Major depression is one of the most common mental disorders worldwide, causing great suffering to those who suffer from it and to their environment. Due to its high prevalence and the high level of vital discomfort and incapacitation it is capable of causing, many approaches have tried to explain and treat it effectively. Many therapies have been developed to treat this condition.
One of the most effective forms of psychotherapy in the treatment of depression is the self-management therapy of Rehm , through which it is proposed to improve the symptoms through work on various aspects related to self-control and self-management.
The problem to be treated: major depression
Major depression is considered to be the continued presence throughout the day, for at least two weeks, of a series of symptoms among which the presence of a sad mood characterized by high negative affect and a low level of positive affect and/or lack of interest and pleasure in the face of stimuli and situations that are generally appetizing for the subject, together with other elements such as weight or sleep disturbances, vital passivity, progressive isolation, feelings of guilt or suicidal thoughts, stands out.
They often feel powerless and defenseless in the face of life’s events, being in a state of helplessness that reduces their participation in the environment and their activity in general.
The symptoms of major depression severely affect a person’s normal functioning, disabling or impairing their performance in one or more areas of life. It is also a source of psychic suffering that makes the person who suffers it feel a continuous discomfort over time . This is why its treatment is of special importance, even more so given the high percentage of the population that has suffered or will suffer some type of depressive episode throughout their lives.
Rehm’s self-control therapy
As we have said, there have been multiple perspectives and authors who have dealt with the subject of major depression in order to explain it and try to deal with it successfully. One of the many treatments that have been developed for this purpose is the self-management therapy of Rehm.
Rehm’s self-management therapy is a psychological treatment that comes from the cognitive-behavioral paradigm and focuses specifically on the treatment of depression. It is a well-established therapy based on the concept of self-control and the importance that the author gives to this aspect in behavioural self-management. In this model, the origin of the depressive symptoms can be found in an imbalance between rewards and punishments.
Depression according to Rehm’s model
Rehm’s self-management therapy is based on the model the author developed for the purpose of explaining depressive disorder. According to this model, depression is mainly caused by a lack of consistent behavioral reinforcement. In other words, the main problem is that depressed people are unable to obtain positive elements or stimulation from the environment .
However, the origin or progressive worsening of this lack of reinforcers can be found in the fact that the individual is not able to ensure his or her behaviour in such a way that he or she can obtain them, or that he or she is not able to manage himself or herself. Thus, the person with depression would have a series of internal characteristics that would make self-control and the adaptation of his/her behaviour to reality difficult , so that in the face of the loss of reinforcements, they could lead to depressive symptoms.
Thus, the problem that leads to depression is that the individual is not able to properly manage his or her own behavior. Thus, the main objective of this therapy is the improvement of mood through the development and training of the different aspects of self-control.
Rehm’s self-management therapy is based on training and strengthening a number of basic self-management skills that in the depressed subject tend to be deficient.
Specifically, Rehm considers that people control their behaviour through three basic processes : self-monitoring or self-observation, self-evaluation and self-reinforcement or self-punishment according to the self-evaluation carried out.
In depressed people, it can be observed how in the processes of self-monitoring , there is a tendency to focus attention on the immediate consequences of the behaviour, in addition to the fact that they generally pay more attention to negative information than to positive information
With regard to self-evaluation, the model from which Rehm’s self-management therapy starts is often biased towards the negative by creating exaggeratedly high goals and targets, which cannot usually be met. This, together with the fixation on the immediate and the negative, generally causes the person to feel frustrated.
Finally, due to the impossibility of carrying out the proposed objectives, depressed people tend to punish themselves or, failing that, not see their behaviour reinforced when faced with the achievement of objectives.
Profile of the person vulnerable to depression
According to this model, depressed people tend to be perfectionists and overly self-demanding, creating very high expectations and goals that tend not to be achievable. For this reason, they often fail to achieve them, so that failure to meet goals leads to self-criticism and punishment.
The depressive would therefore have high rates of self-punishment and low rates of reinforcement, which in the long run causes a decrease in the emission of behaviour which in turn feeds back into the absence of reinforcement. They tend to focus on negative elements, which causes them to end up evaluating themselves negatively and that self-concept and self-esteem are reduced. It is on these aspects that Rehm’s self-management therapy is going to focus in order to improve self-control and make up for the deficits that induce vulnerability to major depressive disorder.
Structure of self-control therapy
Rehm’s self-control therapy is carried out over twelve sessions , divided into three phases in which the three skills that allow for correct self-control and self-management are worked on.
1. Self-observation phase
This part of the therapy is primarily cognitive. Throughout the sessions in which the therapy is carried out, it helps and trains the patient to become aware of the existence of positive and pleasant experiences, which the patient should record and try to associate with the state of mind.
Through this phase, the aim is to make the patient see positive aspects or pleasant situations and to decrease the focus on the negative aspects.
2. Self-assessment phase
As we have mentioned before, in Rehm’s theory of self-control individuals tend to set themselves goals with very high standards, generally unachievable, which end up provoking feelings of impotence and frustration .
That is why in a second phase of therapy the objective will focus on teaching the subject to set more specific, concrete and achievable goals in a realistic way. The aim is for individuals to have a positive self-evaluation of their own abilities in order to achieve their goals.
The last phase of self-management therapy is related to reinforcement, which in subjects suffering from depression tends to be insufficient. The work focuses on training the patient to identify various reinforcers that are important to him, as well as to apply them in a contingent manner according to the objectives that are set.
Effectiveness of the technique
Although is not one of the most applied therapies due to the predilection for other techniques also of a cognitive-behavioral type, the self-monitoring therapy of Rehm is one of the treatments that have demonstrated a high level of effectiveness, having a well established efficacy.
In addition, several studies show that each of the components or phases into which Rehm’s self-management therapy is divided is equally effective on its own, with some of its elements being applied in different techniques. An example of this is Stark and Kendall’s Action cognitive-behavioral program for childhood depression, which is based on self-management therapy and is effective in the treatment of childhood and adolescent depressions.
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