Reality Therapy

Reality Therapy

Reality Therapy is the method of counseling that Dr. Glasser has been teaching since 1965. It is now firmly based on Choice Theory and its successful application is dependent on the counselor’s familiarity with, and knowledge of, that theory. In fact, teaching Choice Theory to counselees (whether clients or students) is now part of Reality Therapy. Since unsatisfactory or non-existent connections with people we need are the source of almost all human problems, the goal of Reality Therapy is to help people reconnect. This reconnection almost always starts with the counselor/teacher first connecting with the individual and then using this connection as a model for how the disconnected person can begin to connect with the people he or she needs.

In Reality Therapy they are classified under five headings:

  • Power – which includes achievement and feeling worthwhile as well as winning.
  • Love & Belonging – this includes groups as well as families or loved ones.
  • Freedom – includes independence, autonomy, your own ‘space’.
  • Fun – includes pleasure and enjoyment.
  • Survival – includes nourishment, shelter, sex.

One of the core principles of Reality Therapy is that, whether we are aware of it or not, we are all the time acting to meet these needs.

In reality therapy sessions, the person’s thoughts and actions are considered the most appropriate material to actively work on, as these are within a person’s control, rather than feelings or symptoms, which are affected by changes in made in the relevant thoughts and actions. Blame and externalizing control are avoided, as these are viewed as impediments to developing healthy relationships. Regardless of the particular complaint, the best possible solution lies in improving connections with others, and specific changes in thoughts and behavior are made in the service of this goal. The practice of Reality Therapy is an ongoing process made up of two major components:

  1. Creating a trusting environment; and
  2. Using techniques which help a person discover what they really want , reflect on what they are doing now, and create a new plan for fulfilling that ‘want’ more effectively in the future.

Virtual Reality Therapy (VRT)

The first research for VRT was done in the early 1990s. Virtually Better, the company Zimand works for, was founded in 1995. VRT was first used for people who had a fear of heights. Virtual reality has been studied in recent years as a possible treatment for phobias. A new study shows that virtual reality therapy combined with cognitive-behavioral therapy is just as effective as conventional treatment for panic disorder with agoraphobia, reports the Doctor’s Guide. An added benefit is that the process is quicker. Developed by Dr. Young-Hee Choi, the process known as experiential cognitive therapy consists of only four sessions

Virtual Reality (VR) is a new, state of the art, powerful technique that immerses you into a virtual environment, using a head mounted display and trackers. This technique creates a visual, auditory and sensory environment that psychologically exposes you to your fear, whether it be flying in an airplane, speaking in front of a large group of people or driving on the highway. Fears and phobias are overcome by combining virtual reality and biofeedback/cognitive-behavioral therapy techniques, through a process known as counter-conditioning, leading to success rates of 93%.



Rational Emotive Behavior Therapy (REBT)

Rational Emotive Behavior Therapy

Rational Emotive Behavior Therapy (REBT) is a cognitive-behavioral approach to treatment developed by Dr. Albert Ellis in 1955.

According to this therapy, emotional and behavioral ailments are the result of irrational thoughts, assumptions and beliefs. This therapy identifies those problematic and erroneous ideas and replace them with more rational, reality-based thoughts and perspectives.

REBT- Rational Emotive Behavior Therapy since its inception, has flourished and spawned a variety of other cognitive-behavior therapies. Its effectiveness, short-term nature, and low cost are major reasons for its wide acceptance and popularity.

The goal is to help clients develop a rational philosophy that will allow them to reduce their emotional distress and self-defeating behaviors. A number of techniques are used in this active approach, such as rational-emotive imagery (in which clients imagine themselves thinking, feeling and behaving in ways they would like to think, feel and behave in real life), role-playing, homework assignments, desensitization, and assertiveness exercises. The goal is freedom from emotional upheaval and a more authentic and joyful engagement in life.

How Rational Emotive Behavior Therapy (REBT) Works?

