Jason Luoma, Ph.D.

Can the Depression Treatment Program Help Me with My Anxiety?

Yes. The Depression Treatment Program is a part of Portland Psychotherapy, where we are able to address a variety of mental health concerns, including anxiety. If you have stand-alone anxiety, we can see you on an individual basis and connect you with appropriate classes and groups. It also turns out that some of the same treatments that help with depression can also help with anxiety, and vice versa. So if you are experiencing a mix of anxiety and depression, our services are an appropriate match for your needs.

Is It Anxiety or Depression? Odds Are Its Both.

If you are experiencing low levels of positive mood, high levels of negative mood, and high levels of worry, you may be wondering whether you are anxious or depressed. While it’s tempting to try to get at an “either/or” description of what’s going on, the truth is that anxiety and depression usually travel together. We tend to worry more when depression has taken over our lives, and all of that worry can be pretty depressing. In one study of care utilization in medical settings, researchers found that more than 50% of people who visited their physician during an episode of anxiety or depression were actually struggling from both disorders at the time of their visit. Additional research has shown that for people who struggle with either anxiety or depression, eventually the rate of struggling with both can exceed 75% over the course of a lifetime. Even though anxiety and depression often feed into each other, the good news is that treatments that address one can lead to improvements in the other. Psychotherapy can help you break out of the anxiety-depression feedback loop and get back to living well.

What Kinds of Psychotherapy Actually Work to Alleviate Anxiety and Depression?

Not all psychotherapies are created equally, meaning you’ll be best off if you participate in therapies that science has shown to be useful to many people. We are dedicated to offering evidence-based cognitive behavioral therapies that have been shown to helpful in treating anxiety and depression, including Acceptance and Commitment Therapy and Behavioral Activation.

How Does Psychotherapy Help?

Anxiety and depression can feel overwhelming, and it’s not uncommon for people to feel as though they might “drown” in these moods. This makes it tempting to “get out of the pool” by staying away from the things that make you anxious, and at least that way you might feel a little bit calmer and safer. The down side to getting out of the pool is that you don’t get to have fun splashing around with your friends, which ultimately makes you feel even worse. Antianxiety and antidepressant medications are a bit like wearing “water wings” that can help you get back out there without drowning, but they really aren’t a full substitute for learning how to swim. Psychotherapy is just that – learning how to swim in the water of your moods – so that you don’t drown and are able to do the things you want to do with your life.

Psychotherapy can help you:

• Clarify who matters to you and what are the most important things in your life
• Develop greater compassion for yourself and others
• Build more intimate and fun relationships
• Become more fully present and engaged
• Get involved in activities that matter to you
• Deepen your satisfaction with life
• And yes, overcome anxiety and depression!

The Depression Treatment Program at Portland Psychotherapy helps you address anxiety and achieve these benefits by decreasing your experiential avoidance and increasing your psychological flexibility.

To learn more about treatment or to schedule an initial consultation, please call 503-281-4852 x1 or fill out the contact form below. We’re happy to be of help.

Depression involves changes in thinking, mood, and behavior that reflect some hurt, emptiness, or dissatisfaction with life. These changes can be problematic because they can lead to further pain and suffering, unless special care and attention is dedicated to promoting your healing and growth.

The Depression Treatment Program (DTP) is a collection of specialized services offered at Portland Psychotherapy. The program was developed to address the treatment needs of individuals with this common but serious disorder, with an emphasis on delivering the best available treatments and the highest standards of care.

WHY CHOOSE THE DEPRESSION TREATMENT PROGRAM AT PORTLAND PSYCHOTHERAPY?

