The Role of Staging in Planning Psychotherapeutic Interventions in Depression

Context: The purpose of this critical review is to examine the role of staging in planning a psychotherapeutic intervention in depressive disorders. Evidence Acquisition: English-language studies concerned with staging in depressive disorders were identified in MEDLINE, PsycINFO, and Web of Science and by manual search of the literature. Selection of articles was based on their methodological quality and implications for clinical practice. Results: Staging may allow clinicians to apply a psychotherapeutic intervention to specific phases of the development of depressive disorders: certain psychotherapeutic approaches, such as well-being therapy and mindfulness-based cognitive therapy, appear to be uniquely suited for addressing the residual phase of depression, whereas interpersonal psychotherapy has been mainly tested in the acute phase. Cognitive behavioral treatment appears to be suitable for all phases, but with chronic or double depression, its modifications (eg, cognitive behavioral analysis system of psychotherapy) appear to be indicated. Staging may also allow clinicians to assess past and potential resistance to treatment. Conclusions: Treatment options, including psychotherapy, need to be filtered by clinical judgment and patient-specific problems that take into account individual staging classifications of the depressive illness.