Saturday, April 19, 2008

Therapy - What Works?

As you might know, I am not fond of therapy. I have blogged about it. Also my cousin has seen some scary things. So I have my reservations concerning therapy.

Ever since my father's death I have had difficulty with anxiety, and depression. Well, the anxiety is nothing new, but the depression is circumstantial. It's been years since his death, and I'm not snapping out of it. My last bout with depression was very difficult. Possibly sever depression. I'm doing fairly good now, comparatively speaking. But I'm aware that I can plummet into depression soon again. In fact I might be going through something difficult soon, that might trigger the depression. I'm starting to think that I might need some therapy to snap me out of this cycle, even though I'm not crazy about the idea.

I want something effective. So do you know which therapy works? I'm sure that there have been some studies somewhere on it. And what medications work? I don't want to end up a gunny pig. Maybe I should avoid meds? So if you have some legitimate stats, or are a therapist, I would appreciate hearing from you. Please back up what your comment with evidence. Personal testimonies are good too. Thanks!

P.S. I don't know much about physiology, and don't know the terminology, so please keep this in mind when replying.


Anonymous said...

The very best therapy for low mood starts with good assessment - sometimes it's important to check there are no physical components to your low mood such as low iron, thyroid or absorption problem.
Then for every person there is a combination of perhaps antidepressants (I've tried a lot, and have been on them now for 18 years, currently on effexor (venlafaxine)); and definitely some sort of psychotherapy. The psychotherapy that has the most support in the scientific literature is cognitive behaviour therapy, but ACT or acceptance and commitment therapy is also gaining recognition and getting sustainable results.
I've had CBT and ACT, both helped but in different ways.

Health Psych said...

Firstly, I think Health Skills has made a very important point. Good assessment is key. If someone doesn't take time getting a detailed history and doesn't make sure the medical things Healthskills have ruled out, it's not a good thing.

Again, as HealthSkills says, there is a lot of support for CBT in the literature. If you want me to provide you with some research articles on effectiveness that you can read yourself, please let me know.

I favour CBT myself. The thing I like CBT is that is usually short term and gives the patient skills to take away and use for themselves. However, having said that, usually no one therapy fits any situation perfectly and I usually draw in elements from other methodologies, including psychodyamic and gestalt therapy where appropriate. Therapy isn't a 'one size fits all' and it's important to find the right fit for the person and be flexible in your approach.

Medications? Most people I see prefer to avoid them and I respect that but there are times when medications are necessary to provide some initial symptom relief to at least allow the person to begin with the work of therapy (and it is work). As psychologists don't prescribe medication, I prefer to work in conjunction with the patient's primary caregiver in this respect or a good psychiatrist, again taking into account my patient's preferences.

From a patient's point of view, it is important to find someone who you feel comfortable with and with whom you have a level of trust. If you see someone and it just doesn't feel right or comfortable, it absolutely is the right thing to try someone else. A good therapeutic relationship is key.

On a personal basis, I have seen a psychologist a long time ago. I wasn't depressed/anxious and so medication wasn't an issue. I was having problems with guilt following the death of my father and with my ongoing relationship with my mother. He used more of a psychodynamic therapy. It helped me get my head around some issues. I found it a little bit of a rollercoaster ride in that sometimes I'd come away feeling good, other times not so, dependent on what came up. What I'm trying to say is that there isn't any magical, immediate fix.
Therapy takes work and commitment.

I also had CBT with an occupational health therapist for chronic illness related issues (before becoming a psychologist), I found that extremely useful and I learnt skills that I still use today.

It sounds like you have been exposed to some less than positive experiences. Please don't let that put you off seeking help if you need it.

Sorry for rambling on.

LadyBanana said...

In the past I have been through some sessions of "therapy" but found it counter productive.. maybe I was just in the wrong place.

I am currently on Citalopram and have been, mostly for severe PMS which pushed me in and out of depressions and awful mood swings for years.

It has helped, but I still have breakthrough bad times...

Sorry this isn't much help to you!

Awake In Rochester said...

Hi healthskills,

Thanks for the heads up on the physical components. I don't have health insurance. When I called the clinic concerning depression, I was told that they didn't offer that kind of help. I suppose I could call again with a check list like you mentioned. It sounds like the doctor doesn't know about this. I wounder if hormone imbalance could affect me?

I have heard of cognitive behavior therapy, but don't know much about it. I never heard of ACT. I guess I need to become familiar with the basics. I did take 2 yrs of psychology in H.S., but things have changed a great deal since. It as if I never took a psych class.

Awake In Rochester said...

Hi Health Psych,

Sure I would appreciate any literature on CBT or anything else you have. I guess I should get a 101 book on depression/anxiety. I don't even know some of the term you have used.

Awake In Rochester said...

My dear LadyBanana,

Thank you for telling me of your personal experience. Sometimes I feel all alone in this. I try to explain a few things to my relatives, but they don't get it.

I'm sorry that you have had problems, and especially that you have found therapy to be counter productive. Although I can see how that can happen. As shown in my post "Therapy and Me."

I wounder if hormones have play a part in it? My hormones are often out of balance. In fact I am suppose to be on meds to help balance them, but can't afford it. Maybe this has something to do with my depression (and anxiety)? I'm glad you spoke up. Thanks!

LadyBanana said...

I'd definitely say it has a lot to do with hormones.

Sorting out the hormones is not an easy task, so I think my Dr took the easy option of the SSRI's, which I'm fairly happy with.

The only major problem is that it kills sexual desire!

Awake In Rochester said...

Hi LadyBanana,

I'm not sure what SSRI's are. I suppose a drug classification. It kills sexual desire? Oh, that doesn't sound good. Maybe you can look into taking something else? It's unfortunate that meds come with side effects.

Health Psych said...

Sorry for the jargon :) Will send you some stuff.

Awake In Rochester said...

Thanks Health Psych!

I appreciate the information. I have to get going on this before I chicken out.

Dr. A said...

I agree with what has already been said. In my experience, if the right therapist is found - meaning someone you really connect with and trust - I've found (in some cases) that this works out better than any meds.

That being said, the best results I've seen is a combination of effective therapy in addition to medications. Good luck!

Awake In Rochester said...

Hi Dr. A,

Thank you for confirming that. I'm a bit afraid of the drugs. It seems like a trial, and error thing.