Recalling the A-B-C theory of personality, successful REBT therapy adds steps D, E, and F. The D stands for disputing: the therapist helps the client to challenge the irrational belief (B). REBT teaching suggests that the therapist ask the client if there is any evidence for the belief, or what would be the worst possible outcome if the client were to give up that belief. In therapy the counselor may point out faulty beliefs, but he or she also teaches the client how to dispute them in day-to-day life outside of therapy. The result of disputing the self-defeating belief and replacing it with a rational one yields an effective philosophy (E), and also a new set of feelings (F) which are not debilitating. Although REBT teaches that the counselor should demonstrate unconditional full acceptance, the therapist is not encouraged to build a warm and caring relationship with the client. The counselor’s only task is to aid the client in identifying and confronting irrational beliefs and replacing them with rational ones. The therapist usually is not even interested in the past events which are the source of the irrational belief; all that matters is getting rid of that belief in the present.

REBT distinguishes between practical problems and emotional problems. Practical problems are actual events and situations that are problematic, whereas emotional problems are reactions to such events and situations that are inappropriate, inaccurate (overreactions or underreactions), and actually or potentially harmful.

Strengths and weaknesses of REBT with suicidal adolescents

Some of the potential strengths of REBT and its application to suicidal youths would be its simplicity. REBT seems to be a model which takes into consideration, developmental levels – an important ingredient when working with teenagers. REBT, in some respect, may not seem like psychotherapy from the teenager’s perspective, due to its direct approach, didactic style, and reliance on empiricism. Where other models of therapy come across as mysterious and intimidating to teenagers, REBT is exactly the opposite.

Weinrach (1990) has indicated that REBT has the capability of rubbing individuals the wrong way. Another criticism, or to be more accurate, a misconception regarding REBT, is its failure to discuss the emotionality aspects of emotional disturbances (Garcia, 1977 ; Satzberg, 1979). REBT has also been lambasted for being a model for tough-minded individuals. In A New Guide to Rational Living, Ellis (1961) corroborates this idea that he/she has a right to decide what to do with his/her life. Surprisingly, Ellis (1961) suggests that one address suicide forthrightly and also with the addition of what Ellis refers to as causal humor. This type of approach may or may not be effective with adolescents. Yet, some may suggest it lacks the necessary degree of empathy to efficiently work with suicidal patients.



Person Centered Therapy

Person Centered Therapy

Person-centered therapy, which is also known as client-centered, non-directive, or Rogerian therapy, is an approach to counseling and psychotherapy that places much of the responsibility for the treatment process on the client, with the therapist taking a nondirective role.


Two primary goals of person-centered therapy are increased self-esteem and greater openness to experience. Some of the related changes that this form of therapy seeks to foster in clients include closer agreement between the client’s idealized and actual selves; better self-understanding; lower levels of defensiveness, guilt, and insecurity; more positive and comfortable relationships with others; and an increased capacity to experience and express feelings at the moment they occur.

The three critical attitudes or values in Person or Client-Centered Therapy are:

  1. Unconditional Positive Regard (Nonpossessive Warmth):
  2. Empathy
  3. Genuineness (Congruence)

Person-Centred Psychotherapy is a way of relating with persons, one to one or in groups, which fosters personality development through personal encounter. It assumes that every person has the capability and tendency to make use of his or her resources in a constructive way. Living in a satisfying way, both personally and in relationships is achieved through increasing self-understanding and less defensive openness to the continuous flow of experiencing. This tendency to actualise one’s own possibilities is stimulated and supported by person-to-person encounter. This encounter of another person is a form of relationship characterised by the fundamental and unequivocal respect held by the therapist. The therapist’s quality of presence in this encounter is authentic, congruent, unconditionally acknowledging the individual otherness of the client, deeply empathic and non-judgemental. Both therapist and client, develop together in this relationship.

