Group, Family and Couples Therapy for Depression Treatment

Group Therapy



As the name suggests, group therapy (including family and couples therapy) is a form of treatment involving a small group of individuals, generally between 4 and 12 in number, who meet regularly to talk, interact, and discuss problems with each other. Therapy groups are typically run by one or more group therapists who keep the group organized and on track therapeutically. Therapy groups can be highly structured in nature (with specific goals set for each meeting) or flexible (group members discuss whatever is important). Groups are often set up to address particular therapy agendas. For instance, a therapy group might address men's issues, or women's issues, or focus on anger management, social anxiety, or chronic illness support. Participants are typically invited into the group based on the degree to which they fit the profile of an ideal member (e.g., having issues that the group is designed to address; being the right gender, etc.) and how likely it is that they may be able to contribute to the group as a whole.

However they are structured, most therapy groups have some basic ground rules that are usually discussed during the first session. Individuals are usually asked not to share what goes on in therapy sessions with anyone outside of the group. This rule protects the confidentiality of the other members and encourages people to be open and honest in their comments. Group members may also be encouraged to avoid seeing other members socially outside of therapy because of the harmful effect it might have on the dynamics of the group.



The emphasis on the patient-therapist relationship in individual forms of therapy is, in group therapy, replaced with an emphasis on patient's relationships with other patients. Group therapists set agendas within the therapy setting, but they are most happy when they are able to get out of the way and allow group members speak to one another directly. Patients are often more receptive to feedback they get from peers than they are to feedback they get from therapists who are often perceived as authority figures.



In a group therapy session, members are encouraged to openly and honestly discuss the issues that brought them to therapy. They try to help other group members by offering their own suggestions, insights, and empathy regarding discussed problems. A well functioning therapy group offers its members a safe and secure place where they can discuss and work out problems and emotional issues. Participants gain insight into their thoughts and behavior by listening to peers who are struggling with similar issues, by offering support and feedback to peers, and by accepting the support and feedback of other members.



Group therapy is often an ideal therapeutic environment for people who are having interpersonal difficulties, including depression (and anger and social anxiety problems, etc.), as the therapy is inherently interpersonal in nature. Affected group members usually benefit from the social interactions that are a basic part of the group therapy experience.



Group therapy provides a sense of identity and social acceptance for some participants. It can be very comforting to realize that other depressed people have similar symptoms, emotional issues, and life stressors. Learning how others cope with depressive symptoms provides new strategies or ideas that people can try in their own lives. Group interactions can also offer people unique insight into their own behavior, and provide immediate feedback about the success of new skills. For instance, many people are not aware of their negative body language (tendency to slump, look down, sit with crossed hands and feet, etc.) or style of communication unless it is pointed out to them directly. Group members may also offer one another social support by providing each other with words of encouragement and empathy. Lastly, by helping others in the group work through their problems, members can gain a personal sense of self-esteem.



As is the case with individual therapy, group therapies may draw on different psychological theories. For example, a depressed person may participate in a cognitive behavioral group that uses the meetings as a workshop for teaching cognitive restructuring and similar exercises involved in monitoring and changing thoughts and behavior. Alternatively, a group might be run more dynamically in nature and focus on interpersonal relationships, both at home and within the group itself. Sometimes, group therapy is used as a way to transition people out of individual therapy. Groups can also be a cost effective way to continue therapy after insurance benefits run out (group therapy sessions usually cost substantially less than individual therapy sessions). Group therapy is probably not helpful as a sole therapy for severely depressed individuals (unless it occurs in the context of a larger therapeutic program). However, research suggests that cognitive behavioral group therapy can be very effective for people with mild to moderate depression.

Types of Depression Group Therapy



There are many different types of depression group therapy available. You can find groups that have a specific type of depression they deal with (like bipolar or seasonal depression), groups that are gender or age specific but are not defined by the type of depression, some that deal with depression in conjunction with other problems (like child abuse or substance abuse), groups that are religiously based are also helpful because they offer spiritual solutions as well as the group therapy. You can try out various groups until you find one where you feel you fit in or that offers you the type of therapy you are looking for.



Offerings of Depression Group Therapy



Depression group therapy offers you the benefits of bonding between members of the group which creates a good support system and it is always led by a mental health care professional. People who are slow to open up may find that they feel comfortable among people who share a similar illness and it can help improve the progress of their other treatments.



