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Researchers develop new specialized treatment for depression

Duke University Pratt School Of Engineering : 21 December, 2006  (Technical Article)
Researchers led by a Duke University psychologist have developed a new type of psychotherapy that is optimally designed to treat a particular type of depression. The new self-system therapy targets patients whose depression is linked to difficulty identifying and pursuing goals involving advancement, growth and achievement, according to Timothy J. Strauman, a co-developer of SST who is professor and co-chair of the Duke Department of Psychology and Neuroscience. About one-fifth of depressed patients fit this profile, Strauman said.
The researchers found that SST was more effective for such individuals than cognitive therapy, a common treatment for depression.

“The advantage of the new treatment is that it was designed in advance to be optimal for this particular subset of depressed people,” Strauman said. “Even though cognitive therapy is generally effective, for these patients SST was significantly better.”

The new therapy also may help therapists choose the best treatment for individual patients, Strauman said.

Typically, when patients seek treatment for depression, their doctors and therapists must experiment with different forms of psychotherapy and medication to find one that works for that individual.

Even the most successful interventions, such as cognitive therapy, interpersonal therapy and the use of drugs called selective serotonin reuptake inhibitors, lead to complete remission of symptoms only about 60 to 70 percent of the time. The treatment process can be frustrating and time-consuming.

But SST offers a method that is specifically tailored for one particular group of depressive individuals, and hence therapists might make it their first choice for treating such patients, Strauman said.

“Until now, there has been no way to predict in advance which treatment will be best for a particular person, even though a number of treatments for depression can be effective,” he said.

SST is based on what psychologists call regulatory focus theory, which defines two types of goals: prevention goals and promotion goals. Prevention goals involve “keeping bad things from happening,” while promotion goals involve “making good things happen.” SST is designed to treat patients who have not learned how to attain promotion goals and so cannot experience the positive motivation and self-esteem boost that accompanies making such progress.

“Many people are better able to take a prevention approach to life, keeping bad things from happening,” he said. “Being prevention-oriented has advantages, but it does not make you happy.”

Self-system therapy draws on techniques used in other types of therapy, including cognitive therapy, which focuses on reversing the effects of depression on how the patients think. But SST sessions focus on helping patients develop skills and strategies to answer four critical questions: What are your promotion and prevention goals? What are you doing to attain them? What is keeping you from making progress? What can you do differently?

Forty-five patients who met diagnostic criteria for depression took part in the study. Half were treated with self-system therapy, while the other half received cognitive therapy. Both groups received about 20 sessions of therapy, at no cost.

Although patients in both treatments improved, patients lacking the ability to pursue promotion goals who received SST made much more significant progress than similar patients receiving cognitive therapy, Strauman said, adding, 'For those patients, the difference between SST and cognitive therapy was substantial.'

“The emphasis in SST on the distinction between promotion and prevention, each of which involves specific strategies for goal pursuit, may have provided a perspective and skill set that allowed these individuals to instigate a self-reinforcing process of pursuing promotion goals,” the researchers said in their report.

Therapists who now use cognitive therapy and other treatment approaches should be able to learn self-system therapy easily, said Strauman, who is a fellow of the Academy of Cognitive Therapy. In fact, the therapists who participated in the study were trained through a manual and weekly discussion sessions, a process that could be replicated so that therapists could add SST screening and treatment to the battery of treatment options they offer.

Co-authors of the study include Angela Z. Vieth, Kari A. Merrill, Alison A. Papadakis and Lori Kwapil of Duke; Gregory G. Kolden, Teresa E. Woods and Marjorie H. Klein of the University of Wisconsin-Madison; and Kristin L. Schneider of the University of Illinois-Chicago.
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