Effects of Person – Centered Therapy

  • Responsibility for self
  • Empathy and unconditional positive regard
  • Self-Exploration
  • Therapeutic change



Humanistic Theory and Therapy

Humanistic Theory

Humanistic psychology is a school of psychology that emerged in the 1950s in reaction to both behaviorism and psychoanalysis . It is explicitly concerned with the human dimension of psychology and the human context for the development of psychological theory.

The Humanistic Approach began in response to concerns by therapists against perceived limitations of Psychodynamic theories, especially psychoanalysis. Individuals like Carl Rogers and Abraham Maslow felt existing (psychodynamic) theories failed to adequately address issues like the meaning of behavior, and the nature of healthy growth. However, the result was not simply new variations on psychodynamic theory, but rather a fundamentally new approach.

Humanistic “theories” of learning tend to be highly value-driven and hence more like prescriptions (about what ought to happen) rather than descriptions (of what does happen).

  • They emphasise the “natural desire” of everyone to learn. Whether this natural desire is to learn whatever it is you are teaching, however, is not clear.
  • It follows from this, they maintain, that learners need to be empowered and to have control over the learning process.
  • So the teacher relinquishes a great deal of authority and becomes a facilitator.
  • Humanistic theory is reality based and to be psychologically healthy people must take responsibility for themselves, whether the person’s actions are positive or negative.
  • The goal of life should always be to achieve personal growth and understanding.  Only through self-improvement and self-knowledge can one truly be happy.

Weaknesses of Humanistic Theory

The biggest criticism of humanistic thought appears to center around it’s lack of concrete treatment approaches aimed at specific issues.  With the basic concept behind the theory being free will, it is difficult to both develop a treatment technique and study the effectiveness of this technique.

Secondly, there are those who believe humanistic theory falls short in it’s ability to help those with more sever personality or mental health pathology.  While it may show positive benefits for a minor issue, using the approach of Roger’s to treat schizophrenia would seem ludicrous.

Further, in their review of different approaches to positive psychology, Seligman & Csikszentmihalyi (2000) notes that the early incarnations of Humanistic psychology lacked a cumulative empirical base, and that some directions encouraged self-centeredness. Rowan (2001) believes that these suspicions are understandable as long as a large amount of time is spent on discussing such issues as the self and self-actualization.

Despite these problems, humanistic theory has been incorporated into many differing views on psychotherapy and human change.  Many argue now that a humanistic undertone in treatment provides a nice foundation for change.  While it may not be sufficient, it may still be necessary for a significant personality change to occur.



Gestalt Therapy

Gestalt Therapy

Gestalt therapy was originated about fifty years ago by Frederick ‘Fritz’ Perls (1893-1970) in collaboration with Paul Goodman. A German word, “Gestalt,” points to a main theme of the therapy. It describes the unified nature of a pattern of elements and, in Gestalt therapy practice, refers to our tendency to see and act in unified wholes, instead of parts. Thus, the mind, body, and spirit act as one and are not treated as separate functions. The main limit to Gestalt counselling is the counsellor himself and his or her lack of imagination. The overall aim is, by bringing elements into the open, people are able to identify and integrate the various diverse parts of themselves and thereby achieve an individual gestalt.

The Gestalt Therapy approach encourages individual personal growth through the development of self-awareness and self support to enable creative and spontaneous contact with people and the environment we live in. This process does not conform to preset rules or expectations. A Gestalt therapist encourages clients to explore and find ways to live life in a meaningful way. The learning and application of Gestalt therapy is always experiential with clients being encouraged to experiment between client and therapist as the vehicle for healing. Gestalt Therapy works through the interconnection of concepts. Here are a few that are key:-

  • Present-centered awareness
  • Profound respect
  • Social responsibility
  • Emphasis on experience
  • Creative experiment and discovery
  • Relationship


Preparation of Gestalt Therapy

Gestalt therapy begins with the first contact. There is no separate diagnostic or assessment period. Instead, assessment and screening are done as part of the ongoing relationship between patient and therapist. This assessment includes determining the patient’s willingness and support for work using Gestalt methods, as well as determining the compatibility between the patient and the therapist. Unfortunately, some “encounter groups” led by poorly trained individuals do not provide adequate pre-therapy screening and assessment.

