Introduction

The interventions described in this chapter are psychological treatments which aim to induce remission in acute depressive disorders and prevent further episodes. Both relapse (early symptom return) and recurrence (a new illness episode) are common: at least 50% of patients with a first episode of depression have a further attack (see Chapter 16). Even higher recurrence rates (75% within 5 years) are reported for those with incomplete recovery from the index episode or with a previous history of depression (Elkin et al., 1989). About 16% of sufferers develop chronic depression (Scott, 1988). Mortality rates from suicide and other causes are also increased in those with depression.

The above issues highlight the need for effective tertiary prevention. The role of pharmacotherapy in the acute, continuation, and maintenance phases of the treatment of depression has been well studied, and clinical guidelines have been developed (Chapter 16). High rates of recurrence are particularly common if antidepressants are withdrawn early, where the individual has a history of previous episodes, or where psychosocial problems are present (Frank et al., 1990; Scott & Paykel, 1995). This has led to increased interest in psychological approaches to treatment.

Although psychological treatments have not been evaluated as extensively as drug therapy, data is emerging on good clinical practice in the use of these interventions in the acute episode (Scott, 1995) and in the prevention of relapse (Ludgate, 1994). This chapter identifies the role and characteristics of effective psychological treatments of depression.