It’s known that several kinds of psychotherapy are effective treatments for depression, but little is known about which ones are best for which patients. A study conducted at the University of Toronto suggests that it may help to consider attachment styles — the patterns of feeling, thought, and behavior that develop as we learn, mainly through childhood experiences, to balance the need for support with the desire for independence.
According to attachment theory, secure attachment in adult life is based on a deep conviction that others will be available for support when needed. Insecure attachment takes several forms; in this study, the researchers compared attachment anxiety with attachment avoidance.
People with an avoidant attachment style tend to minimize the importance of close relationships. They value thought rather than feeling, often seem cool and remote, and retreat when threatened with intimacy. People with an anxious attachment style are more likely to seek contact and support from others, but their personal relationships are volatile and they are hypersensitive to what they see as rejection or abandonment.
In the Toronto study, questionnaires were used to judge attachment avoidance and anxiety in 56 depressed patients. Then they were assigned at random to interpersonal or cognitive behavioral therapy in four to five months of weekly sessions. The researchers expected interpersonal therapy to be more effective for people high in attachment anxiety, cognitive behavioral therapy more effective for those high in attachment avoidance.
Both treatments were equally effective in reducing depressive symptoms. As the researchers predicted, depressed patients who were high in attachment avoidance responded better to cognitive behavioral therapy than to interpersonal therapy — whether the result was judged by the patient or the therapist.
It did not work the other way, though. Patients high in attachment anxiety benefited equally from interpersonal and cognitive behavioral therapy. The authors suggest that attachment anxiety responds better to psychotherapy in general than attachment avoidance does. In support of that opinion, they point out that in this study, irrespective of a good or bad overall outcome, both cognitive behavioral therapy and interpersonal therapy reduced attachment anxiety much more than attachment avoidance.
The field of mental health is rapidly evolving, and whether your interest is professional or personal, staying informed about these mental health issues is no easy job. The Harvard Mental Health Letter is a source of mental health news you can trust…and it comes directly from the more than 8,000 doctors and researchers at Harvard Medical School.
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Comments: 9
About five years ago I went through a severe depression and I had 13 ECT treatments. Would I ever do that again? Right now I would say no. If things get really bad again and nothing is helping, you never know.
Check this discussions out about attachment: Welcome to the Twilight Zone of Political In-Correctness, a Wombat Disscussion
Here's the study that Carolyn suggests — I hope I'm paraphrasing correctly — how does the patient-doctor relationship affect the success of treatment? That has been studied.
The result? The better the relationship, the better the outcome.
That's not a big surprise, but it certainly underscores what many of you have been writing about in this group.
I'm thinking loosely about the article — and about how difficult it is to find just the right treatment for a person suffering with depression. Maybe it will help to know that most of the psychiatrists I know struggle with the same questions you struggle with. That is, they also wish they could predict better what would be most helpful.
I am resonating with Brenda's comment: "It depends on the day!" Mood is as unpredictable as Brenda indicates.
I picture a roulette wheel and the hope that the ball will fall on the right number. Hitting treatment right is partly a matter of luck.
You all come at an important theme from slightly different angles: We don't want to be "lumped" or to be treated according to an inflexible set of rules. We want our caregivers (whether a therapist, psychiatrist or an insurance company) to be interested in us and to persevere with us.
Seems like every individual is unique and lacking in some area. I have a friend that I am attempting to research for in which we are looking for an organic and healthy diet to build the basis of a healthy female and then attempt to use only the necessary medications.
I truly believe that as individuals it is a painstaking process to find out what is lacking and how our genomes have been affected by poor diet, exposure to negative elements (smoking, dietary negatives, etc.) We fear that in her case the Fibromyalgia diagnosis to be at the bottom of the symptoms including the feeling of depression.
I have always supported the view that the good doctor Miller has underscored... a good patient doctor relationship is at the root of success. I love to have an inquisitive medical professional to play Sherlock prior to the dispensing of the latest miracle drug. lol
To everyones' health! Remember to finish your veggies!