percent of those who continued to take their medication.
In the first large-scale study of its kind, Willem Kuyken, lead author and Professor of Clinical Psychology at the University of Oxford in the UK, said: "Whilst this study doesn't show that mindfulness-based cognitive therapy works any better than maintenance antidepressant medication in reducing the rate of relapse in depression, we believe these results suggest a new choice for the millions of people with recurrent depression on repeat prescriptions. "
This is all very good news—and there’s more—positive group psychotherapy (PPT) is also quite effective in treating depression and preventing relapse. Traditional psychotherapy focuses on helping clients through symptom reduction. This means that when the indicators for therapy fade away the therapy is considered successful. But, as the above research indicates, there is a very new perspective emerging as to what group psychotherapy can offer. PPT is a strengths-based approach that is directly aimed at offering a more comprehensive perspective of a client and their life circumstances. It is becoming known as an evidence-based standpoint that explores both strengths and weaknesses to achieve greater well-being and functioning.
Consider one of the studies in positive psychotherapy conducted in a group therapy format. Forty mild to moderately depressed University of Pennsylvania students were divided into a treatment and a non-treatment group. The treatment condition consisted of two groups of 8-11 participants seen for 6 weeks for 2 hour sessions. The session was half a discussion of the exercise assigned from the previous week, and an introduction to the new exercise. The participants carried out homework assignments and reported back each week on their progress. The first week participants were asked to take the VIA-IS survey and use their top five strengths more often in their day-to-day lives. Week two involved writing down three good things that have happened during the day and why you think they occurred. The third week participants were asked to write a brief essay on what they want to be remembered for the most: A biography or obituary, if you will, of having lived a satisfying life. The next session involved composing a letter of gratitude to someone they may never have thanked adequately and reading that letter to them in person or by phone.
During the fifth session the members were asked to respond very positively and enthusiastically each day to good news received by someone else. The final session involved savoring daily events in our life that we normally do not take the time to enjoy, and journaling how this experience differed from our normally rushed occurrence. Time was also spent during this last session on tailoring the exercises for their use following the end of the study.
As you might expect the group PPT participants did better than the no-treatment group on assessments of depression and satisfaction with life. But there is a powerful finding beyond this positive change. The gains made by the PPT groups were maintained with no other intervention by the researchers throughout a one-year follow-up, while the baseline levels of depression for the non-treatment group remained unchanged.
Six sessions and twelve hours: With no booster sessions during the year. This is very unusual in the study of depression and highlights how the use of these exercises involved self-maintaining features that served the participants beyond the intervention.
While MBCT and PPT have their own protocols for alleviation the research seems clear: Group treatment can be a viable way to treat depression and prevent relapse.
Further reading:
Duckworth, A. L., Steen, T. A., & Seligman, M. E. P. (2005). Positive psychology inclinical practice. Annual Review of Clinical Psychology, 1, 629–651
Kuyken, W., Et al.,Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. The Lancet, April 2015 DOI: 10.1016/S0140-6736(14)62222-4
Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbookof classification. New York: Oxford University Press.
Rashid, T., & Ostermann, R. F. (2009). Strength-based assessment in clinical practice.Journal of Clinical Psychology, 65, 488–498.
Seligman MEP, Rashid T, Parks AC. Positive psychotherapy. American Psychologist.2006;61:774–788.
Note: Sections of this blog appeared in two previously published versions by the author at:
http://depression.answers.com/treatments/meditation-or-medication-a-new…
http://psychcentral.com/blog/archives/2013/01/27/moving-from-whats-wron…
