Becoming a self-therapist: using cognitive-behavioural therapy for recurrent depression and/or dysthymia after completing therapy.

OBJECTIVES: To explore the ways in which people use cognitive-behavioural therapy (CBT) for recurrent depression and/or dysthymia after leaving therapy. DESIGN: A qualitative interview was used in this study. METHOD: Semi-structured interviews were carried out with nine people who had completed a course of CBT at least three months previously. The interviews explored their use of CBT techniques or models outside of therapy and their everyday management of depression. RESULTS: Eight of the nine participants reported engaging in some self-therapeutic activity, and identified depression, or the threat of depression, as a continuing presence in their lives. They used a range of techniques, either directly transferred from therapy or modified in some way, and identified a number of changes in the way they reacted to difficult situations or negative emotions. These included enactive responses such as leaving the room, making self-efficacy statements, or remembering what the therapist had said to them. Participants also described situations in which they could not use the things they had learnt in CBT. Finally, a range of factors that influenced the ways in which participants became self-therapists were identified. CONCLUSIONS: A number of implications for clinical practice are described. An understanding of how people modify CBT and use it (or not) in their everyday lives is important to understanding and improving effectiveness.

The challenge of patient power.

How can the rights of psychiatric patients best be safeguarded--and how far should those rights go? In the first of two articles, David Glasman reports on the Dutch experience.