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Is Cognitive Behavioral Therapy for Psychotic Depression an Appropriate Treatment?

written by: renasherwood • edited by: Paul Arnold • updated: 11/24/2010

Cognitive behavioral therapy is appropriate for long term treatment for those suffering from psychotic depression or even schizophrenia. But if the patient’s life or the lives of the general public are in immediate danger, it is not appropriate.

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    Cognitive behavioral therapy for psychotic depression can help patients with their long-term treatment in between psychotic episodes. But if a patient is experiencing any symptoms of psychosis such as hearing voices or seeing hallucinations, then CBT is not appropriate. In this state, a patient needs hospitalization and sedation until the psychosis passes.

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    How Common is Psychotic Depression?

    Depression afflicts people with different symptoms that can be hard to define in medical or psychological terms. For example, psychotic depression is not found in the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders Manual" or DSM-IV, although “psychotic disorder not otherwise specified" is. But the University of Massachusetts Memorial Medical Center states that 16 to 54% of all depressives suffer from psychotic depression or delusional depression.

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    What Happens During a Psychotic Episode?

    A psychotic episode is a medical emergency, whether or not the patient has already been diagnosed with a mental illness. Usually, the episode begins gradually and this is when cognitive behavioral therapy for psychotic depression can be used best. Unfortunately, a person has to experience at least one full-blown psychotic episode in order to learn to recognize the beginnings of an episode.

    People in a psychotic state are not rational and calm, which are two features needed for a patient during cognitive behavior therapy sessions or practices. Just how bad can people behave when gripped in psychosis? In 2001, Andrea Yates of Houston, Texas drowned all five of her children. The youngest was only a few months old. Because of the dangers to others, depressives in a psychotic episode need to be hospitalized until they become somewhat rational again.

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    Long Term Treatment

    People with psychotic depression are not always suffering from delusions or hallucinations. These episodes come periodically. In between episodes, psychotic depressives can gain help from cognitive behavior techniques. They can use talk therapy, journaling and talking to family members in order to help them distinguish their delusions from reality.

    This takes time, support from family members and therapists. Getting into group therapy may also help the patient hear the stories of others and learn from them. Family members should also be involved in treatment as they may help the patient recognize when a delusional episode is beginning. They also can help a patient stay away from anything that may trigger an episode.

    For example, Andrea Yates believed demons inhabited the body of her youngest baby and that her older children would grow up to be demons. She obsessively read the Bible. In her circumstances, getting religious material out of her home may have helped avoid the situation that lead to the murder of her children. She was also diagnosed with post-partum depression and advised not to have any more children.

    According to The BeST Center, patients with any sort of delusions need to discover the common theme behind them. When this is identified, the patient can learn how to replace obsessive, negative thoughts, such as devils inhabiting family members, to positive coping strategies such as singing a song, going for a walk or calling a friend. The BeST Center focuses on treating schizophrenia, but psychotic episodes are similar in many types of mental illnesses, including psychotic depression.

    In Yates’ case it can never be proven if cognitive behavioral therapy for psychotic depression could have helped her. But it certainly can help people with psychotic episodes by teaching them to know when to call for help.

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    Sources

    Depression Today. “DSM-IV: Major Depressive Episode." http://www.mental-health-today.com/dep/dsm.htm

    University of Massachusetts Memorial Medical Center. “Psychotic Depression: New Treatment Means New Hope." http://www.umassmemorial.org/MedicalCenterIP.cfm?id=3822

    Medicine Plus. “Major Depression with Psychotic Features." http://www.nlm.nih.gov/medlineplus/ency/article/000933.htm

    The Best Practices in Schizophrenia Treatment BeST Center. “List of 60 Coping Strategies for Hallucinations." http://www.neoucom.edu/bestcenter/uploads/pdf/List%20of%2060%20Coping%20Strategies%20for%20Hallucinations.pdf

    CNN.com. “Postpartum psychosis: A difficult defense." David Williams. Feb, 27, 2002. http://edition.cnn.com/2001/LAW/06/28/postpartum.defense/