Gestalt therapy is often criticized as being too technique orientated with little research into what actually works. In fact some say no matter what the style or technique used it is the actual counsellor who is the biggest factor as to whether the client moves on or not. Perls  himself was in his later years says this about therapists, One of the objections I have against anyone calling himself a Gestalt Therapist is that he uses a technique. A technique is a gimmick. A gimmick should only be used in the extreme case.



Existential Therapy

Existential Therapy

Existential therapy is based on developing a client’s insight, or self-understanding, and focuses on problems of living such as choice, meaning, responsibility, and death. This therapeutic approach emphasizes “free will,” the ability to make choices that are not dictated by heredity or past conditioning, through which an individual can become the person that he or she wants to be. Existential therapy attempts to restore meaning to life so that the client is inspired to have the courage to make choices that are both rewarding and socially constructive.

Existential therapy is a dynamic type of psychotherapy that can help us to get in touch with these questions and the ultimate concerns that often underlie many of our conflicts, anxieties, and motives. These ultimate concerns include:

  • Awareness of our limited lifespan
  • Our freedom to make choices
  • Awareness of our existence as individuals (separateness)
  • The threat of meaninglessness

Goals of Existential therapy

It is possible for people to face the anxieties of life head-on and embrace the human condition of aloneness, to revel in the freedom to choose and take full responsibility for their choices. They courageously take the helm of their lives and steer in whatever direction they choose; they have the courage to be. One does not need to arrest feelings of meaninglessness, but can choose new meanings for their lives. By building, by loving, and by creating one is able to live life as one’s own adventure. One can accept one’s own mortality and overcome fear of death. Some of the goals of existential therapy are:-

  • Taking responsibility for decisions
  • Finding personal meaning
  • Increasing self-awareness and authentic living

The benefit of existential therapy is that it helps people to clarify and choose among different ways of living, and ultimately lead richer and more meaningful lives.




EFT – Emotional Freedom Techniques


This technique was created by Gary Craig, who studied TFT under Dr. Callahan. EMOTIONAL FREEDOM TECHNIQUE is based on the meridian system, comparative to acupuncture without the use of needles. The process is used to release negative emotional energy stored in the nervous system. It is used in the treatment of trauma, PTSD, phobias, grief, anger, guilt, anxiety, etc.

EFT (Emotional Freedom Techniques) is becoming known to many amazed users as a modern miracle. It can dramatically relieve emotional disturbances along with many physical symptoms. It often works in minutes, its results are usually long lasting, and side effects are almost always positive.

EFT is versatile and has been used confidently by hundreds of therapists on thousands of clients with successes on even the most difficult problems, by relieving imbalances in their clients’ energy systems. Phillip and Jane Mountrose have been using it personally and with clients and class participants for over 5 years, with consistent success.


How EFT – Emotional Freedom Techniques Works?

EFT is a very effective yet gentle method of directly balancing the body’s energy system for the feelings that you want to change. It’s a bit like clearing a log that’s blocking a stream where the log represents a stuck emotion in your stream of energy. You don’t have to believe in the theory though, just as you don’t need to know how a car works under the bonnet to drive one. Some people do like to find out more about the theory, while others are happy simply to have their problem resolved.