Most people who take on group therapy also have individual or family based therapy in addition to any drug treatment that may be necessary. Many mental health care professionals recommend depression group therapy in conjunction with individual therapy because it helps the depressed person adjust to dealing with other people and breaks the isolation for depression. This type of therapy works for people with various levels of depression, from mild to severe. The therapy may use any of a number of therapy types which include:



• Cognitive Behavioral Therapy (CBT) – focusing on the thoughts and behaviors that lead to depression and ways to change those thought and behavior patterns.



• Interpersonal Therapy (IPT) – focusing on other peoples’ roles in your depression. Your interactions with people in your life may affect the way you feel and your interpretation of those interactions can lead to depressive states.



• Psychodynamic Therapy (PDT) – focusing on trauma in your early life that may have led to the depression. This is an older form of depression talk therapy.



Suitability for Group Depression Therapy



Not everyone is a suitable candidate for depression group therapy. Group therapy is generally not advised for people in the middle of a stressful or traumatic life event. People who are suicidal, experiencing delusions, or suffering from other depression complications are not appropriate candidates for group therapy. Such people may be candidates for group therapy after receiving antidepressants or other treatment.



Some people find it too unsettling to talk about their problems in group therapy, or are too sensitive to criticism from other group members. Such people are better suited to individual types of psychotherapy. A good group, however, can have a very positive effect on depression treatment.



Also, recent studies shows gender related difference in terms of suitability for group depression therapy. For example, one of the researches suggests, that for depressed men seeking support for severe grief, group therapy may not be the best choice. A study of men and women in group therapy found that men did not benefit as much as women. “Men and women respond differently to the group therapy format,” Dr. Anthony S. Joyce of the University of Alberta in Edmonton told AMN Health.

Family and Couples Therapy



Couples therapy occurs when intimate relationship partners (married or otherwise) enter therapy together. Family therapy occurs when an entire family comes for therapy. Both of these forms of therapy tend to take a Family Systems approach to therapy. Therapists working from this approach treat the entire unit in front of them (e.g., the entire couple; the entire family) as the patient, and the individual members of these social groups are seen as components of that single patient. Though entry of couples and families into therapy may be motivated by problems that a single individual within the couple or family is having, the family systems therapist will tend to view the identified problem as a problem shared by all system members. In this way of doing therapy, a husband's depression is considered, at least in part, as a symptom of something going wrong with the relationship, and not simply something going wrong with the husband.

Family therapy and couples therapy sessions delve into the details of the interactions between partners, or family members as a core component of treatment. Both therapies examine the role of the depressed member in the overall psychological well-being of the family (or couple), as well as the role of the family (or couple) in creating depressive symptoms. Both family therapy and couples therapy aim to identify and then change destructive relationship patterns that may be contributing to the system's difficulties. For instance, if a family has been scapegoating one of it's members, and that member has become depressed, the therapist will call attention to this scapegoating behavior. If one spouse is enabling the other's abuse of alcohol, and both spouses are depressed, the therapist will call attention to this dysfunction too. Family and couples therapy can also uncover hidden issues and/or teach people new strategies for dealing with emotions and behavior.

Family and couples therapy isn't generally viewed as a good primary means of obtaining therapy for depressed individuals, but it can be an excellent adjunctive therapy strategy, as depressed individuals are both affected by and affect their relationship partners. Family or couples therapy is most useful when a person's depressive symptoms are: 1) seriously jeopardizing his or her marriage and family functioning, and/or 2) clearly being caused (or maintained) by dysfunctional marital and family interaction patterns. Patients with mood disorders have a very high rate of divorce. Many people (approximately 50%) report that they would not have married their spouse if they knew that he or she would develop a mood disorder. Family and couples therapy, therefore, can be a crucial and effective component of treating depression.





Sources and Additional Information:

http://www.gulfbend.org/poc/view_doc.php?type=doc&id=13029&cn=5

http://abcnews.go.com/Health/DepressionTreatment/story?id=4361100

http://www.survivingdepression.net/living/grouptherapy.html

http://patient-health-education.suite101.com/article.cfm/group_therapy_for_depression

http://www.health.am/ab/more/group_therapy_not_always_best_choice_for_men/

Therapeutic Gardening against Clinical Depression

Getting dirty might help lift our spirits, according to a new study which reveals that common soil bacteria could act like antidepressant drugs.



Mycobacterium vaccae, a harmless bacteria normally found in dirt, has been found to stimulate the immune system of mice and boost the production of serotonin, a mood-regulating brain chemical.