• Expert care. Our DTP therapists are specialized in the treatment of depression, meaning their expertise is matched to your treatment needs. If you are already seeing a healthcare provider outside of Portland Psychotherapy for other issues, he or she may recommend that you participate in one of our program’s groups or see one of our therapists on an individual basis to help you receive special attention and support in this area.
• Personalized care. Your suffering will be met with compassion and understanding. Our therapists are skilled listeners and guides who are dedicated to helping you find a way forward that works best for you. If it is determined that group therapy is a good match for your needs, we will help you connect with your fellow group members to form a community of mutual appreciation and support. We will work closely with you to form goals, take actions, and monitor your progress as you make peace with your suffering and become more engaged with healthy living.
• Modern treatments. Our depression treatments are based on the best available modern research. Portland Psychotherapy is itself a dedicated research facility, meaning our clinicians are highly informed and up to date with providing the most effective and proven care.
• Treatment for complicated cases. In addition to offering depression-focused individual and group psychotherapy through the DTP, Portland Psychotherapy has competent therapists available who can help you address other issues that can come along with depression, such as anxiety, substance abuse, body image concerns, trauma, and other issues.
• Care coordination. We will communicate and work with your other health care providers to help insure that your treatments are working together to produce the best possible care.

ARE YOU READY TO START?

If you or a loved one is struggling with depression or mood problems, we’re here to help.

Give us a call at: 503-281-4852

or send us a message using the confidential form below.

Initial Consultation. The first step on the road to recovery is to talk with one of our therapists who can help develop a treatment plan that fits your situation. During your first meeting, you will have the opportunity to express your concerns, talk about how depression has affected your life, and ask any questions you may have. Your therapist will want to learn more about your symptoms, your history, and about what is important to you in life.

Your therapist will also ask you to complete some questionnaires to help measure your depression and life satisfaction. These measures will help you and your therapist better understand your experience, and will serve as a baseline when tracking your progress.

In addition to addressing your depression, issues such as substance abuse, trauma, suicidal ideation, and medical conditions may need to be considered when planning your treatment. By learning more about your personal situation during your initial consultation, your therapist will help determine whether individual therapy and/or group therapy will be the best match for your treatment needs.

Depending on your situation, you may have other medical or mental health care providers involved in your treatment. Your therapist will want to know about the types of care you are receiving in order to coordinate your care. It can be helpful to bring a list of your other health care providers’ contact information to give to your therapist, along with information about any medications you may be taking.

Finally, while there are practical matters to attend to, you and your therapist will want to have a good working relationship that is personal, genuine, and fulfilling. The initial consultation is an opportunity for you and your therapist to begin forming a meaningful and curative relationship.

Individual Therapy. Following your initial consultation, you and your therapist may conclude that you are a good match for individual therapy. Individual therapy can work as a stand-alone treatment for depression, or can be supplemented with group therapy. Individual therapy can help address issues that may not be fully addressed in the ACT for Depression Group (see below), such as substance abuse, trauma, suicidality, or chronic illness. Individual therapy is tailored to your specific treatment needs, but generally involves developing new skills to deal with difficult thoughts and emotions while moving forward with life. Individual therapy involves meeting once per week for 45-50 minute sessions over roughly 3 or more months; the time frame is adjusted depending on whether you are continuing to make progress.

Group Therapy or Skills Class. During the initial consultation, it may also be determined that you are a good match for a therapy group or skills class that relates to your problems. While you may be facing other issues such as anxiety or substance abuse, the group is an opportunity to focus your attention on finding new ways to overcome depression. Depending on the level of care appropriate to you, you may attend the group alone or attend both the group and individual therapy. Group therapy is effective in treating depression, with the added benefits of the support and perspective that can be gained from interacting with your fellow group members. We usually offer a variety of other groups and classes. You are welcome to consider attending any services you find helpful.

Medication Evaluation. Your provider will speak with you about whether you would like to consider antidepressant medication if you are not taking one or whether you are happy with your current medications if you are already taking some. They will then help you either get in to see our psychiatrist on staff or help you find an appropriate referral (this often depends on your health insurance).

Get an initial consultation

If you’d like an initial consultation to learn about your treatment options, or just want more information, we’re here to help.

To reach us, give us a call at: 503-281-4852

or send us a message using the confidential form below.

