Interpersonal Therapy Interpersonal therapy (IPT) is another effective, evidence- based psychotherapy for clients with major depression (Bleiberg & Markowitz, 2014; Lipsitz & Markowitz, 2013). This therapeutic approach focuses on current stressors, interpersonal difficulties, and depressive symptoms (Bleiberg & Markowitz, 2014; Lipsitz & Markowitz, 2013). The underlying premise of IPT is that depressive symptoms are caused by a biological disease (Bleiberg & Markowitz, 2014; Lipsitz & Markowitz, 2013). However, negative life events, like the death of a spouse or loss of a job, compromise interpersonal functioning, which in turn exacerbates depressive symptoms and often triggers more negative life events and interpersonal factors (Dietz & Mufson et al., 2018; Bleiberg & Markowitz, 2014; Lipsitz & Markowitz, 2013). Interpersonal therapy focuses on interrupting the cyclic pattern of dysfunction caused by negative life events, psychosocial stressors, and symptoms of depression (Bleiberg & Markowitz, 2014; Lipsitz & Markowitz, 2013). There are two overarching principles for IPT: (1) depression is a medical illness that causes a predictable set of symptoms that can be understood and managed, and (2) the current episode of depression is linked to a current life event (Bleiberg & Markowitz, 2014; Lipsitz & Markowitz, 2013). Therefore, IPT views depression only within the context of interpersonal functioning as opposed to focusing on psychological symptoms. According to the IPT model, once the individual is able to manage the current problem, interpersonal functioning will stabilize, and the individual’s depression should improve. Interpersonal therapy is usually employed in combination with psychopharmacology, which deals with the biological aspect of depression. The following characteristics define IPT’s therapeutic approach: • Time-limited and focused on one or two problem areas • Targeted toward diagnosis, symptoms, and the interaction of symptoms and interpersonal functioning • Focused on the here-and-now as opposed to childhood issues • Focused on interpersonal problems • Focused on the interrelationship between mood and current life events • Emphasizes clients’ ventilating feelings and learning to manage negative effects (Bleiberg & Markowitz, 2014; Lipsitz & Markowitz, 2013) IPT is comparable to CBT in that they both use role-playing, skill-building, and action planning toward the reduction of depressive symptoms. One difference between the approaches is that IPT does not use formal homework assignments. Interpersonal therapy is less structured and focuses on expressing feelings, particularly negative ones, and learning to manage them. Another difference between CBT and IPT is that, while CBT focuses on distorted cognitions and associated behaviors, IPT treats depression as a medical illness that can interfere with the development of positive interpersonal relationships (Lipsitz & Markowitz, 2013). Although IPT recognizes the impact of childhood experiences, this therapy does not incorporate them into present functioning because IPT is more focused on how the symptoms of depression themselves affect psychosocial functioning (Bleiberg & Markowitz, 2014). According to the IPT approach, the four primary areas of interpersonal difficulty are grief, role disputes, role transitions, and interpersonal deficits (Bleiberg & Markowitz, 2014; Lipsitz & Markowitz, 2013). The IPT therapist encourages clients who have lost a significant other to express their grief and mourn their loss (Lipsitz & Markowitz, 2013). As clients proceed through the bereavement
process, the IPT therapist will help them develop new social networks and establish new social relationships (Lipsitz & Markowitz, 2013). Role disputes are another area of interpersonal difficulty involving conflict with a significant other. The IPT therapist encourages clients to vent their feelings of frustration and anger and then work toward either a reconciliation or acceptance that the dispute is at an impasse. Role transitions are a change in life status (Bleiberg & Markowitz, 2014). The IPT therapist helps clients redefine and develop coping skills when there is a major change in life, such as becoming a parent, ending a relationship, or learning of a medical illness. Interpersonal deficits are present in clients who may lack social skills and gravitate toward isolation (Lipsitz & Markowitz, 2013). The IPT therapist helps clients with interpersonal deficits identify maladaptive social skills and develop more positive, healthy ways of building relationships. For example, a client complains that he has no friends and feels very lonely. The therapist then asks the client to describe a situation when he has tried to approach a person for a potential friendship. The client relates that when he tries to hug a certain friend, the friend rejects him, and the client then becomes angry, yells, and throws things. The therapist helps the client identify behaviors that may trigger a conflict, like trying to hug someone he does not know very well or becoming angry and throwing things. Once the client understands how his behaviors contribute to a conflictual relationship, the therapist can help him learn new ways of developing relationships and minimizing conflict (Lipsitz & Markowitz, 2013). Mindfulness and Mindfulness-Based Cognitive Therapy (MBCT) Mindfulness-based interventions (MBIs) are effective for the treatment of biopsychosocial issues, including, among others, depression, anxiety, stress, anxiety, insomnia, substance abuse and addiction, and pain (Zhang et al., 2021). Meta-analysis supports the use of mindfulness as a stand-alone treatment, beneficial for the treatment of depression and anxiety (Blanck et al., 2018), even when not used in conjunction with traditional psychotherapy. Initially researched for impact on the reduction of stress, mindfulness-based interventions have now been associated with a decreased reduction in the vulnerability to depression and decreases in worry, rumination and reactivity, reappraisal, and suppression, resulting from the impact on the prefrontal cortex (Parmentier et al., 2019). Utilizing imaging, researchers examined the brain structure of novel mindfulness practices. Imaging indicated changes in brain structures that were associated with decreased symptoms of depression in just 40 days (Yang et al., 2019). Cheng et al. (2019) hypothesize the pathway of deep breathing activating the parasympathetic nervous system and heart rate variability in the reduction of depressive symptoms. Research supports that mindfulness practice focused on the reduction of rumination and worry may be especially beneficial in the prevention of developing symptoms of depression (Parmentier et al., 2019). Mindfulness-based cognitive therapy, a form of cognitive therapy that incorporates mindfulness practices rooted in the work of Jon Kabat-Zinn, was developed to prevent relapse for people with depressive disorders. MBCT utilizes the tools of mindfulness, including present moment awareness, meditation, awareness of sensations, and breathing to help the client learn the skills of being in the present moment, aware of thought patterns that drive depressive symptoms, and armed to experience and tolerate sensations and replace negative thoughts with compassion and acceptance (Psychology Today, 2022).
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Book Code: PCIL1525
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