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32ALTERNATIVETHERAPIESjulaug2011VOL.17NO.4AnEvidence-basedIntegrativeCAMModelforDepressionPsychological.Psychologicalinterventionisanimportantcomponentintreatingdepression.Psychologicaltechniquesmaybeemployedinpracticebycliniciansalthoughincasesoflackofexpertiseonthepartoftheclinicianormarkedpsychologicaldys-functioninthepatientreferraltoaclinicianwithanadequatelevelofqualiAcationandexperienceinpsychologyisadvised.Basicx1cpsy-choeducationx1dshouldalwaysbeofferedtothepatientinitiallypro-vidinganoverviewofthebasicsofdepressionpossibletriggersandtreatmentoptions.70Thismayempowerthepatientbygivinghimorhermoreinsightintothecondition.MDDtreatmentguidelinesoftensupporttheuseofpsycho-logicalinterventionssuchasCBTandIPTinmilddepressionoversyntheticmedication.21617CBTandIPTareacceptedpsycho-logicalinterventionsbothhavingasimilargrade-Alevelofevi-denceinthetreatmentofMDD.CBTinvolveslearningcognitiveskillstoreprogramorreplaceerroneousornegativethoughtpat-ternswithpositivebalancedcognitionsandtoinstitutepositivebehavioralmodiAcations.71Thetheoryisbasedontheconceptthatnegativecriticalanderroneousthoughtpatternsprovokedeleteriousemotionalandphysiologicalresponses.Interveningbeforethiscascadeoccursandestablishingapositivebalancedinnerdialoguecanpreventthisspiral.ThemodiAcationofcogni-tivebiasesalsomayhaveabiologicalbeneAtbyreducingareac-tiveresponsefromtheamygdalaandreducinganupregulationoftheHPA-axiswhichifchronicincreasescortisolwhichhasaharmfuleffectonneurogenesisviainhibitionofbrain-derivedneurotropicfactor.7273MindfulnesstechniquesalsomaybebeneAcialastheycanpreventruminationonpastproblemsorfutureconcerns.74TheuseofmindfulnesshasarichhistoryinEasternmeditativepractices75andtheteachingofsimplemeditativetechniquessuchascoordinatedbreathingandmentalfocusonthepresentenvironmentbodilysensationsbreathcurrentemotionsmayhaveaplaceinanintegrativemodel.Mindfulnesstechniquesalsocanbeappliedinthecontextofrelaxationtherapy.Ameta-analysisofrelaxationtherapieshasrevealedagreatereffectthanplaceboinreducingdepressionsmallclinicaleffectalthoughitwasfoundtobelesseffectivethanpsychologicalinterventionssuchasCBT.76Teachingproblem-solvingskillsalsomaybeofbeneAtespeciallyinpatientswithexternalcircumstancesthatarecreatingstressandimpactingmood.77Othertechniquessuchasemotion-focusedtherapyself-systemtherapycognitivecon-troltrainingandpositivepsychotherapyalsomaybeofassis-tance.78PsychologicaltechniquesmayalterbiologicalprocesseswithCBTandIPTbeingfoundtomodulatelimbicactivityespe-ciallythehippocampusandamygdalaenhanceneuronalplas-ticityandexerteffectsonGABAergicandserotonergicpathways.79-81Posttreatmentbrainimaginghasdemonstratedthattheseinterventionsmayincreaseactivityinthelefttemporallobeandhippocampalandcingulatedareas.7980Social.Evidenceconsistentlysuggeststhatfamilialorenvi-ronmentalfactorssuchaspresentorearlychildhoodtraumaticeventsandacutestressfuleventsorchronicexposuretostresscanincreaseriskofadepressiveepisode.912Thoughcognitively-focusedpsychologicaltechniquesmaybeeffectiveinterventionssocialelementsmayneedtobespeciAcallyaddressedinsomepatients.Evidenceconsistentlyrevealsthatsocialisolationandreducedsocialcontactisdepressogenic.82Thismaycauseorexac-erbateanepisodeanddepressioninturnmaypromptalackofsocialengagementtherebyprolongingandworseningtheepi-sode.Supportnetworksarecrucialwithsocialunitsfamilyandfriendshavingaprofoundimpactonmentalhealthprovidingemotionalnourishmentandsupport.Theclinicianisthereforeadvisedtoconsidertranspersonalelementsthatmaybeaffectingthepatientx19smentalhealth.Insuchcasesafamily-focusedcoun-selingmodelmaybeofassistance.ThesocialconBictmodelsug-geststhataperceivedattacktoapersonx19sself-esteemmayunderminehisorherplaceinthesocialhierarchyandperceivedhopelesssituationsmayprovideapowerfultriggerforadepres-siveepisode.83Theteachingofassertivenessrecognitionofhealthysocialboundariesandgeneralcommunicationskillsmayprovidethetoolsnecessarytoimprovesocialrelationsandtomitigatetranspersonalchallenges.78TABLE2SpeciAcClinicalFociinTreatingDepressionPossibledepressivetriggercausationorexacerbatingfactorInitialprimarytreatmentfociBiologicalgeneticnodiscerniblepsychosociallife-styletriggerAntidepressantCAMHypericumx0perforatumx0S-adenosylmethionineL-tryptophanor5-HTPacupunctureLifeeventegbereavementcrisisPsychologicalsupportcounselingproblemsolvingAbusivefamilysocialdynamicPoorsocialskillsUnemploymentPsychosocialtechniquesinterperson-altherapyproblemsolvingasser-tivenesstrainingfamily-focusedther-apyreferralforsocialsupportandnetworksemploymentservicesNegativecognitionsPsychologicaltechniquescognitivetherapybehavioraltherapypsycho-therapyPoordietDietlowinomega-3orfolateDietaryadviceadequatelevelsoffruitvegetablescomplexcarbohy-dratesomega-3AshoilsleanmeatslowersaturatedfatsandreAnedcar-bohydrates.SupplementwithfolicacidEPADHAblendifdeAcientObesitySedentarylifestyleExerciseplangradedapproachincreasinginintensity3-5dwkwithsocialinteractionifpossibleCircadianrhythmfactorslackofsunlightpoorsleepWakeSleepcyclealterationsleephygienelighttherapyinthemorningexerciseavoidanceofstimulantsComorbiditiesmedicalsubstanceabusedependencyReferralmedicaldoctorforclinicalexaminationandappropriatetestssubstanceabusedependencyclinicclinicalpsychologist