A Review of Psychological Treatments for Major Depressive Disorder

This literature review provides an overview of Major Depressive Disorder (MDD) and examines psychological treatments, including cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and supportive psychotherapy. The review highlights the increasing prevalence of MDD and the importance of up-to-date knowledge for mental health professionals. It discusses the structure and aims of each therapy, emphasizing the effectiveness of CBT in modifying maladaptive cognitions, IPT in resolving interpersonal issues, and supportive psychotherapy in offering empathy and support. The review also addresses research questions regarding the safety and efficacy of these therapies, comparing them to control groups and other treatment modalities. The discussion section delves into the specifics of each therapy, providing evidence for their effectiveness and safety. It also examines the benefits of individual versus group CBT, and the impact of combining CBT with pharmacotherapy. The review concludes by emphasizing the importance of tailored treatment approaches to address the varied needs of individuals with MDD, ultimately aiming to improve patient outcomes and prevent symptom recurrence.

Running head: MAJOR DEPRESSIVE DISORDER 1
Major Depressive Disorder
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Abstract
This literature review will present an overview of Major Depressive Disorder and then
summarize the available research concerning psychological treatments. Despite advancements in
modern day research and treatment incidences of Major Depressive Disorder (MDD) are
continuing to increase. The individuals who are employed in the field of psychology will
undoubtedly treat people affected by MDD daily. The psychotherapy treatment preference is
usually determined by the training and education of the mental health professionals. In order for
mental health professionals to offer best care available, they ought to have adequate up-to-date
knowledge regarding the disorder including current treatment recommendations,
pathophysiology and presentation of the disease. The individual should choose the treatment of
his/her choice despite the educational background of the provider. Several psychological
methods can be used to treat MDD they include cognitive behavioral therapy, supportive
psychotherapy and interpersonal psychotherapy. This review will discuss the three psychological
methods mentioned above.
Overview of Major Depressive Disorder
Evidence of prevalence of MDD has been found around for several years. The Major
Depressive Disorder is a common health concern due to its high mortality rates, economic
impacts, prevalence and suicide risk in the society. Major depressive disorder (MDD) is a
common condition the causes an alteration in the moods (Schmaal et al, 2016). It causes serious
symptoms and signs like fatigue, significant weight gain or loss, diminished pleasure/interest and
psychomotor retardation or agitation that influences the way an individual think, feel and handles
activities of daily life like working, eating or sleeping (Goldsmith et al, 2016). Symptoms and

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signs of MDD should be present for at least two weeks for a person to be diagnosed with MDD.
MDD is a severe condition that should be adequately addressed since the feelings of despair and
hopelessness that are associated with it can lead to suicidal thoughts (Flory & Yehuda, 2015).
Cognitive behavioral therapy, supportive psychotherapy and interpersonal psychotherapy have
proven to be efficient for managing major depressive disorder. Interpersonal psychotherapy and
cognitive behavioral therapy are structured psychotherapies since they are preplanned with
definite aims, use defined psychological techniques and have specified time frame. Supportive
therapy is not a structured psychotherapy since it involves skills of the therapist (Bockting,
Hollon, Jarrett, Kuyken & Dobson, 2015).
Literature Review
MDD can be in form of both episodic (consisting of separate episodes) and chronic that
can last for 3 months or more. It comprises of initial stage that is the continuation and acute
phases, each lasts for approximately 3 months and the maintenance stage which approximately
lasts for 6 to 24 months. The aim of psychological treatments during the acute and continuation
stage is the elimination or reduction of symptoms associated with the MDD and restoring the
psychosocial functioning that is helping the affected person to return to the level of social and
psychological functioning experienced previously before developing MDD. The main purpose of
the psychological treatments during the maintenance stage is to help in preventing the recurring
of the symptoms associated with the MDD (Otte et al, 2016). Even thou antidepressants are the
mainstay for the treatment of MDD, the rates of adherence remains low since patients are
concerned about possible dependency and side effects linked with them. Additionally, surveys
have shown that many patients prefer psychological treatments as compared to treatments using

