On the 18th of July this year NICE produced new draft guidelines on the treatment of depression.
It is a welcome development on the previous guidelines from 2009 not least because it recognises that there are ‘depressions’ rather than just ‘depression’.
There are psychotic and complex depressions. The guideline pays particular attention to chronic depression.
Chronic depression lasts for two years or more. It’s different. The style of thinking of the person who has it changes. It is summed up by the words of J.K. Rowling who spoke about her own depression
“….our thinking becomes global. Depressed people find it hard to see individual differences. If someone lets them down it means that no one can be trusted. If someone does not get in touch it means that no one cares.”
The new draft NICE guidance both recognises the nature of chronic depression and the one type of psychotherapy which seems to help.
Cognitive analysis system of psychotherapy or CBASP is an approach which has been around since the 1980s in America.
Its perspective on chronic depression borrows from the work of Piaget, the child psychologist who outlined the different stages in childhood development.
In the stage that he called 'pre-operational' learning, which takes place between the ages of 2 and 7, he talked about children 'living in their head'; being unable to make links between their thoughts, feelings and actions, jumping to conclusions and seeing their feelings as “stone cold” fact.
As the founder of CBASP, Jim McCullough noted that children at this stage, look at the world in the same way as people with chronic depression Andrew Solomon in talking about his own depression in the Noonday Demon, recognises that his depressed thoughts were “never real and always true.”
Ordinarily children will pass through the pre-operational stage. For people with chronic depression there is the suggestion that problems seem to occur around these ages.
They withdraw from relationships which are seen as a threat rather than something which can help them grow and develop. They believe that nothing works and anything they do will not matter. Their past will be the same as their present and future and will live, in the words of Thoreau, ‘lives of quiet desperation’.
CBASP appears to understand chronic depression. The therapist-client relationship is important. The therapist role provides more direct feedback to the client about the impact that they are having on them and by extension on others. This is important because in chronic depression the client can lose sight of the fact that they do have an impact on others.
This is built upon through an approach called situational analysis which looks at building up the clients’ sense of self efficacy in their lives.
The research base of CBASP is particularly strong and although it is not common in the England, it has been practiced for a number of years in Scotland.
Chronic depression is not easy to work with, and in my opinion it is good to see NICE recognising it and suggesting a treatment pathway for people with this condition.
What are your thoughts on the new NICE guidelines for depression? Are they a welcome change or not? Let us know in the comments below