All people feel sad at times, and it is a normal part of life to occasionally feel “down” for a few days, particularly when losses are experienced or bad things have happened. Some people find themselves stuck in feelings of helplessness, hopelessness, and worthlessness, sometimes for weeks and even years at a time. This dark and empty state is often labeled clinical depression. In this state, motivation to do the things that once seemed worthwhile and meaningful drains away and not much feels worth doing. This pain is real and can feel devastating, but you are not alone in this suffering. In fact, nearly 10% of adult Americans could be diagnosed with some form of depression in any given year. Depression can take various forms, and each individual’s struggles are unique. Some of the various forms of depression include:

Major Depression. The DSM-IV is a book that provides the most accepted guidelines for distinguishing between various forms of depression. The DSM-IV describes Major Depression as a period of at least two weeks in which a person feels sad or empty, or does not have interest or take pleasure in things that used to be enjoyable. Other symptoms include significant changes in weight and appetite, over or under sleeping, being restless or slowed down, fatigue or loss of energy, excessive feelings of worthlessness or guilt, difficulties with concentration and decision-making, and recurrent thoughts of death or suicide. These symptoms last most of the day, nearly every day, and can be distinguished from the symptoms associated with medical conditions (e.g., thyroid problems) or bereavement.

Bereavement. While sometimes extremely painful, the grief felt in response to the loss of a loved one, technically speaking, is not a form of depression. A person who is experiencing grief usually does not require therapy, but eventually comes to terms with the loss with the guidance of their cultural support system. However, some grieving individuals may choose to seek additional support from a therapist to help relieve associated symptoms (e.g., insomnia). It is possible for a person to experience both bereavement and depression, in which case additional support is likely to be helpful.

Dysthymic Disorder. A person with dysthymia has many of the symptoms of Major Depression, though the symptoms tend to be less severe. The key feature of dysthymia is it’s chronicity – the DSM-IV says the symptoms must have lasted at least two years.

Bipolar Disorder. People with Bipolar Disorder experience the symptoms of Major Depression, but also experience periods of persistently elevated, expansive, or irritable mood. Despite sometimes being depressed, they may also sometimes feel “on top of the world” and become very active in pursuing pleasurable activities that are later regretted (e.g., buying sprees, sexual indiscretions). Other symptoms of feeling “keyed up” may include a decreased need for sleep, being more talkative or feeling pressure to keep talking, racing thoughts, and distractibility. These “manic” symptoms last several days at a time and can sometimes lead to hospitalization.

Seasonal Affective Disorder. When depression is tied to the winter months but resolves over the summer, it is possible that the person is experiencing Seasonal Affective Disorder (SAD). This form of depression is specifically linked to the winter months and is not better accounted for by changes in lifestyle (e.g., seasonal work).

HOW PEOPLE GET STUCK IN DEPRESSION

Sometimes depression can seem like a major struggle in a never ending battle. At other times, depression means not feeling like doing anything at all. The apathy drains out all motivation, and it’s hard to see the point of going on living. A person who is depressed is likely to give up, stop striving for anything, and can’t picture how the world could ever mean anything again. What remains is a desire for the pain and suffering to go away, to finally have some relief.

Because depression is so painful, we can become consumed with trying to get rid of it. We try to look on the bright side, find a silver lining, drink alcohol, use drugs, take prescription medications, exercise, sleep in, ruminate, read books, go to therapy, seek spiritual guidance, give up, and try all over again, desperately trying to make the pain go away. Unfortunately, our attempts to escape the suffering that comes with depression can actually backfire, leading to more of the very thing we were trying to escape. The problem is that focus on escaping the suffering can cause us to lose contact with the activities and people that connect us with a sense of purpose and meaning in life.

Have you tried different treatments for depression but are still struggling? Whether your depression is mild or severe, treatment-resistant depression often produces additional feelings of frustration and hopelessness. Understandably, there may be a temptation to give up on treatment all together, but it is important to explore all of your options if there is a chance of treatment helping you lead a meaningful, worthwhile, and satisfying life.

If this is your first time struggling with depression and you have had no prior treatment, the odds are that you can expect a complete recovery (American Psychiatric Association, 2000). However, without appropriate treatment, about 20-30% of individuals who experience a major depressive episode continue to have some degree of impaired functioning or distress months to years longer than would be expected. For some individuals, symptoms can persist even after having tried various types of medication or therapy. The Depression Treatment Program at Portland Psychotherapy is designed to help people who have tried other treatments without success.

Medical doctors use the term “treatment resistant” depression when two or more medications have failed to relieve depressive symptoms. Typically, the initial medical response to this situation is to continue rotating through medications and to address other possible medical causes of the symptoms (e.g., respiratory problems). It is also possible that you have tried alternative medical treatments (e.g., electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation) without achieving the desired effects. Likewise, you may have had limited success with psychotherapy if you are struggling with treatment-resistant depression. Clearly, treatment-resistant depression calls for specialized, high quality attention and care.