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antidepressants. Hence, psychological treatment methods have proven to provide additional or
alternative interventions for MDD (Linde et al, 2015).
Cognitive behavioral therapy (CBT) mainly concentrates on assisting the patient to
become alert on how particular unfavorable automatic beliefs, expectations, attitudes and
thoughts give rise to feelings of sadness. An individual becomes aware of how the negative
patterns of thinking can be recognized and altered in order to decrease unhappiness and also deal
with painful or difficult past occurrences (Karyotaki et al, 2017). Interpersonal psychotherapy
concentrates in identification and resolutions of problems in maintaining and establishing
satisfying relationships. Such difficulties can include life changes, growing ease in social
situations and dealing with a loss. Supportive psychotherapy which is also referred to as non-
directive supportive psychotherapy mainly relies on the basic personal skills of the therapists
which include encouragement, empathic listening and reflection. The therapist does not use any
therapeutic strategy he/she is only involved in listening actively and offer support which focuses
on the patient’s concerns and problems. Supportive psychotherapy mostly emphases on the
current problems and concerns rather than long term difficulties. The general aim of the
supportive psychotherapy is to decrease the discomfort levels of the patient and help the patient
on how to cope and deal with the current situations (Newby, McKinnon, Kuyken, Gilbody &
Dalgleish, 2015).
Research questions
 What are the safety and effectiveness of supportive psychotherapy, interpersonal
psychotherapy and cognitive behavioral therapy in successfully improving the outcomes
of a patient with MDD?

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 What are the safety and effectiveness of psychotherapy versus waitlist control or no
treatment?
 What are the safety and effectiveness of psychotherapy treatments provided by therapist
versus psychotherapy treatments provided by non-therapist?
 What are the safety and effectiveness of individual therapies versus group therapies?
 What are the safety and effectiveness of psychotherapy treatments without or with
pharmacotherapy treatment versus pharmacotherapy treatments only?
Discussion
Cognitive Behavioral Therapy
Cognitive behavioral therapy is one of the mostly used psychotherapy treatment across
the lifespan. CBT suggests that maladaptive cognitions maintain and precipitate MDD and other
types of emotional distress. Specifically, MDD is as a result of triad negative perceptive about
one’s future, world and about oneself (Jiang et al, 2015). Hence, CBT helps in engaging patients
in identification and modification of maladaptive cognitions and also includes behavioral
components which include skill rehearsal, relaxation training and behavioral activation. CBT
usually involves 12-16 treatment sessions (van der Velden et al, 2015). But CBT among adults
can be amended in order to incorporate gerontologically-relevant aspects which include cohort
beliefs, role transitions, losses, cognitive and physical changes in order to make CBT a
successful psychotherapy treatment among older adults. Meta-analyses usually finds that CBT is
capable of yielding large effects on MDD comparing to non-active controls like waitlist or no
treatment (Stockings et al, 2015).

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CBT is a safe and effective psychotherapy for the treatment of MDD since it involves
addressing the longstanding and varied problems of an individual with MDD for various reasons.
CBT for MDD usually emphasizes the significance of collaborative, well defined and supportive
therapeutic relationship that help in enhancing the affected person to be willing to make effective
changes and also serves as potent source of contingency. Several factors of CBT’s technical
flexibility and conceptual framework make it effective and safe for addressing the pervasive and
diffuse impairment that are commonly observed among people with MDD. According to
available research CBT is more effective and safe for reducing symptoms of MDD post
treatment comparing to the usual care. It helps in reducing the dangers of recurrence or relapse as
compared to the usual care (Amick et al, 2015). According to Karyotaki et al, (2016) there exists
no significant difference in the treatment of MDD when using CBT combined with
antidepressant comparing with using CBT alone at for up to 6-12 months of post randomization.
But after 12 months CBT combined with pharmacotherapy suggestively improves the response
of treatment as compared to CBT or pharmacotherapy methods only. Individual CBT has proved
to be more effective and safe in improving post treatment recovery from MDD as compared to
group CBT, this can be attributed to the fact that in individual CBT patients seem to be more
open in communication hence making the treatment more effective. The other reason that makes
individual CBT more effective is because the cohesion among the group members and the
connection between the group leader and the patient may be not so strong comparing to the
connection between the patient and his/her personal therapist. Disagreeable events that may arise
in the group may also make individual CBT more effective and safe as compared to group CBT.
Also, another factor that makes individual more effective and safe is that the patient obtains one
on one attention and care from therapist. This makes the therapist to have a better understanding

