Therapeutic Goals for Depression in Mental Health Treatment

Introduction

We all experience depression at some point, but when it begins to interfere with functionality, something must be done. Treatment plans are available, but are more effective when they target specific goals. When goals are established, treatment becomes measurable, with an endpoint in sight.

While goals differ among patients, they can be generalized. For example, many therapists use a SMART approach, ensuring goals are Specific, Measurable, Achievable, Relevant, and Time-bound. Let’s look at how that might play out in a clinical setting.

Overview of Depression and Its Impact

Depression is a common emotion, but it is classified as a mental health issue when it is persistent and interferes with daily life. According to a CDC report, spanning from 2021- 2023, 13.1% of people 12 and over struggle wth clinical depression. Symptoms of depression include:

• Persistent sadness and emptiness
• Loss of interest and pleasure in the things you once enjoyed
• Difficulty sleeping or sleeping too much
• Weight loss, weight gain, and changes in appetite
• Fatigue and low energy
• Difficulty concentrating, indecisiveness
• Feelings of worthlessness, guilt, or hopelessness,
• Slowed movements or feeling restless
• Suicidal ideation

Depression symptoms can manifest in different ways depending on the type of condition, and it’s essential to understand and diagnose each condition to ensure proper treatment. Common conditions are as follows:

Major Depressive Disorder (MDD)

• At least 2 weeks of depressed mood and other depression symptoms
• Symptoms are bad enough to impact daily life
• Episodes can be isolated or recurrent

Persistent Depressive Disorder

• Depressed mood for at least 2 years (1 year in teens and children)
• Symptoms are milder than MDD but generally longer-lasting
• People often feel that they have always been that way
• Can have more severe depression on top of chronic depression, AKA ‘double depression.’

Bipolar Depression

• Low mood related to bipolar disorder
• Similar to MDD but countered by periods of mania and hypermania
• Treated differently from regular depression, considering the highs and lows of the disorder

Seasonal Affective Disorder (SAD)

• Episodes typically occur in the fall and winter and improve in spring and summer
• Individuals may ‘hibernate’ socially during these times of year
• Typically treated with light therapy

Postpartum/ Peripartum Depression

• Occurs during pregnancy or within 12 months after delivery
• In addition to regular depressive symptoms, the mother may have difficulty bonding with the baby, feel overwhelmed, anxious, and irritable, and may have thoughts of harming the baby and themselves
• The pattern repeats and may interfere with daily life

Understanding Therapeutic Goals for Depression

The idea of a depression treatment plan goes beyond the patient having someone to talk to every week. The patient should be achieving specific goals over time. A 2022 NIH study reveals that goal setting improves engagement and accountability in treatment, especially when treating youth.

Preferably, these goals will be measurable and follow a specific timeline, wherein therapy is no longer needed once a patient becomes self-sufficient in emotional regulation.

While there may be some generality in goal setting, such as improving mood and quality of life, each treatment plan should be tailored to the client’s needs. They should consider the patient’s lifestyle and unique goals.

Although patient input is helpful, mental health professionals must also exercise clinical judgment in goal-setting. For example, in SMART goal setting, the goal must be achievable. If not, the patient may get discouraged and fall deeper into depression.

Common Therapeutic Goals in Depression Treatment

Therapeutic goals are typically broken down into short-term and long-term categories as follows:

Short-Term Goals

• Establish daily routines, exercise regularly, and improve sleep hygiene
• Attend therapy sessions and participate in stress-reducing and mindfulness activities
• Track mood changes, set small achievable tasks, and spend time with friends and family
• For moderate depression, develop three coping skills, such as deep breathing, journaling, or time-outs, and challenge one negative thought pattern daily
• For severe depression with suicidal ideation, create a safety plan to handle triggers with coping strategies, and adhere to medication (selective serotonin reuptake inhibitors, SSRIs)

Long-Term Goals

• Eliminate or minimize symptoms of hopelessness, loss of interest, and irritability
• Identify and treat the underlying cause of depression to break the cycle
• Maintain a stable mood, develop effective coping strategies for triggers, and reduce medication reliance
• Improve overall quality of life, relationships, and daily functioning, self-esteem, and physical health
• Build a strong social network and maintain self-care habits to prevent relapse

Treatment Modalities Supporting Therapeutic Goals

Once goals are established, therapists must determine the most effective techniques to achieve successful outcomes. This typically requires a combination of therapy, medications, and alternative treatments, an approach which, according to a 2022 NIH study, yields 70-80% success rates. Typical approaches include the following:

Psychotherapy Approaches

• Cognitive Behavioral Therapy (CBT): Requires identifying and addressing negative thought patterns and learn how to deal with situations and emotions in a healthier manner.
• Interpersonal Therapy: Working on communication skills and expressing feelings to improve relationships.
• Psychodynamic Therapy: Encourages the patient to explore feelings, memories, and recurring themes in their life to determine how these affect their emotions and how they interact with others.
• Talk Therapy: A broad term referring to any type of therapy that requires sharing thoughts and feelings.
• Supportive Therapy: The therapist offers sympathy, empathy, and validation, helping the patient feel understood while placing less emphasis on past exploration.

