Psychotherapy

The two main parts of major depressive disorder (MDD) treatment are antidepressant drugs and talk therapy (psychotherapy). Some people may benefit from just 1 or the other. But research suggests that the strongest treatment plans include both.¹

The exact type of psychotherapy and who provides it varies. You and your doctor will work together to figure out the best plan for you. Some therapy options can be given in person or virtually through telemedicine. Certain forms are done 1-on-1 with a therapist, while others may be done with loved ones or in a group setting.¹

Some forms of psychotherapy that may benefit people with MDD are described below.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is one of the most common types of psychotherapy given to people with MDD. CBT involves identifying problematic ways of thinking that cause distress. With a therapist, a person learns how to recognize, challenge, and reframe these thoughts. Many of these thought processes have been learned over years of experience.^2-4

Readjusting learned ways of thinking can be hard. But this approach can lead to better:^2,3

• Coping skills
• Communication skills
• Problem-solving abilities
• Confidence
• Understanding of the way you and others think

CBT may also focus on calming the mind and body. It may involve facing fears or planning what to do in uncomfortable or stressful situations with others. There is usually homework to do outside of sessions. These activities are meant to help you identify and challenge patterns of thinking in your daily life.²

CBT is also used to treat anxiety, PTSD, eating disorders, and substance use disorder. CBT can be a good option for kids and teens.^3,5

CBT is given by a trained mental health counselor, psychologist, or psychiatrist. You and your therapist will decide on the number of sessions, how often they occur, and how long they last. Typically, CBT is held once a week and lasts for 3 to 6 months.^2,3

Interpersonal therapy (IPT)

Interpersonal therapy (IPT) focuses on the relationships you have with others. The idea behind IPT is that current relationship struggles have an impact on your mood. The main goal of IPT is to create stronger communication skills and notice conflicts that are causing stress. This can help improve relationships, increase social support, and reduce tension.^6,7

IPT also focuses on other big life changes that can impact personal relationships. These changes may include getting a new job, losing a job, losing a loved one, or having a child. IPT may also be helpful in treating other conditions including anxiety, certain eating disorders, chronic fatigue, and bipolar disorder. IPT is commonly used in teenagers, too.^5-7

IPT is often done 1-on-1. However, depending on what relationships you are focusing on, couples or family therapy may be good options. These types of therapy involve you and your loved ones. They aim to find ways you can work together as a team and better understand each other’s needs.⁸

Behavioral therapy

When a person has MDD, they often experience anhedonia. Anhedonia refers to not feeling pleasure around things that used to bring them joy. In addition, low mood or low energy can make people want to withdraw from certain activities and hobbies. This can all lead to worsening symptoms of depression.⁹

Behavioral therapy (also called behavioral activation) focuses on encouraging a person to participate in things that bring them positive emotions. The idea is that encouraging someone to engage in these activities, even when they do not want to, may help improve their mood. Some people consider behavioral therapy a type of CBT. But it can stand on its own, too.^10,11

You and your behavioral therapist will identify things that at one point brought you joy. This could be exercising, pursuing a hobby, or seeing loved ones. They will work with you to create a plan to engage in those things more often, little by little. Behavioral therapy may be especially helpful for kids and teenagers.^10,11

Problem-solving therapy (PST)

Problem-solving therapy (PST) focuses on issues that are causing stress in a person’s current life. These problems may be related to finances, employment, or another area that is causing strain. You and your therapist will work together to identify healthy, productive ways to cope with or face these problems.¹²

In PST, you will create goals and plans for achieving them. Over time, you will carry out these plans and your therapist will monitor your progress. PST can be done 1-on-1 or in a group. PST may only last for a few months at a time. But the idea is that you will develop stronger problem-solving skills that you can use to tackle future stressors.¹²

Solution-focused brief therapy (SFBT)

SFBT is a therapeutic approach that focuses on identifying and implementing solutions to problems rather than dwelling on the problems themselves. It is a brief and goal-oriented form of therapy that helps people, couples, or families create positive change in their lives.¹³

Solution-focused therapy is future-focused. It emphasizes the exploration of a person’s desired future state rather than delving into past problems or traumas. The therapist helps clients clarify their goals, preferences, and hopes for the future.¹³

Psychodynamic psychotherapy

Most therapy options for depression focus on current or future relationships, situations, or thoughts. But psychodynamic psychotherapy focuses on the past. It is based on the theory that unresolved conflicts and trauma from childhood lead to the way we feel today. It aims to dive into unconscious thoughts and bring them to the surface.¹⁴

Examples of psychodynamic psychotherapy include:^15-17

• Developmental needs meeting strategy (DNMS) – DNMS addresses the unmet emotional and developmental needs of people, especially those who have experienced trauma, neglect, or attachment issues. DNMS is often used to treat complex trauma and a range of psychological difficulties stemming from early developmental experiences.
• Parts therapy – Also called internal family systems (IFS) therapy, this approach views the mind as consisting of different inner "parts" or sub-personalities, each with its own unique thoughts, feelings, and motivations.
• Eye movement desensitization and reprocessing (EMDR) therapy – EMDR is used to help people who have experienced trauma, such as post-traumatic stress disorder (PTSD), process and heal from their traumatic memories.

Not everyone will benefit from this form of therapy. Trauma can be difficult to talk about. If not handled well, it can make mood and distress worse. This type of therapy should be given by a professional specifically trained in it.¹³