Therapy

Therapy Can Help Even Those Who Did Not Benefit Before

Don’t give up if mental health treatment didn’t work the first time.

Posted Feb 26, 2020

wavebreakmedia/Shutterstock
Source: wavebreakmedia/Shutterstock

Have you gone to therapy or taken medication for your anxiety or depression?  And maybe it hasn’t worked as well you’d hoped and you are still struggling? You are not alone: Approximately 30 to 40 percent of people do not recover after a first-line mental health treatment. They are called non-responders.

When a course of psychotherapy or counseling doesn't lead to recovery, good therapists work with the patient to figure out what might be standing in the way of significant improvement. If therapy still is not helping, they change their approach or ultimately refer the patient to another provider with different expertise. Unfortunately, some therapists are reluctant to concede that their approach is not working, so it is up to the patient to decide to try something new.

When a particular dose of a medication fails to help, prescribing doctors often try increasing the dose, adding another medication, or switching to another medication altogether. This approach often works, but some people can’t tolerate the side effects that can come with higher doses or multiple medications, or they just get worn out trying various medications with nothing working well. 

Unfortunately, treatment non-responders tend to have particularly low psychological well-being and functioning in different areas of life. They might feel discouraged, hopeless, and blame themselves for their treatment not working out. However, there are many reasons why therapy or medications don’t help someone. Mental health experts often say there is no treatment that works for every patient.

If you tried medications and/or therapy, and you still suffer from significant depression, anxiety, or both, do not despair. Trying psychotherapy when your first treatment failed to help is a worthwhile option. This is the conclusion of this month’s study in Clinical Psychology Review by Andrew Gloster from the University of Basel in Switzerland and his colleagues. They reviewed 18 psychotherapy randomized control trials with 1,734 non-responders, and their results indicated that therapy is very successful in treating non-responders.

The study’s authors found no outcome differences in terms of the type of psychotherapy non-responders engaged in. However, certain Cognitive Behavioral Therapy (CBT) approaches were particularly helpful in significantly reducing symptoms and improving patients’ overall functioning and quality of life. These approaches are Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT), and Dialectical Behavioral Therapy (DBT).

Although it can be difficult to seek therapy after you have tried to get help for anxiety or depression and it didn't work, remember that “no size fits all” when it comes to dealing with psychological problems. There are numerous reasons why medication, therapy, or both don’t help a particular person at a particular time. If you did not respond well to mental health treatments in the past, it does not mean that you can’t be helped; it just means that you need to muster courage and try again. 

Make sure that you do your research and find a well-trained and experienced therapist, through recommendations from family, friends, or your primary care doctor or a search of Psychology Today’s Find a Therapist directory for specialists in your area. Then set up an initial consultation with a few therapists, because research shows that patients who “shop around” before settling on a therapist do better overall. During the initial consultation, pay attention to how you feel when talking to this provider, but also ask them questions about how they envision working with you on the particular problems you are bringing in. Don’t shy away from asking anything you are wondering about. This is your treatment and you need to make an informed decision about who might best fit your needs. After you choose your therapist, embark on this process with the hope that this time therapy will work for you, because chances are, it will.

References

Gloster, A.T. et al. (2020).  Treating treatment non-responders: A meta-analysis of randomized controlled psychotherapy trials.  Clinical Psychology Review, 75.