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of the patient specific concerns and problems and hence develop an individualized treatment
approach that will address concerns of the patient (Karyotaki et al, 2015). Sometimes a patient
can try to solve his/her problems himself/herself alone or with the aid of friends and family. But
CBT provided by a qualified therapist is more effective and safe since he/she has special
training, skills and experience that can be more helpful in solving problems. The therapist helps
in classifying, treating and evaluating behavioral and emotional problems (Huguet, Rao,
McGrath, Wozney, Wheaton, Conrod & Rozario, 2016).
Interpersonal Psychotherapy
Interpersonal psychotherapy (IPT) is a method of treating MDD that is brief and has a
limited time. IPT has been derived from theories that hold the notion that interpersonal function
is significant in psychological wellbeing and adjustment. Also IPT is based on empirical research
that connects alteration in the social environment to the maintenance and onset of MDD
(Driessen et al, 2015). Although the IPT is initially carried out to decrease the symptoms of
MDD, its major aim is improving the quality of the affected person current social functioning
and interpersonal relations. Also, IPT helps in improving an individual interpersonal functioning
by encouraging them to be more efficient in expressing their emotions, helping them to be clear
while communicating with family members and friends and increases the understanding of the
individual behavior patterns in interpersonal interactions. The justification underlying the usage
of IPT is that since it supports therapies that assist in solving interpersonal problems, then the
patient with MDD will improve their life circumstances and simultaneously reduce the intensity
and number of MDD symptoms (Ekeblad, Falkenström, Andersson, Vestberg & Holmqvist,
2016). IPT that help in treatment of MDD is divided into three phases. The first (initial) phase
usually comprises of the first three sessions, during this phase the therapist educates the patient

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about MDD, conducts an evaluation on the diagnostic for MDD and then conducts an evaluation
on the interpersonal relationships of the patient. The therapist will then continue with the
establishment of which of the four social realms that is role transitions, interpersonal role
disputes, interpersonal deficits and grief is closely linked to the patient’s current MDD situation.
The second (middle) phase usually comprises of the 4-13 sessions of treatment. In this phase the
therapist uses particular treatment techniques that are designed in a way that they address the
four social realms. These techniques help in engaging the patient in new behavior patterns and
changing the cognitions of the patient. The third (final) phase usually involves the 14-16 sessions
of the treatment. During this phase the focus is to consolidate the changes that the patient has
made throughout the duration of the therapy and also support the patient counter and recognize
MDD symptoms in future if they arise again (Titov et al, 2015).
IPT has been wisely assessed across a number of research protocols and has proven to be
appropriate and effective in treating MDD in a variety of populations including postpartum
depressed women, the elderly, adolescents, married spouses and patients who are in primary
medical care settings and facilities. IPT is an effective and safe psychotherapy method since it
involves treatment strategies that are unique that aim at resolving difficulties associated with
MDD within four social realms; role transitions, interpersonal role disputes, interpersonal
deficits and grief. These latter vulnerabilities are discussed and adequately talked using a
confident alliance between the patient and the therapist, and helping the patient to understand the
importance of trusting relationships in the biography of the patient. The interpersonal exploration
of patterns and expectations of communication in both unsatisfactory and satisfactory
relationships can be helpful in assisting the patients in mending relationships (Lemmens,
DeRubeis, Arntz, Peeters & Huibers, 2016). According to the available research about IPT it

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indicates that IPT greatly decreases symptoms associated with MDD comparing with the usual
care or no treatment. Interpersonal psychotherapy has proven to be more effective in the
treatment of MDD when combined with pharmacological treatments as compared to
pharmacological methods only (Huibers, Cohen, Lemmens, Arntz, Peeters, Cuijpers &
DeRubeis, 2015). Individual interpersonal psychotherapies have proven to be more safe and
effective for treatment of MDD. This can be attributed to the fact that in individual IPT the
patient is capable of arranging time for the sessions of the therapy that is conducive according to
his/her schedule and it can help in determining the pace of the therapies according to the specific
patient. Also, another aspect that makes individual IPT more effective is that it helps in
maintaining the confidentiality of the issues of the patient (Dietz, Weinberg, Brent & Mufson,
2015). Interpersonal psychotherapy provided by the therapists are more safe and effective since
the therapist will help in interviewing the patient about his/her history and then talk with the
patient in order to define problems and also determine the treatment method that best suits the
patient (Schramm et al, 2017).
Supportive psychotherapy
Supportive psychotherapy involves any attempt made by the therapist to help the patients
tackle their problems in daily life and emotional distress associated with MDD. Although
supportive psychotherapy is a common psychotherapeutic treatment method for many MDD
cases, in the training curriculum of mental health professional it is relatively being given less
time and attention. This, together with the fact that it involves usage of various techniques from
diverse psychotherapy paradigms, has made many mental health professionals confused as to the
fundamental process and nature of supportive therapy (Thornicroft et al, 2017). Basic tactics that
help in provision of the foundation for effective and safe supportive psychotherapy have been

