Psychological therapies are one of the fundamental pillars in the management of major depression, alongside pharmacological interventions and, in more severe or treatment-resistant cases, somatic therapies. These evidence-based approaches aim to modify dysfunctional thoughts, emotions, and behaviors, promoting awareness, change, and adaptive strategies for coping with emotional suffering.
Unlike medications, which act mainly on brain neurochemistry, psychological therapies target mental and relational processes, providing the patient with tools to recognize and manage affective experiences, improve interpersonal functioning, and reduce relapse risk. In many cases, an integrated approach—psychotherapy plus medication—produces better outcomes than either treatment alone.
According to the main international guidelines (NICE, APA, CANMAT), psychotherapies are indicated:
As first-line intervention for mild and moderate depression;
In combination with pharmacotherapy for severe or treatment-resistant forms;
To prevent relapse in recurrent depressive disorders;
When the patient has contraindications to, refuses, or poorly tolerates medication.
Multiple therapeutic models are available, each with specific theoretical rationales and operating methods. Some approaches focus on modifying dysfunctional thoughts (e.g., CBT), others on exploration of relational and unconscious dynamics (e.g., brief psychodynamic psychotherapy), and still others on communication and social skills (e.g., interpersonal therapy).
In recent years, third-wave therapeutic models have also become established, 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 the specific content of thoughts.
Alongside structured therapies, integrative and complementary interventions —such as music therapy, pet therapy, or mindfulness—are increasingly used and, while not replacing a complete treatment, may support psychophysical well-being and reduce social isolation.
The following pages examine in detail the main psychological therapy models used to treat depression, describing their rationale, techniques, clinical efficacy, and specific indications.
References
National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222]. 2022.
American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. 2010.
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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Butler AC et al. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17–31.
Wampold BE et al. The great psychotherapy debate: the evidence for what makes psychotherapy work. New York: Routledge. 2015.
Driessen E et al. The efficacy of psychodynamic psychotherapy and cognitive behavior therapy in the treatment of adult depression. World Psychiatry. 2013;12(2):137–148.
Jakobsen JC et al. Psychological interventions for major depressive disorder in adults: a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2022;10:CD010558.
Segal ZV et al. Mindfulness-based cognitive therapy for depression. New York: Guilford Press. 2013.
Hayes SC et al. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25.
