EP90 Panel 02 - Treatment of Depression and Anxiety - Alexander Lowen, MD; Donald Meichenbaum, PhD; Paul Watzlawick, PhD; Joseph Wolpe, MD

Description:

Educational Objectives:

1. To compare and contrast clinical and philosophical perspectives of experts.

*Sessions may be edited for content and to preserve confidentiality*

Outline:

Depression and Its Unique Characteristics

• Dr. Alexander Lowen introduces depression as distinct from downheartedness or disappointment

• Defined by lack of response to positive stimuli, stemming from weakened impulse formation

• Depressed individuals show reduced movement, appetite, sexual desire, and energy, often linked to restricted breathing

• Psychological roots include reliance on illusions that eventually collapse

Treating Depression Through Breathing and Emotional Expression

• Emphasizes breathing as key to increasing vitality and reducing depression

• Sustained breathing exercises are critical for lasting impact

• Emotional expression (e.g., crying, anger) reactivates feeling and alleviates depressive states

• Bioenergetic analysis helps patients connect physically and emotionally with therapists

Cognitive Behavioral Therapy for Anxiety and Depression

• Dr. Donald Meichenbaum discusses anxiety–depression comorbidity and CBT’s effectiveness

• Strong results in treating panic disorder and social phobias

• Therapy addresses clients’ misinterpretation of physiological symptoms and appraisal processes

• Skills training (e.g., relaxation, breathing retraining) is central to treatment

Depression: Unipolar vs. Bipolar and the Role of Personality Disorders

• Differentiates unipolar from bipolar depression; CBT shows lower relapse rates

• Marital conflict and interpersonal problems are significant in onset/relapse

• CBT increasingly involves partners or significant others

• Personality disorders often require longer interventions beyond standard session limits

Environmental Factors and Depression

• Dr. Watts Levesque highlights the role of environment and ineffective “cheering up” efforts

• Treatment must block counterproductive solutions and shift systemic dynamics

• Human attempts to lift mood can backfire and reinforce depressive systems

• Example: changing a husband’s behavior creates a new reality that relieves his wife’s depression

Treatment of Depression and Anxiety: Diagnosis and Psychopathology

• Dr. Joseph Wolpe critiques insufficient attention to psychopathology in current research

• Emphasizes tailoring treatment to individual case pathology

• Highlights conditioning therapy and matching treatment to cause

• Notes success of EMDR in treating PTSD in few sessions

Reactions and Additional Insights

• Meichenbaum supports integration of CBT with psychodynamic and systems models

• Levesque describes paradoxical worsening of depression to restore client control

• Wolpe stresses the diagnostic foundation to prevent ineffective treatment

• Lowen states that therapeutic failure is often part of the process toward self-acceptance

Audience Questions and Panel Responses

• Dr. Lowen elaborates on helping clients re-experience themselves physically to access joy

• Meichenbaum advocates collaborative problem-solving after failed treatment

• Wolpe reinforces the need for deeper analysis to prevent failures

Handling Non-Responding Clients and Systemic Therapy

• Meichenbaum recommends joint exploration of treatment barriers with client

• Levesque emphasizes understanding system rules before intervening

• Wolpe stresses accurate diagnosis and pathology-based treatment

Meditation and Breathing in Therapy

• Lowen explains that shallow breathing during meditation requires mind–body balance

• Proposes bioenergetic meditation to enhance aliveness and alertness

• Advocates for balancing mental and physical activity in therapeutic work

Working with Couples in Therapy

• Meichenbaum discusses deciding whether to involve one or both partners

• Encourages collaborative choice with the client and consideration of relational dynamics

• Emphasizes systemic understanding when working with couples