WHY HAVE OTHER TREATMENTS NOT WORKED?

• Was your care evidence based? For all their good intentions, not all health care providers deliver evidence-based treatments. There is literally no reason to expect a treatment to work if there has not been high quality research showing it to be effective. All therapy delivered at Portland Psychotherapy is evidence based.
• Was your care substandard? Not all treatments are created equally. Even if there is some evidence that a particular treatment works, there may be other treatments you haven’t tried that have been shown to work even better. Furthermore, no treatment is one-size-fits all. The Depression Treatment Program at Portland Psychotherapy will provide you with access to the highest quality individual and group psychotherapy for depression, with an emphasis on meeting your unique treatment needs as an individual.
• Was your care thorough? It’s likely that the depression you are facing touches many aspects of your life, and addressing problems in one area may not automatically lead to improvements in other areas. For example, masking difficult emotions with medications does not necessarily lead to finding a sense of meaning and purpose in life. The Depression Treatment Program helps you explore and consider your full experience in helping you make choices and move forward.
• Was your care coordinated? You may be working with different organizations and providers in managing your health, and poor communication between these resources can have a negative impact on outcomes. As a part of your services with the Depression Treatment Program, we will be sure to communicate with your other providers to create a coordinated team that will insure your best possible overall treatment.

Over the centuries, many people across different cultures have developed many diverse ways of dealing with life’s hardships. These include spiritual, artistic, meditative, medical, interpersonal, behavioral, educational, psychological, and community-based techniques. There is no single “right” technique, and there are many paths available for you to choose from. With so many options available, it can be difficult to wade through them all. In general, there are two main things to keep in mind when evaluating a particular treatment for depression: 1) What do you want out of therapy? and 2) Does the treatment do what it is supposed to do?

What Do You Want Out of Treatment?

When it comes to finding a treatment for depression, many people find themselves focused on trying to find something that will get rid of their unwanted feelings of sadness, worthlessness, emptiness, and loss. Indeed, many treatments (e.g., traditional Cognitive Therapy, antidepressant medications) are geared towards eliminating these symptoms of depression. Alternatively, rather than trying to get rid of depression, some therapies focus on finding meaning and improving your quality of life (e.g., Acceptance and Commitment Therapy). Although more meaningful living often reduces depression, the aim is about getting more satisfaction out of life rather than having fewer negative thoughts and feelings. By choosing a particular therapy you are choosing to make something important- what is important to you?

Does the Treatment Do What It is Supposed to Do?

After deciding upon what you want out of treatment, there is the question of whether a given therapy actually produces the outcomes that it is supposed to produce. Some therapies help almost no one (e.g., “quackery”), whereas other therapies tend to work well for many people. What works for some people might not work for others, so your own experience with trying a particular therapy will be the best way to find out what actually works for you. The downside to this “trial and error” approach is that you might have to try many therapies before landing on the one that works best for you, which can be costly and prolong your suffering. Fortunately, concerned researchers have spent decades systematically sorting through existing therapies and developing new techniques to learn the difference between what tends to work best for people and what tends to be a waste of time. Choosing an evidence-based therapy gives you the best chance of being effective and efficient in successfully overcoming your depression.

Of the various types of psychotherapy that have been researched, one particular family of therapy, Cognitive Behavioral Therapy (CBT), has the largest body of research showing it to be consistently effective in treating depression. The Depression Treatment Program at Portland Psychotherapy is based in the CBT tradition, and specifically employs Acceptance and Commitment Therapy (ACT), Behavioral Activation (BA) , and Radically-Open Dialectical Behavior Therapy (RO-DBT) for the treatment of depression. You can learn more about the research behind these evidence-based therapies by clicking on the following links:

• A summary review of various studies showing ACT to be as effective as the most effective treatments for a variety of disorders, including depression
• A study showing ACT to be as effective as traditional Cognitive Therapy for the treatment of depression and anxiety
• A study showing BA to be as effective as antidepressant medications and more effective than traditional Cognitive Therapy in treating severe depression
• A study showing that BA and traditional Cognitive Therapy are more effective than antidepressant medications at preventing relapses of depression
• A paper describing and comparing ACT, BA, and traditional Cognitive Therapy
• A website dedicated to information about ACT and related topics

AFFORDABILITY

When choosing a therapy, it is also important to take into consideration your insurance, financial resources, time resources, and ability to travel to a clinic. The therapists at Portland Psychotherapy are able to accept a variety of forms of insurance, and we also have reduced fee services available for those in financial need. In addition to Portland Psychotherapy, there are several other low-fee clinics at various locations across the Portland area.