The bacterium has already been successfully used in people as a vaccine against tuberculosis. It is also being tested as a treatment for cancer patients and in asthma sufferers, as a way to control the allergic reaction and help 'rebalance' the immune system.



Now, studies on mice led by neuroscientist Christopher Lowry at the University of Bristol in England, suggests that the bacteria may have other applications as a treatment for mood disorders like depression.



"These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health. They also leave us wondering if we shouldn't all spend more time playing in the dirt," said Lowry.



Interest in the unusual antidepressant properties of M.vaccae arose by accident following an experimental treatment for human lung cancer led by cancer researcher Mary O'Brien at the Royal Marsden Hospital in London, England. Under that treatment, patients received heat-killed inoculations of the bacteria.



Following the tests, O'Brien's team observed not only fewer symptoms of cancer, but also improvements in their patients' vitality, emotional health and mental abilities.



Lowry and his colleagues speculated that the bacteria in these earlier experiments might have activated brain cells to release mood-lifting chemicals. To investigate the idea further, they injected heat-killed bacteria into a group of mice and found that they initiated an immune response, which activated serotonin-producing neurons in the brain.



Low levels of serotonin cause depression – an illness which afflicts around 1.3 million Australians. The most commonly prescribed antidepressant medications help treat depression by delaying the re-uptake of serotonin, thus raising levels in the brain.



According to Lowry, the strange effect of the bacteria may work by prompting the body's immune cells to release cytokines, chemicals known to activate sensory nerves that stimulate the brain. The findings are published in the journal Neuroscience.



"We believe that the brain then responds by activating serotonin neurons," he said. "These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health."



They also raise the question of whether exposure to common bacteria from a young age, could make us less vulnerable to disease. "We believe that prolonged exposure to [M.vaccae] from childhood could have a beneficial effect," said Lowry.

Further studies are required to confirm the effect in people and to see if other types of bacteria might have a similar effect, he said.



The study lends further support the 'hygiene hypothesis' whereby exposure to bacteria and pathogens from an early age helps balance the immune system. The idea is that some experience of disease early in life prevents our immune systems from attacking our own bodies - leading to allergies, asthma and other so-called auto-immune diseases.



Gardening benefits in combating depression are not limited exclusively to the bacteria related weaponry. Dr Cosmo Hallstrom, a psychiatrist in Chelsea and member of the Royal College of Psychiatrists, said gardening provides also a distraction therapy, vital in helping deal with depression.



"If I was seeing you in cognitive behavior therapy (CBT) I might say, 'Let's look at three things you enjoy doing,' and let's say you say one of them is gardening, I would then say, 'OK let's do one hour's gardening,' he said. "CBT is a modern form of psychological therapy dealing with the here and now as opposed to your past experiences looking at thinking and behavior and can include all manner of techniques.



"When you get depressed you stop doing things and get isolated which makes you more depressed. The theory is that if you do pleasurable things you will in time get better



"Gardening is a pleasurable activity and it focuses you away from thinking about your health problems.

"Why gardening and not running? Well I think at first it is a bit much doing things that are too physical. It is important to find something you enjoy."







Sources and Additional Information:

http://www.cosmosmagazine.com/news/1154/how-gardening-could-cure-depression

http://news.bbc.co.uk/2/hi/health/8027335.stm

http://www.epinions.com/content_3461390468

Indirect Suicide is still Suicide!

Suicide, perhaps the most obvious type of avoidable death at any age, is an intentional act that quickly results in death. However, there is a wide range of indirect suicidal behaviors in which death results gradually rather than immediately, and in which the degree of intentionality is less obvious than in an overt suicide attempt.



Defining Indirect Suicidal Behavior



Robert Kastenbaum and Brian Mishara, in their discussion of the concept of premature death and its relationship to self-injurious behavior, suggested that behaviors that shorten life are varied in form and widespread. They recognized that in one sense all human behavior affects a person's life expectancy. Some obvious examples of potentially life-shortening behavior include smoking cigarettes, taking risks when driving, and ignoring doctors' orders. On the other hand, life span can be prolonged by exercising regularly, eating well, using care when crossing the street, and driving an automobile in good condition equipped with air bags while always wearing a seat belt.



Indirect suicidal behavior is thus a matter of probabilities rather than certainties. Not taking one's heart medication or crossing the street carelessly will certainly increase the probability of a premature death. However, the timing of the occurrence of a subsequent heart attack is unknown; some people cross recklessly and live a long life, while others are hit by a car and die the first time they are not careful. Similarly, smoking cigarettes is clearly associated with a reduction in life expectancy, and most people know this, including smokers. However, as many smokers will point out, there is usually a case of a person someone knows who has smoked for decades and lived to old age.