EFT Step What’s Involved in Each Step Time Taken
The Setup Massage a tender area of lymph nodes in your upper chest and repeat a specially-worded statement of your problem. 10 sec
Tap with the pads of your fingers on a series of acupressure points to stimulate energy flow through the meridian system. 20 sec
9-Gamut Procedure Tap one acupressure point on the back of your hand; do 9 brain-connecting actions with eye movements, humming and words. 10 sec
Again, tap with pads of your fingers on the same acupressure points to stimulate energy flow through the meridian system. 20 sec

Total EFT Treatment Time = about 60 seconds

EFT is a form of psychological acupressure, based on the same energy meridians used in traditional acupuncture to treat physical and emotional ailments for over five thousand years, but without the invasiveness of needles. Instead, simple tapping with the fingertips is used to input kinetic energy onto specific meridians on the head and chest while you think about your specific problem – whether it is a traumatic event, an addiction, pain, etc. — and voice positive affirmations.

Most energetic imbalances may be partially or completely relieved within a short time using this process. Others may be relieved through repetition of the process. Some examples of energetic patterns that have been successfully cleared using EFT:

  • Fears related to performance like public speaking, concentration, sports, etc.
  • Phobias like the fear of heights, flying, enclosed spaces, driving, etc.
  • Emotional trauma from war experiences, physical abuse, etc.
  • Disturbing emotions like depression and anger.
  • Emotions related to addictive patterns like eating and smoking
  • Insomnia
  • Emotions related to physical conditions.



Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT)

The term ‘dialectical’ is derived from classical philosophy. Dialectical Behavior Therapy (DBT) was originally developed by Marsha Linehan for treating borderline personality disorder, and has subsequently been adapted for binge eating disorder. Typically clients with BPD, as defined in DSM-IV, are notoriously difficult to treat (Linehan 1993a). They often do not attend regularly, frequently fail to respond to therapeutic efforts and make considerable demands on the emotional resources of the therapist (particularly when suicidal and parasuicidal behaviors are prominent). The effectiveness of DBT has been demonstrated in many controlled studies across different research groups. Because of this success and due to similar behavior patterns, DBT is now being used in many settings as a viable therapy for the treatment of bipolar disorder.

How it works

Dialectical Behavioral Therapy (DBT) consists of two parts:

  1. Once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem:
    Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship. . . the emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. . . . Telephone contact with the individual therapist between sessions is part of DBT procedures.
    (Linehan, 1991) DBT targets behaviors in a descending hierarchy:

    • decreasing high-risk suicidal behaviors
    • decreasing responses or behaviors (by either therapist or patient) that interfere with therapy
    • decreasing behaviors that interfere with/reduce quality of life
    • decreasing and dealing with post-traumatic stress responses
    • enhancing respect for self
    • acquisition of the behavioral skills taught in group
    • additional goals set by patient
  2. Weekly 2.5-hour group therapy sessions in which interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught (see summaries of sample worksheets). Group therapists are not available over the phone between sessions; they refer patients in crisis to the individual therapist.

There are four modules in DBT group skills training:

  • Core Mindfulness Skills – These are derived from Buddhist meditation techniques to enable the client to become aware of the different aspects of experience and to develop the ability to stay with that experience in the present moment.
  • Interpersonal Effectiveness Skills – These focus on effective ways of achieving one’s objectives with other people: to ask for what one wants effectively, to say no and be taken seriously, to maintain relationships and to maintain self-esteem in interactions with other people (comparable to assertiveness training).
  • Emotion Modulation Skills – These skills are ways of coping with intense emotional experiences and their causes. They also allow for an adaptive experience and expression of intense emotions.
  • Distress Tolerance Skills – These include techniques for putting up with, finding meaning for, and accepting distressing situations if there is no conceivable solution at present.

DBT for Binge Eating Disorder Techniques

  1. Mindfulness training: Learning to fully experience thoughts, emotions, and action urges without attempting to suppress them or judge them, and without experiencing secondary emotions such as guilt or shame.
  2. Identifying the antecedents and consequences of emotions.
  3. Becoming aware of the bodily responses that accompany negative emotions.
  4. Understanding the relationship between cognitions and emotions, and modifying cognitions that evoke negative emotions.
  5. Learning adaptive methods of coping with negative emotions: relaxing, taking walks, socializing, taking a warm bath, listening to soothing music.
  6. Getting adequate sleep and reducing excessive exercise and the use of drugs and alcohol.
  7. Reducing negative emotions, for example by facing rather than avoiding feared situations, and by revealing rather than hiding feelings of shame.



Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

Cognitive therapy is fairly new to the mental health field, but we can actually trace its development back in time 2,600 years to the Buddha and the great emphasis his followers place on watching – and eventually taming – one’s thoughts. There, the goal is eventual enlightenment. Here, we are speaking in relatively more modest terms of saving one’s own life – of watching how you think in certain situations, and making the appropriate adjustments.

What is CBT?

Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and “negative” emotions. (Maladaptive behavior is behavior that is counter-productive or interferes with everyday living.) The treatment focuses on changing an individual’s thoughts (cognitive patterns) in order to change his or her behavior and emotional state.

Cognitive therapy is a well-researched method of psychological treatment that can be effective for dealing with emotional and behavioral problems. It is a way of talking about:

  • How you think about yourself, the world and other people
  • How what you do affects your thoughts and feelings.

CBT can help you to change how you think (“Cognitive”) and what you do (“Behaviour)”. These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” problems and difficulties. Instead of focussing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

It has been found to be helpful in:

  • Anxiety
  • Depression
  • Panic
  • Agoraphobia and other phobias
  • Social phobia
  • Bulimia
  • Obsessive compulsive disorder
  • Post traumatic stress disorder
  • Schizophrenia

How effective is CBT?

CBT has been shown in clinical trials to help ease symptoms of various health problems. For example, research studies have shown that a course of CBT is just as effective as medication in treating depression and certain anxiety disorders. There may be long-term benefits of CBT as the techniques to combat these problems can be used for the rest of your life to help to keep symptoms away. So, for example, depression or anxiety are less likely to recur in the future. There is good research evidence too to show that CBT can help to improve symptoms of some physical conditions such as rheumatoid arthritis.


Cognitive-behavioral therapy does not suit everyone and it is not helpful for all conditions. You need to be committed and persistent in tackling and improving your health problem with the help of the therapist. Those who don’t have a specific behavioral issue they wish to address and whose goals for therapy are to gain insight into the past may be better served by psychodynamic therapy. Patients must also be willing to take a very active role in the treatment process.

Cognitive-behavioral intervention may be inappropriate for some severely psychotic patients and for cognitively impaired patients (for example, patients with organic brain disease or a traumatic brain injury), depending on their level of functioning.



Clinical Depression (Major Depression)

Clinical Depression

Clinical depression is also know as major depression, it is the most severe category of depression. It is normal for people to feel depressed when something bad happens, such as the death of a loved one. This type of depression normally goes away after a couple of weeks; but sometimes it persists. It can last for periods of six months or more, and then it is classified as clinical depression. Without treatment, symptoms of clinical depression can last for weeks, months, or years. Appropriate treatment for clinical depression, however, can help most people who suffer from clinical depression.

Signs and Symptoms of Clinical depression

In a clinical depression, more of the symptoms of depression are present, and they are usually more intense or severe. However, each individual may experience symptoms differently. Symptoms may include:

  • Inability to experience pleasure
  • Hopeless about the future, excessive pessimistic feelings
  • Insomnia or excessive sleeping
  • Fatigue or loss of energy nearly every day
  • Drug or alcohol abuse
  • Thoughts of suicide
  • Feelings of guilt, worthlessness, helplessness
  • Significant weight loss or gain

What are the Causes of Clinical Depression?

Current theory suggests those clinical depression results from complex interactions between brain chemicals and hormones that influence a person’s energy level, feelings, sleeping and eating habits. These chemical interactions are linked to many complex causes–a person’s family history of illness, biochemical and psychological make-up, prolonged stress, and traumatic life crisis such as death of a loved one, job loss, or divorce. Sometimes no identifiable cause triggers an episode of clinical depression; usually one or more stresses are involved. Medical research has found that people who suffer from clinical depression have changes in important brain chemicals, such as serotonin and norepinephrine. New medications are available that restore these brain chemicals to their proper balance and relieve symptoms of clinical depression.


