As an illness frequently masked by a façade, many of us are unaware of how much depression is around us. Yet depressive disorders affect 9.5 percent of adults in the United States each year, which translates into over 18 million people. Similar statistics can be found in Israel and many other countries. The World Health Organization maintains that by 2020, depression is expected to become the second most common illness disrupting everyday life, after heart disease.
Sigal Zilcha-Mano of the Department of Psychology was training as a clinical psychologist and treating students suffering from depression, when she began questioning the standardized approaches to therapy. “I was seeing patients of similar ages, lifestyles and backgrounds and yet each individual was experiencing depression very differently from the other. I witnessed how psychotherapy methods were being applied for patients based on average patient responses to treatment – and the rest were being left behind,” she says. “I couldn’t come to terms with the fact that so many individuals continue to carry the burden of depression and that lost productivity weighs so heavily on societies and economies.” At that point Zilcha-Mano decided to take up empirical study to support new approaches to personalized therapy for depression.
She points out that decades of research have focused on generalized approaches to depression and therapies for the “average” patient. Research has primarily demonstrated what is known as the “Dodo bird verdict”, which asserts that regardless of the type of therapy used for any group of patients, the average person will always reach the same results. Her research examines the mechanisms behind changes that take place in the patient over the course of therapy to understand how and why patients improve during treatment. “Understanding the mechanisms of therapeutic change in psychotherapy is crucial for maximizing treatment efficacy,” she explains. Her primary focus is on the therapeutic “alliance”, the bond that develops between patient and therapist. One of her recently published studies has shown that therapeutic alliance is indeed one of the most promising mechanisms of change. One group of patients diagnosed with high levels of depression was given anti-depressant medication, while a second group was treated with a placebo. Both groups underwent the same individual sessions with the therapist. Zilcha-Mano found that in both groups, many of the patients experienced positive change. A patient questionnaire revealed that the alliance mechanism had more relevance in bringing about therapeutic change for placebo patients than for medicated patients, and it could be that this factor can actually compensate for some of the effects of medication.