Suicides are often deemed indirect where there is no immediate and clearly identifiable intentionality. The pioneer suicidologist Edwin Shneidman spoke of "subintentioned death" and "indirect suicide". He felt that orientations toward death, or "toward cessation," fall into four categories, which include intentioned, subintentioned, unintentioned, and contraintentioned. Suicide is by definition generally considered to be intentioned. Accidental deaths are unintentioned, and his category of "contraintention" includes people who feign death and threaten death. He specifies four groups of persons who have subintentional orientations.



First, there is the "death-chancer" who gambles with death by doing things that leave death "up to chance." Suicidal behavior in which there appears to be a calculated expectation for intervention and rescue are examples of this form of sub-intentional suicidal behavior.



The "death-hasteners" are individuals who unconsciously aggravate a physiological disequilibrium to hasten death. Death-hasteners may engage in a dangerous lifestyle, such as abusing the body, using alcohol or drugs, exposing themselves to the elements, or not eating a proper diet.



The "death-capitulators," by virtue of some strong emotion, play a psychological role in hastening their own demise. These people give in to death or "scare themselves to death." Shneidman includes in this category voodoo deaths and other deaths in which psychosomatic illness and higher risk of complications (e.g., high blood pressure and anxiety) increase the probability of an early death.



Shneidman's fourth and final category is the "death-experimenter," who does not wish consciously to end his or her life but who appears to wish for a chronically altered or "befogged" state of existence. This includes alcoholics and barbiturate addicts.

Interpretations by Freud and His Followers



Although Freud did not discuss indirect suicide, he developed the concept of the death instinct later in his life. It was his student Karl Menninger who elaborated on the concept of a death instinct, Thanatos, which he viewed as being in constant conflict with the opposing force of the life instinct, or Eros. According to Menninger, there is an inherent tendency toward self-destruction that may, when not sufficiently counterbalanced by the life instincts, result in both direct and indirect self-destructive behavior.



Norman Farberow expanded upon Menninger's theory and developed a classification system for what he called "indirect self-destructive behavior." Farberow felt that direct and indirect self-destructive behaviors differ in many ways. The impact of indirect self-destructive behaviors is most often long-term and frequently permanent, so that only the results are clearly apparent. Unlike direct suicidal behavior, indirect self-destructive behavior is not linked to a specific precipitating stress; hence this behavior is not sudden or impulsive. Unlike completed suicides and suicide attempts, indirect self-destructive behavior does not entail a threat to end one's own life; nor does it involve clear messages that indicate a death wish. Indirect self-destructive people are generally self-concerned and unable to invest much of themselves in a relationship with significant others. They are often alone and have limited social support systems. In contrast, the suicide attempts of the direct self-destructive are often related to the loss of a significant other.



Studies of Other Species



Humans are the only species who engage in intentional self-destructive behavior. Philosophers generally limit the possibility of voluntary and intentional self-destruction to the human race. Nevertheless, self-initiated behaviors that result in harm and death do occur in other species. These behaviors, while obviously self-destructive, do not have the characteristic of conscious decision-making that is unique to humans. Nevertheless, they may ultimately result in injury or death. Researcher Jacqueline Crawley and her colleagues present a review of ethological observations of self-sacrificing deaths in some animal species—usually in defense of territory.

Parental behavior may be at the core of many altruistic behaviors, with parents in many species performing some forms of self-sacrifice for the survival of their offspring.



When environmental conditions become stressful for animals, such as for those confined in zoos, self-mutilation and refusal to eat may result. Similarly, pets that are boarded at a kennel or have lost masters to whom they were very much attached may refuse to eat or may mutilate themselves. Crawley speculates that similar dynamics may explain the increased incidence of self-destructive behavior in humans who are imprisoned. More humane care in institutional settings can result in an elimination of self-destructive behaviors in animals. Crawley speculates that greater nurturing and caring behavior may similarly reverse many of the stress-related, self-injurious behaviors in humans.



Research Studies



Indirect suicidal behavior has been studied in several populations. For example, researchers Carol Garrison and colleagues conducted a survey of a community sample of 3,283 American youths in the range of twelve to fourteen years of age. They determined that 2.46 percent of males and 2.79 percent of females engaged in "non-suicidal physically self-damaging acts". Those who engaged in these behaviors had more suicidal ideation, were more likely to have been suffering from a major depression, and had more frequently experienced recent misfortunes.