Online Self Help Programs for the Treatment of Depression:

Another approach to geographic or financial limitations is to consider whether online therapy might work for you. Below are some links to resources outside of Portland Psychotherapy regarding online depression treatment programs. The links are provided for access and informational purposes; we are not necessarily endorsing any products or services.

Beating the Blues (free online program)
The ANU Centre for Health Research e-hub (several free online programs)

Contact us:

If you or a loved one is struggling with depression or mood problems, we’re here to help. We are happy to help you figure out your treatment options and figure out the best path for you toward health and wholeness.

Feel free to give us a call at: 503-281-4852 x1

or send us a message using the confidential form below.

Behavioral Activation (BA) is a core component of Cognitive Behavioral Therapy and is one of the most powerful and lasting treatments for depression. Whereas some treatments characterize depression as a medical illness, Behavioral Activation was born out of a psychological tradition that views depression as a set of learned behaviors – such as avoidance, withdrawal, and rumination – which can be “un-learned.” It offers hope that people with depression can learn new ways of living more rewarding lives.

The basic premise of Behavioral Activation is that increased engagement in meaningful activity will decrease depression. In contrast, the avoidance of unpleasant feelings and thoughts can backfire and lead to greater suffering. For example, a person may avoid the stress of the upcoming day by sleeping in late, but this strategy may leave the person with fewer chances for rewarding experiences; having fewer positive experiences can cause more unpleasant thoughts and feelings, leading to more avoidance, and ultimately more suffering. The solution to this depression feedback-loop is to learn how to become more active and engaged with meaningful activities (hence the name Behavioral Activation), even while feeling unhappy, anxious, unmotivated, or irritated.

Behavioral Activation is an evidence-based therapy, meaning research shows that it can help people. In one study (Dimidian et al., 2006), BA was shown to be as beneficial as anti-depressant medication in treating major depression – without the harmful physical side-effects. Further still, Behavioral Activation has been shown to be more effective than anti-depressant medications at preventing relapse of depression after treatment has ended (Dobson et al, 2008). In fact, research shows that it is primarily the behavioral component of Cognitive Behavioral Therapy that has accounted for its success (Jacobson et al, 1996). This point makes sense because, instead of directly trying to change the ways people think and feel, Behavioral Activation works “from the outside in” – the focus on changing behavior can lead to a better quality of life that then improves people’s inner experience – their thinking and emotions.

In conjunction with mindfulness practices and ACT, therapists at Portland Psychotherapy utilizes Behavioral Activation in individual and group therapy. Clients who participate in our program can learn how to stop the cycle of depression and prevent future depressive episodes. Our therapists help clients to work with rumination, to overcome avoidance and passivity, and to gain more flexible problem-solving skills. As a part of this work, we help clients achieve insight into the difficulties they experience by fostering greater self-awareness through mindfulness. We look closely at triggers of avoidance and help clients become less reactive and more deliberate in making effective choices. Most importantly, our therapists help coach clients to pursue activities they value. Our expertise in Behavioral Activation offers clients an opportunity to live more rewarding and meaningful lives.

People with dysthymia usually feel like they have little or no joy in their lives. Rather, things seem gloomy most of the time. If you have dysthymia, you may feel like you’ve been depressed your whole life. You may have a hard time enjoying things and having fun. You might tend to be withdrawn, worry frequently, or criticize yourself as being a failure. You may feel guilty, worthless, or have difficulties with sleep. In any given year, about 3% of people could be diagnosed with dysthymia.

If you believe you may be suffering with the symptoms of dysthymia and would like to discuss treatment options with one of our therapists, please call us at 503-281-4852 x1. Evidence-based treatment of dysthymia gives you the best chance that treatment will be successful and minimize the risk of relapse.

