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The psychoanalytic theory that dominated the 20th century is being overtaken by therapies in which talking interventions for depression concentrate not on what has already happened, but on thinking about what will happen in the future in a positive way.

A positive focus on what might be ahead

Traditionally, talking therapies for depression have involved delving into the past, unearthing painful memories and discovering how they affect us in the present. These psychoanalytic methods were overtaken in the cognitive revolution of the 1950s, which means that now, patients are commonly exposed to Cognitive Behavioural Therapy (CBT), which concentrates on altering irrational and overtly negative thoughts.

Though the move was made from analytical to cognitive, both therapies involve a great deal of hindsight. Some researchers are suggesting it’s time for a new therapeutic revolution into the age of Future-Directed Therapy (FDT), in which talking interventions for depression concentrate not on what has already happened, but on thinking about what will happen in the future in a positive way.

Cedars-Sinai, a non-profit hospital to the stars in Los Angeles, is becoming a hotbed of FDT research. Dr Pandya, interim chair of their department of Psychiatry and Behavioural Neurosciences, described FDT as “designed to reduce depression by teaching people the skills they need to think more positively about the future and take the action required to create positive future experiences.”

Scientific support

The development of this approach was informed by several important findings: Thinking positively about the future and being able to anticipate positive outcomes has been consistently related to positive well-being, but people with depression tend to have fewer of these skills, and the brain regions responsible for optimism and positive anticipation that mediate these skills show reduced functioning in the depressed too. Fortunately however, teaching people these skills can increase positive future thinking and well-being, and reduce negative emotion and hopelessness.

Focusing on a positive future

With this evidence in mind, it is understandable that setting aside an hour a week to talk only about what makes you unhappy (as per Freudian psychoanalysis) may be detrimental to the recovery of depressed patients. FDT by contrast helps people to concentrate on what they want of the future and help them develop proactive behaviours to assist them in getting there.

Comparison with CBT

Researchers at Cedars-Sinai compared 90 minute sessions of FDT administered twice a week for 10 weeks to patients with Major Depressive Disorder (MDD), with ‘treatment as usual’ (cognitive based). Both groups showed improvements in anxiety, quality of life and satisfaction with the therapy, but the FDT group showed the greatest improvements in depression. Although this was only a small pilot study involving just over 30 patients, it may be the start of a new therapeutic revolution. Considering suicidal patients have been shown to have low positive anticipations of the future, FDT may prove in time to be a life-saving intervention.

The House Partnership, 17th February 2016


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