Introduction

During the first half of the twentieth century, chronic mood disorders, such as the condition we now call dysthymia, were viewed as personality disorders for which the treatment of choice was psychotherapy (Scott, 1988; Markowitz, 1994). It was not until the publication of DSM-III (American Psychiatric Association, 1980) that dysthymia was recognized as an affective syndrome that could overlap or coexist with a major depressive disorder, and might respond to treatment with antidepressant medication. This reclassification and the subsequent interest in the nosology of chronic mood disorders led to a number of studies of the phenomenology, prevalence and treatment options available for chronic and treatment-resistant affective syndromes (Guscott & Grof, 1991). Unfortunately, the definitions used and the treatments explored emphasized almost exclusively the biological aspects of chronic disorders (Scott, 1991). Most experts on treatment-resistant mood disorders recommend that the patient be offered a systematic course of somatic treatments, with little or no mention of a need for psychological or social therapy (Greenberg & Spiro, 1987). In this chapter, we highlight the influence of psychosocial factors on the course and outcome of chronic and treatment-resistant mood disorders, and we review the potentially important therapeutic role of psychosocial interventions. We then describe and identify the evidence for the effectiveness of psychosocial approaches with this patient population, with an emphasis on cognitive therapy (CT) in chronic affective disorders.

The potential role of psychosocial interventions

All professionals working with people experiencing chronic and treatment-resistant mood disorders are psychologically important to those patients.