Etiotropic psychotherapy for depression through addressing unprocessed aggression: an approach within Integral Causal Psychotherapy

Objective: This pilot study aimed to evaluate the effectiveness of a short-term psychotherapeutic technique for treating depression by addressing unprocessed aggression, developed within the framework of Integral Causal Psychotherapy. Method: The study involved 18 adult patients diagnosed with major depressive disorder with moderate and severe recurrent episodes (ICD-10 codes F32.1 and F32.2, corresponding to DSM-5 codes 296.32 and 296.33, respectively) and persistent depressive disorder (ICD-10 code F34.1, corresponding to DSM-5 code 300.4). The patients were assessed by a psychiatrist before and after psychotherapeutic treatment. Treatment outcomes were assessed using psychiatric evaluations. In addition to the psychiatric examination before and after treatment, standardized psychological measures (e.g., Ryff Scales of Psychological Well-Being) and Tor’s ‘Satisfaction with Dynamics in Key Areas of Life’ questionnaire were used to measure the patients’ psychological well-being pre- and post-treatment. Results: As a result of psychotherapy, 83% (N=15) of the participants achieved full remission, 17% (N=3) of the participants were diagnosed with a decrease in the severity of the disorder. At the same time, patients with neurotic personality organization, who made up half of the sample (N=9), achieved remission in 100% of cases, and among patients with borderline personality organization, who made up the other half of the sample (N=9), 67% of the participants achieved remission, and 33% showed a reduction in symptom severity. In the follow-up, which at the time of writing is about a year for most participants, there was not a single case of recurrence of depressive episodes in patients who achieved remission and not a single case of worsening of symptoms in patients who had a decrease in the severity of depressive episodes during treatment. Conclusions: The method of treating depression developed in Integral Causal Psychotherapy, in which the therapeutic target is prohibitions on the awareness and expression of aggressive impulses, can be recommended as an etiotropic short-term method of treating primary (non-comorbid) depressive disorders for adult patients with neurotic and borderline personality organization. The method offers a drug-free, structured approach with no relapses observed in a one-year follow-up. This pilot study’s small sample size (N=18) limits generalizability, necessitating larger-scale research. Keywords: major depressive disorder; unprocessed aggression; Integral Causal Psychotherapy; short-term psychotherapy; psychodynamic psychotherapy.