Pharmacological Treatments

• Serotonin reuptake inhibitors: Block the reuptake of serotonin in the brain, to make it more available
• SSRIs (Selective serotonin reuptake inhibitors): These specifically block serotonin reuptake, whereas SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) block the reuptake of both serotonin and norepinephrine.
• Atypical antidepressants: As atypical medications, these differ from the traditional SSRIs and SNRIs. Examples include Wellbutrin, which blocks the reuptake of norepinephrine and dopamine, not serotonin; Remeron, which increases norepinephrine and serotonin via receptor effects rather than reuptake; and Trazodone, which is serotonin-related with weaker doses, often used as a sleep aid.
• Tricyclic Antidepressants: Block the reuptake of serotonin and norepinephrine, but also affect other receptors.
• Monoamine oxidase inhibitors: Block monoamine oxidase, an enzyme that breaks down neurotransmitters such as dopamine, serotonin, and norepinephrine, making more of these neurotransmitters available in the brain.

Alternative Treatments

• ECT: Electroconvulsive therapy is used to treat severe depression in cases when medications aren’t working. Controlled electrical currents are sent to the brain, triggering a brief, carefully monitored seizure to impact brain chemistry.
• TMS: Transcranial magnetic stimulation is similar to ECT in that it is used to treat severe depression when medications aren’t working and changes brain chemistry. It involves magnetic pulses being sent to the areas of the brain that impact mood.
• Lifestyle interventions: A therapist may recommend that patients adopt a healthy diet, exercise regularly, establish a daily routine, and practice mindfulness and stress-relieving exercises to improve mood.
• Support Groups: Group therapy can complement individual counseling, helping people learn from one another and understand they are not alone.

Developing a Depression Treatment Plan

Components of the Plan

The first step in developing a depression treatment plan is to work out its components. This may include:

• A Comprehensive Assessment: The therapist will carefully assess the patient’s mental and physical health to officially diagnose the condition and identify factors that may contribute to it.
• Treatment Goals: The next step is to determine short-term and long-term goals that align with the patient’s needs and lifestyle.
• Therapy/Medication/Lifestyle Plan: Mental health professionals decide which therapies, medications, and lifestyle changes will be most effective in helping the patient achieve remission.

Setting Measurable and Achievable Objectives

Next, the therapist will set measurable and achievable goals to guide positive outcomes in therapy. Here’s what this might look like:

• For a College Student with Mild to Moderate Depression: Short-term goals may include attending class, talking to friends, and tracking mood. Long-term goals include improving the PHQ-9 score and completing the semester with passing grades.
• For a Working Adult with High Stress and Depression, short-term goals may be to take a 10-minute break from work each day, set boundaries with colleagues, and practice relaxation techniques. Long-term goals include reporting and improving average mood on most days, and completing regular work tasks on time for three consecutive weeks.
• For a Parent with Major Depression Affecting Family Life: Short-term goals may be to spend time with the family, improve communication skills, and identify and address triggers. Long-term goals include improving mood on most days, spending at least 1 hour with family each day, and feeling confident in using coping strategies.

Monitoring the Patient’s Progress and Adjusting Goals

While a treatment plan may be set in advance, goals can be adjusted over time, in accordance with the patient’s progress. For example, a patient may have encountered an issue that makes it difficult to achieve their goals or a lifestyle change that affects them. In other instances, a patient may be hitting their goals sooner than predicted, making it easier to schedule future goals or shortening the overall treatment duration.

Special Considerations in Depression Treatment

No two patients are exactly alike, but some may be more challenging to treat than others, necessitating special considerations. Beyond basic therapy, it’s also important to orchestrate safety planning and recognize warning signs. Here are some examples:

Severe Depression

• Warning Signs: Intensive depression symptoms such as guilt, feelings of worthlessness, and loss of interest.
• Safety Plan: Ensuring the patient has a plan for people they can call, minimizing access to medications, and potential weapons.
• Therapy Approach: CBT, development of coping strategies, medication, frequent monitoring, and check-ins.

Psychotic Depression

• Warning Signs: Delusions, hallucinations, severe confusion about what’s real and not real
• Safety Plan: Similar to the safety plan of severe depression, but with extra attention
• Therapy Approach: Medication must be included, once the patient is more stable, focus on coping strategies, routines, and relapse prevention.

Bipolar Disorder Co-occurring with Depression

• Warning Signs: Bouts of depression countered by mania and hypermania
• Safety Plan: Similar to previously mentioned safety plans, with special attention to suicide risk
• Therapy Approach: Medication is a core treatment, followed by psychoeducation, CBT, and monitoring

Disruptive Mood Dysregulation Disorder Co-occurring with Depression

• Warning Signs: Persistent delusions, hallucinations, and disorganized thinking or speaking
• Safety Plans: Identify who can notice early changes, ensure medication adherence, and a safe environment
• Therapy Approach: Antipsychotic medications as the backbone, CBT, psychoeducation, social skills training, and family involvement

Conclusion

At BNI Treatment Centers, we understand the complexity involved when treating depression. We integrate evidence-based treatment with therapeutic goals in mind. Our emphasis on collaborative care, patient-centered treatment, and ongoing evaluation and adaptation meets young patients where they are, ensuring a customized approach.

Contact us to learn how we can help your teen achieve a higher quality of life.

Dr. Aram Keshishyan, PsyD.

Aram Keshishyan, PsyD. is a bilingual, Armenian-speaking, licensed clinical-forensic psychologist who has been practicing since 2013. Dr. Keshishyan emigrated to the United States at the age of 1 and grew up in the highly diverse Los Angeles County area. He obtained a Bachelor of Arts degree in Psychology from the University of California, Los Angeles, and Master of Arts and Doctorate of Psychology degrees in Clinical-Forensic Psychology from Alliant International University, Alhambra.

Arastou Aminzadeh, MD

Dr. Aminzadeh co-founded BNI to provide patients with exceptional and complete care that goes beyond the regular standards. Each individual is unique and based on each person's genetic makeup, some have a more painful response to challenges that arise on their journey and need assistance to get back on track.