Psychological Therapies for Depression

Psychological therapies represent one of the main pillars in the management of major depressive disorder, alongside pharmacological interventions and, in severe or treatment-resistant cases, somatic therapies. These are evidence-based approaches aimed at modifying dysfunctional thoughts, emotions, and behaviors, while promoting awareness, change, and adaptive strategies to cope with emotional distress.

Unlike medications, which primarily act on brain neurochemistry, psychological therapies focus on mental and relational processes, providing patients with tools to recognize and manage their emotional experiences, improve interpersonal functioning, and reduce relapse risk. In many cases, an integrated approach—psychotherapy combined with pharmacotherapy—yields superior outcomes compared to either treatment alone.

According to major international guidelines (NICE, APA, CANMAT), psychotherapy is recommended:

• As a first-line treatment in mild to moderate depression;
• In combination with pharmacotherapy in severe or treatment-resistant cases;
• To prevent relapse in recurrent depressive disorders;
• When the patient refuses, cannot tolerate, or has contraindications to medication.

There are various available therapeutic models, each with specific theoretical foundations and clinical techniques. Some focus on modifying dysfunctional thoughts (e.g., CBT), others explore relational and unconscious dynamics (e.g., brief psychodynamic therapy), while others still target social and communication skills (e.g., interpersonal therapy).

In recent years, third-wave therapeutic approaches have also gained recognition, such as metacognitive therapy, ACT (Acceptance and Commitment Therapy), and mindfulness-based interventions, which aim to improve the patient's relationship with their mental states rather than focusing on the specific content of thoughts.

Alongside structured therapies, integrative and complementary interventions—such as music therapy, pet therapy, or mindfulness—are increasingly being used. While not replacements for comprehensive treatment, they may provide additional support in enhancing psychological well-being and reducing social isolation.

The following pages explore in detail the main psychological therapies used in depression, highlighting their rationale, techniques, clinical effectiveness, and specific indications.

References
1. National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222]. 2022.
2. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. 2010.
3. Canadian Network for Mood and Anxiety Treatments (CANMAT). Clinical guidelines for the management of major depressive disorder in adults. Can J Psychiatry. 2016;61(9):510–523.
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