RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
DEPRESSION
August, 2006
Dimensions and Costs of the Problem
MDD
(Major Depressive Disorder) is defined as a depressed mood,
accompanied by loss of interest in usual activities,
changes in appetite, energy level, or sleep pattern,
hampered mental and physical function, or suicidal thoughts
or action (APA, 1994).
Depression is the leading cause of disability in the U.S.
and established market economies worldwide; the various
types of mood disorders affected approximately 20.9 million
American adults in a given year (The Numbers Count, 2006).
Women are about twice as likely as men to suffer from
depression (Robins and Reiger, 1990).
The total cost to the U.S. economy in 1990 rose to $83.1
billion, which included $26.1 billion in direct medical
costs; $51.5 billion in workplace costs, and $5.4 billion
in suicide-related costs (Greenberg, Kessler, et al, 2003).
Depression ranks among the top three workplace problems for
employee assistance professionals, following only family
crisis and stress (Greenberg, Stiglin, et al, 1993).
The milder form of depression, called dysthymic disorder,
affects approximately 1.5% of the population age 18 and
older during their lifetime (Kessler, Chiu, et al, 2005).
Depression can end lives as well as impoverish them. In
2003, 41,484 people died from suicide in the U.S. The vast
majority of these people suffered from depression (Hoyert
and Heron, 2006). Depression also contributes to increased
deaths and severity of heart disease and other conditions
(Ades, Savage, et al, 2002; Williams, Kasl, et al, 2002).
The causes of depression are thought to include genetic
predisposition, stress, loss, physical symptoms such as
pain or disability, low sense of self-efficiency, learned
helplessness, repressed anger, distorted, negative
thinking, and metabolic processes (Bresler, 2001).
Decreased levels of the neurotransmitter serotonin are
usually found in depressed patients.
Treatment
of Depression
Selective
Serotonin Reuptake Inhibitors (SSRIs) have largely replaced
the somewhat more dangerous tricyclics and monamine oxidase
inhibitors. Still, SSRIs are no more effective than those
older drugs for most indications (Summary of Current
Evidence, 2000). SSRIs can have many side effects,
especially gastrointestinal symptoms, loss of sexual desire
or ability, tremors and nervousness.
Fifteen to 30% percent of patients in various studies took
themselves off an SSRI because of side effects, and 20-50%
fail to show any benefit from these medications
(Aberg-Wistedt, Agren, et al, 2000; Summary, 2000). Even
when SSRIs work, they leave the patient unprepared for
future episodes of depression, which may require
re-treatment.
Non-drug Approaches Including Imagery
Psychotherapeutic
approaches include cognitive therapy (changing patients’
distorted negative thinking), behavioral therapy
(especially stress management programs), psychodynamic
approaches, solution-oriented brief therapy, and others
(Bresler, 2001). Many experts believe that combining
psychotherapy or behavioral therapy with SSRIs is a more
effective approach for depression than either treatment
alone, at least in women (Altshuler, Cohen, et al, 2001).
Exercise often has lasting positive effects (Babyak,
Blumenthal, et al, 2000).
We know that therapy, including cognitive behavioral
therapy (CBT), can change the brain (Linden, 2006). Use of
CBT has been effective in reducing the number of relapses
(Hollon, DeRubeis, et al, 2005; Lam, Watkins, et al, 2003).
In another study, CBT had been so successful that in
six-year follow up, CBT patients had significantly lower
relapse rates, even when medication was discontinued
(Fava,
Ruini, et al,
2004). CBT enhances the effectiveness of Fluoxetine (March,
Silva, et al, 2004). Absenteeism, depression, and anxiety
in workers showed improvement after using CBT (Grime,
2004). Cognitive therapy has also reduced depression in
cancer patients (Savard, Simard, et al., 2006).
Web-based, CBT programs have also shown promise
(Christensen, Griffiths, & Korten, 2002).
Relaxation, guided imagery, meditation, and other mind-body
approaches improve mood and decrease depressive symptoms
(Jarvinen and Gold, 1983), often significantly (p=0.001)
(Finucane and Mercer, 2006). Breath work and yoga are
useful adjunctive approach to reducing depression (Brown
and Gerbarg, 2005a, 2005b). Mindfulness meditation shows
promise in reducing suicidal ideation (Williams, Duggan, et
al, 2006).
Mind-body techniques also improve depression in subjects
with medical conditions: cancer patients (Burns, 2001);
post-operative and other procedure patients (Kim S and Kim
H, 2005; Leja, 1989); postpartum first-time mothers (Rees,
1995); multiple sclerosis patients (Maguire, 1996),
diabetics (McGinnis, McGrady, et al, 2005), cardiac
patients (van Dixhoorn and White, 2005), and those in
chronic pain (Turner, Ersek, and Kemp, 2005).
Autogenic relaxation training is also helpful for children
with depression and other psychological symptoms (Goldbeck,
Schmid, 2003). These techniques are also helpful for
otherwise healthy adults (McKinney, Antoni, et al, 1997),
and college students (Gold, Jarvinen, and Teague, 1982).
The anti-depressant effects of guided imagery and
relaxation may result from reduced anxiety and an increased
sense of control over life stresses (Bresler, 2001;
Kabat-Zinn, Massion, et al, 1992).
Conclusion
Guided
imagery can improve people’s ability to cope with
depression, and will lift mood in many cases. This leads to
decreased use of medical resources, better quality of life,
and possibly, improved physical health status in some
users.
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