RESUMO
OBJECTIVE: Many studies have shown that a considerable number of patients with prolonged depression are refractory to drug therapy or supportive psychotherapy. A few studies have shown the short-term effectiveness of intensive Naikan therapy for prolonged depression, but the long-term effects have not been reported. For other psychotherapies also, few studies have demonstrated their long-term effectiveness for prolonged depression. The purpose of the present study was to assess the long-term efficacy of intensive Naikan therapy for patients with prolonged depression and to investigate the factors contributing to its efficacy. METHOD: At Tottori University Hospital, 23 inpatients with prolonged depression were treated with intensive Naikan therapy. The age, sex, age at onset, number of depressive episodes, duration of the present episode, diagnosis and family history were investigated. The Tokyo University Egogram (TEG), Yatabe-Guiltora personality inventory (YG test) and Rosenzweig picture-frustration (PF) study were conducted before and after intensive Naikan therapy to investigate psychological changes. The long-term efficacy (average: 24.5 +/- 10.6 months) of intensive Naikan therapy for prolonged depression was assessed with Global Assessment of Functioning scale (GAF). "Improvement" was defined as a post-therapy GAF score of 61 or higher. The Hamilton Depression Rating Scale (HAM-D) was applied to confirm the GAF results. Whether the patient achieved awareness of other's viewpoint, awareness of egocentricity, feeling of love, breaking out from self and sense of fulfillment after intensive Naikan therapy was investigated. RESULTS: Fifteen patients (65.2%) showed improvement in GAF and HAM-D (improved group) and eight patients showed no improvement (non-improved group). The average GAF score changed from 46.1 (before Naikan therapy) to 81.8 (at outcome assessment) in the improved group and from 45.3 to 52.8 in the non-improved group. The improved group had significantly shorter average duration of the present depressive episode and significantly less depressive episodes compared to the non-improved group. Only the improved group showed significantly lower scores on the critical parent (CP) scale of TEG, cyclic tendency (C) on the YG test and extraggression (E-A) in PF study. In the improved group, significantly more patients achieved deep insight (Naikan); and significantly more patients achieved awareness of other's viewpoint, awareness of egocentricity, feeling of love, breaking out from self and sense of fulfillment after intensive Naikan therapy. CONCLUSIONS: Our results suggested that intensive Naikan therapy for prolonged depression was equally as effective as Morita therapy, interpersonal therapy or group psychotherapy, and the effects of intensive Naikan therapy continued for a long term. Attainment of deep Naikan brought psychological changes in patients showing improvement, motivating them to continue Naikan therapy in daily life. We consider that this is the key factor that maintains the long-term efficacy of intensive Naikan therapy.