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described in order to ensure that the supportive therapist focus his/her interventions so as to help
in maximizing benefits of the patient. It includes reassuring, encouraging, advising, comforting
and mostly listening sympathetically and attentively. The therapist helps in providing an
emotional outlet that is giving the patients a chance to express themselves and helping them to be
themselves. Also the therapist informs the patients concerning their illness and ways to adjust to
it and ways to manage the illness (Kaiser, Andrews-Hanna, Wager & Pizzagalli, 2015). On
various occasions during the course of the treatment the therapist usually intercedes on behalf of
the patient with a number of authorities including social agencies, schools, family and with all
those with whom a patient can be contending. Occasionally the therapists must provide an
explanation concerning the behaviors of the patient to others and also at the same time provide
an interpretation to the patient about the behavior of other people. The therapist should provide
an education to the patient concerning the unwritten but essential rules that help in governing all
social interaction.
Supportive psychotherapy is a safe and psychotherapy tactic since it involves the
therapist encouraging the patients in expanding their interests in the world by going to school or
work, participating in hobbies or sports and making friends. What makes supportive
psychotherapy more effective is the reason that the therapist functions as model for appropriate
and proper behavior. Research indicates that supportive psychotherapy help in decreasing the
symptoms of MDD compared with the usual care methods or no treatment. According to
Cuijpers, Cristea, Karyotaki, Reijnders & Huibers, (2016) there exist no significant different
between pharmacotherapy and supportive psychotherapy in the treatment of MDD. But
supportive psychotherapy has shown to be more safe and effective in the treatment of MDD
when combined with pharmacological treatments as compared to only pharmacological methods

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only. Individual supportive therapies have proven to be more safe and effective compared to
group supportive psychotherapy. This can be attributed by the difference between factors like
facilitating patient centered conditions like congruence, warmth and empathy and provision of
therapeutic alliance that is the cornerstone for a successful intervention practice. In group
supportive psychotherapy the group cohesion usually play an essential role of helping the group
members in realizing the influences associated with the intervention. But in individual supportive
psychotherapy they usually help in strengthening the relationship between the therapist and client
compared to group supportive psychotherapy (Cuijpers, Ebert, Acarturk, Andersson & Cristea,
2016). Supportive therapy using a qualified therapist is more effective and safe since the
therapist sometimes will involve usage of specialized techniques like behavioral modification,
stress management and biofeedback in tackling the patient problems.
Conclusion and Recommendations
In conclusion, it is evident from the literature review that Major Depressive Disorder is a
chronic condition that is continuously affecting the lives of many people. People with MDD
experience many difficulties in life since they experience loss of pleasure or interest in their
activities and depressed mood. These negative symptoms and signs usually influence the social
interactions, education and work of the affected people. Treatment for MDD can consist of
pharmacological methods and psychological methods. The patient should be given effective and
safe treatment according to his/her condition in order to ensure better management of the
condition. The three most used psychological treatments for MDD are supportive psychotherapy,
interpersonal psychotherapy and cognitive behavioral therapy. The three psychotherapy methods
have proven to be effective in the treatment of MDD. Comparing the three psychotherapy with
the usual care or no treatment they have been found to reduce symptoms associated with MDD

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and increase recovery or response post treatment. From the above literature review it can be
concluded that psychotherapies treatment combined with pharmacological treatments are more
effective and safe as compared with pharmacological or psychotherapies alone. Also, individual
setting psychotherapies have shown to be more safe and effective compared to those provided in
a group setting for the treatment of MDD.
Further research is recommended to determine that effective and safe care is considered
standard care for all age groups and population groups and that it is implemented in clinical
practice. This research will help patients with MDD to obtain effective care in time. Also, further
research is recommended to enhance knowledge for appropriate identification of the processes of
vulnerability to and protection from MDD including environment, stressful life events, family
support and family history.