Two-thirds of depression sufferers don’t experience significant relief from antidepressant medication. Fortunately, new research findings might help improve their treatment. A large scale trial in the UK found that the combination of antidepressants combined with cognitive behavioral therapy (CBT) is far more effective at conquering depression than pills alone.
Researchers prescribed 469 patients with treatment-resistant depression to one of two regimens: Antidepressants alone, or a combination of antidepressants and CBT. Of the pills-only group, 22 percent reported reduction in symptoms after six months. In contrast, 46 percent of patients treated with the combination of medication and therapy reported a reduction in symptoms. Not only that, but the beneficial effect was maintained over twelve months.
For people who turn their noses up at the idea of therapy, CBT is nothing like the tired cliché of spending a lifetime on the couch, untangling your dreams or exploring your childhood. “CBT is a short-term, goal-directed treatment focused on the here and now,” explains Dorothea Lack, Ph.D., a member of the American Psychological Association and a psychologist in private practice in San Francisco. “The therapist works with the patient to restructure negative thought patterns and acquire better coping skills.” Patients take an active role in their treatment, and therapists generally assign homework (which could be anything from journaling to scheduling a positive activity into the week) with the expectation it will be discussed during the next session. “The idea is that sessions build upon themselves to help the patient develop the tools she needs to manage on her own,” explains Lacks. “But the specific sessions will vary based on the individual.”
The get the most out of CBT, it’s essential to find a therapist you feel you click with. Here’s how to get started.
Get a referral
If you’re on antidepressants, ask your prescribing doctor for a CBT-trained therapist he or she recommends. “An advantage of working with a therapist who’s already worked with your doctor is that it may be easier for them to collaborate—with your permission—on future treatment plans,” explains Lack. In other words, if your therapist and your MD often work with each other, it may be easier for your MD to get a bigger picture insight into how your medication is working than if she’s never spoken with your therapist. But if her own referral network isn’t ideal, it’s no big deal—you can always connect them later. Other places to find a therapist include online—therapists.psychologytoday.com has an extensive directory that’s searchable by location, insurance, and treatment modality, meaning you can specifically look up CBT therapists in your area. Another option is to ask your insurance provider for local practitioners.
Arrange an interview
Just because you received a referral doesn’t mean you’re locked in to that particular provider. “In the first session, you should feel comfortable asking just as many questions as the potential therapist,” says Lack. Schedule a quick phone call or a brief office visit where you ask about their training (effective therapists have a range of degrees but all should be licensed by the state), their therapeutic approach, and whether they’ve often dealt with your own particular issue. “Therapists aren’t psychics,” reminds Lack. “It’s essential for you to explain your own goals and expectations so you can get a sense of whether or not you and she are on the same page.” Other stuff to bring up in the initial meeting: What she expects from her patients (such as homework assignments, journaling, or committing to agreed-upon goals each week), how she handles between-appointment communication like phone calls or e-mails, and any need-to-know billing info. Getting the policy stuff out of the way early ensures that it won’t interrupt your treatment once it officially gets started.
Check in with yourself
“You should leave the first encounter genuinely feeling like you trust and respect the therapist,” says Lack. Not only that, but it’s key to pay extra attention to minor annoyances. Since you’re going to be visiting her more often than you would, say, your dentist, an out-of-the-way office or a less than ideal time slot could compromise your commitment to treatment.