The researcher Yeates Conwell and his collaborators found that although suicide is rare in nursing homes, indirect self-destructive behaviors, such as refusing to eat or not taking life-sustaining medications, are commonplace. Reviews by McIntosh, Hubbard, and Lester suggest that more elderly persons may die from indirect suicide than from direct suicidal behavior.



Larry Gernsbacher, in his book The Suicide Syndrome, speaks of individuals who engage in what he calls "a suicidal lifestyle." He includes in this category alcoholics and drug addicts. These behaviors are considered to be expressions of unconscious suicidal motivations. Gernsbacher asks, "What better way for him to express his self-hatred than to destroy himself with alcohol? How could he more effectively express his vindictiveness than to inflict on those about him the consequences of his addiction? What better way to express his hopelessness than to drown his life in drink?"



In The Many Faces of Suicide: Indirect Self-Destructive Behavior, Farberow presents chapters by different authors on a wide variety of indirect suicidal behavior. The contributors discuss physical illnesses "used against the self," including self-destructive behavior in diabetics, "uncooperative" patients, self-destructive behavior in hemodialysis patients, spinal cord injury, and coronary artery illness. Several chapters are concerned with drug and alcohol abuse and their relationship to indirect self-destructive dynamics. Hyper-obesity and cigarette smoking are also analyzed as possible ways of increasing the probability of a shortened life. Similarly, gambling, criminal activities, and deviance are judged forms of indirect suicides. Criminals and delinquents often put themselves in situations where there is a high risk of a premature death. Finally, a variety of stress-seeking and high-risk sports activities draw on unconscious or sub-conscious motivations to risk death or to test one's ability to master death.



Conclusions



It may be that direct intentional acts that result in death (i.e., completed suicides) constitute only a small proportion of the various human behaviors that result in premature death. Perhaps these behaviors are, as Freud and Menninger hypothesized, the result of an intrinsic human proclivity to self-destruction that is locked in constant combat with an inherent motivation to preserve life at all costs. Perhaps indirect suicidal behavior is simply part of one's cultural baggage, with different societies encouraging or condoning certain forms of risky and dangerous activities, such as engaging in high-risk sports or having unprotected sex with a high-risk partner. Perhaps, as several research studies indicate, indirect suicidal behavior may be linked to treatable depression, stressful life events, and more obviously identifiable suicidal thoughts and intentions.



It is clear that indirect suicidal behaviors can decrease when the surrounding environment improves; for example, offering patients better treatment in a nursing home. Research in the twenty-first century indicates that it is important to be aware of indirect suicidal behavior and to understand it as a signal of treatable problems. Such vigilance cannot only improve lives, it can save them as well.



Source: http://www.deathreference.com/Sh-Sy/Suicide-Types.html

Historical retrospectives of depressive disorder

Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time.

Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.

In the 1950s and 60s, depression was divided into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job.

The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) classification, and has become widely used since. The general term depression is often used to describe the disorder, but as it can also be used to describe other types of psychological depression, more precise terminology is preferred for the disorder in clinical and research use. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of people who commit suicide have depression or another mood disorder.

Major Depressive Disorder

In the 1970s and 80s, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive disorder? Although there is some argument even today (as in all branches of medicines), most experts agree that:

1. A depressive disorder is a syndrome (group of symptoms) that reflects a sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional disabilities than is normal.


2. Depressive signs and symptoms are characterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The functional changes of clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain cause many physical symptoms that result in diminished activity and participation.


3. Certain people with depressive disorder, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.


4. Depressive disorders are a huge public-health problem, due to its affecting millions of people.

·         The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism.

·         In a major medical study, depression caused significant problems in the functioning of those affected more often than did arthritis, hypertension, chronic lung disease, and diabetes, and in two categories of problems, as often as coronary artery disease.

·         Depression can increase the risks for developing coronary artery disease, HIV, asthma, and some other medical illnesses. Furthermore, it can increase the morbidity (illness/negative health effects) and mortality (death) from these conditions.

5. Depression is usually first identified in a primary-care setting, not in a mental health practitioner's office. Moreover, it often assumes various disguises, which causes depression to be frequently under-diagnosed.


6. In spite of clear research evidence and clinical guidelines regarding therapy, depression is often undertreated. Hopefully, this situation can change for the better.

Major Depressive Disorder

Sources and Additional Information:

http://www.medicinenet.com/

http://en.wikipedia.org/wiki/Major_depressive_disorder