What is depression?

Major depression is a serious problem for individuals and for society. According to a recent report published by the World Health Organization, major depression is the number one cause of death and disability in industrialized nations. This means that depression causes more problems for society than heart disease or diabetes or HIV or any other single health problem you can think of.

Selling the idea of a “chemical imbalance”

Over the last few decades, television and print commercials stating that depression is caused by a “chemical imbalance” have become commonplace. It seems that you cannot watch TV anymore without seeing a commercial advertising that some psychological problem is due to a “chemical imbalance.” Unfortunately, this depiction of depression is greatly oversimplified and leaves out many important factors in understanding this problem. While describing depression as due to a chemical imbalance may be useful in helping a drug company sell more of its products (prescriptions for antidepressant drugs increased about 400% from the mid 1990s to the mid-200s), this notion can also lead to negative effects among those struggling with depression. Many others have written about this misconception and advertising technique (for a few examples see here, here, and here). The main problem with this idea is that it is disempowering to the individual dealing with the problem, as it can lead to a person believing that there is nothing they can do to deal with their depression beyond taking a pill.

At this point, some readers may be thinking that I am blaming people with depression for being in the predicament they are in, but I am not. The answer is far more interesting than that. Read on to find out more.

Two problems with the idea of a chemical imbalance as the cause of depression

The idea that depression is due to a chemical imbalance has been thoroughly debunked by modern science. It’s widely acknowledged to be a marketing ploy or perhaps more generously, a “figure of speech.” It’s definitely not scientifically accurate.

Research has consistently failed to show a correlation between levels neurotransmitters in the brain and depression. There are no blood tests that can correlate neurotransmitters with depression levels. There are millions of chemical reactions occurring in the brain at any given time and there is no way to tell if those are related to derpession.

The origin of the idea was not based on research about levels of neurotransmitters in the brain, but instead on early research showing that anti-depressants affect seratonin (among other neurotransmitters). The logic was that if antidepressants increase seratonin levels, that therefore depression must be due to low seratonin levels. But this is a logical fallacy. Making this conclusion is simlar to saying that pain is caused by a lack of asprin in the brain. Just because asprin reduces pain doesn’t mean that pain is caused by an “asprin imbalance.”

The idea that depression is solely a “chemical imbalance” also does not account for the fact that several forms of psychotherapy have been shown in multiple studies to be just as effective as (and better at preventing relapse than) antidepressant medication. These findings are evaluated in more detail below.

How could psychotherapy be just as effective as medications?

We behave the way we do because our brain reacts in certain ways to our environment. Any new information or changes in our behavior or habits are stored in our brains. In fact, whenever we learn a new way of thinking or behaving, our brain changes to reflect this new behavior. For example, when someone learns to do mathematics problems better, a region of their brain has changed its structure to reflect this new learning. Both the cellular structure of individual neurons has changed as have the levels of neurotransmitters (for some research that shows that exercise, for example, changes the brain’s structure, look at this link).

This idea also applies to depression. Events in our lives can teach us to be depressed, and in turn our brain changes in a way that is consistent with acting depressed. As a result of experiences in life, we end up with a brain which reacts in certain depressed ways. Just like our brain changes when we learn to live in a depressed manner, we can also learn how to live a non-depressed life and our brain will change to reflect that. Consistent with this idea is research showing that similar changes are found in peoples’ brains when they recover from depression, whether this is the result of psychotherapy or medication. In simpler terms, if you change your behavior, regardless of how this occurs, your brain will change. Similarly if your brain changes, your behavior changes.

Thus there may be multiple ways of recovering from depression, including both medication and psychotherapy. In fact, several studies have shown that some forms of psychotherapy (e.g., CBT, mindfulness based cognitive therapy, and interpersonal therapy) can decrease the rates of relapse to depression even after therapy is stopped. This doesn’t happen with medication. With medication, relapse prevention only lasts as long as the medication is taken. Thus, in order to prevent future episodes of depression, a person may need to stay on medication indefinitely. And other research shows that once on antidepressants, it can often be hard to get off due to antidepressant discontinuation symptoms.