Major depression can profoundly alter social, family, and occupational functioning. However, suicide is the most serious complication of major depression, resulting when the patient’s feelings of worthlessness, guilt, and hopelessness are so overwhelming that he no longer considers life worth living.

Note: If specific plans for suicide are uncovered or if significant risk factors exist (previous history, profound hopelessness, concurrent medical illness. substance abuse, social isolation), refer the patient to a mental health specialist for immediate care. Nearly 15% of patients with untreated depression commit suicide, and most of these patients sought help from a doctor within 1 month of their deaths.

Diagnostic criteria

A patient is diagnosed with a major depressive episode when he fulfills the criteria documented in the DSM-IV.

  • At least five of the following symptoms must have been present during the same 2-week period and represent a change from previous functioning; one of these symptoms must be either depressed mood or loss of interest in previously pleasurable activities (Don’t include symptoms that are due to a general medical condition, delusions, or hallucinations):

– depressed mood (irritable mood in children and adolescents) most of the day. nearly every day, as indicated by either subjective account or observation by others

– a markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

-significant weight loss or weight gain (greater than 5% of the patient’s body weight in a month) when not dieting or a change in appetite nearly every day

– insomnia or hypersomnia nearly every day

– psychomotor agitation or retardation nearly every day

– fatigue or loss of energy nearly every day

– feelings of worthlessness and excessive or inappro­priate guilt nearly every day

– diminished ability to think or concentrate or indecisiveness, nearly every day

– recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide.

  • The symptoms aren’t due to a mixed episode.
  • The symptoms aren’t due to a medical condition (such as hypothyroidism) or the effects of a medication or other substance (drug abuse, for example).
  • The symptoms aren’t better accounted for by bereavement (for example, symptoms persist for more than 2 months after a loved one’s death or are characterized by marked functional impairment, morbid thoughts of worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation).

Psychological tests such as the Beck Depression Inventory can be used to determine the onset, severity, duration, and progression of depressive symptoms. The dexamethasone suppression test may show a failure to suppress cortisol secretion; however, this test has a high false-negative rate. Toxicology screening may suggest a drug-induced depression.

Treatments for Clinical Depression

The first step to getting appropriate treatments for clinical depression is a physical examination by a physician. If a physical cause for the clinical depression is ruled out, a psychological evaluation should be done by referral to a psychologist or psychiatrist. Physical treatments have several options including antidepressant medication therapy, psychotherapy or electroconvulsive therapy or ECT.

  1. Antidepressant medication therapy, it takes about 5 or 6 weeks to find out if that antidepressant medication is appropriate – that is it is working and does not have untoward side effects – and then it takes 6 months or more of continuation treatment to ensure that the medication remains effective.
  2. Psychotherapy – most often cognitive-behavioral and/or interpersonal therapy) for the individual. Cognitive-behavioral focused on the negative thinking and behavioral patterns associated with depression, and teaches the individual to recognize and target the self-defeating behavioral patterns that contribute to their depression.
  3. Electroconvulsive therapy (or ECT). This usually involves 8 to 10 treatments over a 3 to 4 week period. One can consider ongoing treatment once every 2 weeks to once every 4 weeks over a several month period if this treatment has been successful. (ECT)

The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control he or she has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.

While treatment is generally effective, there are some cases where the condition fails to respond. Treatment-resistant depression requires a full assessment which may lead to the addition of psychotherapy, higher medication doses, changes of medication or combination therapy, a trial of ECT /electroshock, or even a change in the diagnosis with subsequent treatment changes. Although this process helps many, some people’s symptoms continue unabated.