How does psychotherapy help depression?

Science has not been completely clear on this point yet. But neither do we know why antidepressants help with depression. We just know that both help people some of the time. Anyone who tells you they absolutely know how psychotherapy helps alleviate depression is trying to sell you something.

Nevertheless, in this author’s eyes, one theory appears particularly promising in accounting for much of how psychotherapy works. This is what is called the behavioral theory of depression, first proposed by Ferster in 1973. This theory holds that depression is the result of a lack of rewarding activities in a person’s life, whether this is due to lack of opportunity (e.g., being trapped alone in a cave) or due to other reasons (e.g., a person withdraws from friends as a result of “not wanting to bring them down”). According to this theory it is the lack of engagement in activities that are truly meaningful and valued that results in depressed feelings. In depression, a person then typically reacts to these depressed feelings by further withdrawal or disengagement with life, which results in exacerbating the depressed feelings.

According to this theory, the problem here is not actually the depressed feelings or thoughts, but rather a person’s reaction to these depressed feelings or thoughts that perpetuates the lack of rewarding activities and keeps the person depressed. Thus, techniques which help the depressed person become reengaged in the world are the route to recovery. This is the basic theory behind much of the therapy that we  do at Portland Psychotherapy. We help people to overcome the obstacles to engagement in valued activities in their life and to not just feel better but also to live better, with more vitality and meaning. This is, of course, an oversimplification, but it’s an important part of recovery from depression.

If you need help with depression…

If you think you may be suffering from depression, don’t hesitate to find someone who can help. Studies show that while depression can sometimes go away on its own, often it does not and requires treatment. Other studies show that even if your depression would have improved without professional help, it usually improves more quickly with treatment, either psychotherapy or medication or even a placebo. Some people choose to see their primary care doctor for medication. If medication helps, that’s great. Some people find that medication doesn’t help or doesn’t help enough. They may find that side effects are too high of a price to pay or may not want to have to take an antidepressants for the rest of their life. For many people, psychotherapy is a good alternative to medication. Psychotherapy can often be helpful even if medications aren’t.

Some people try psychotherapy first. Some forms of psychotherapy have more evidence for depression than others. Particularly well proven are cognitive-behavioral therapies, interpersonal psychotherapy, and emotion-focused therapies. I’d recommend starting with someone who practices one of these approaches. If they are not helpful, look for other approaches. At Portland Psychotherapy, we use evidence based practices in treating depression, which includes cognitive behavioral approaches and emotion-focused therapy.

Depression is highly treatable. In consultation with you, we will design the most effective treatment plan for your specific situation. Our approach is active and focused on your values and specific needs. We also provide referrals to our in-house medication provider if needed as part of a complete treatment experience.

In our depression treatment program, we specialize in using evidence-based therapy and counseling methods for mood disorders. This means that the work we do is informed by science and is based on what has been shown to be effective in research studies.

Nearly 6.3 million Americans are on antidepressant medications, a rate that has more than doubled in just the past ten years (Olfson, 2002). Many people wonder why they might want to go to psychotherapy for their depression symptoms when medication is such a common treatment. That is a very legitimate question, and one that should be explored with all the facts. While medication is helpful for some forms of depressive disorders, it is often not the only or even best treatment for depressive symptoms. Numerous scientific studies, including those conducted by the National Institutes of Health, have shown that several forms of psychotherapy are at least as effective in reducing symptoms of depression as are medications. In addition, some studies have shown that psychotherapy is more effective at preventing relapse of subsequent depressive episodes than medications. Furthermore, for those who do respond well to antidepressant medication, studies have shown that the addition of psychotherapy to pharmacological treatment (i.e. medication) often results in even greater benefit. Psychotherapy can help make sustaining changes in your life so that you aren’t just able to get out of bed in the morning, but you have created a life that is worth getting out of bed for.

Some of the specific evidence-based treatment for depression we offer are:

• ACT group treatment for depression
• Behavioral activation treatment for depression
• Acceptance and Commitment Therapy for depression
• Radically Open Dialectical Behavior Therapy for Chronic and Treatment-Resistant Depression

If you would like to talk to someone for an initial consultation, you can call our confidential phone line at 503-281-4852 x1 or leave us a message using the secure contact form below: