What if You're Depressed or Anxious and Can't Find Help?

Friendship Benches offer a new tool in the fight against depression and anxiety.

Posted Jan 06, 2017

Even though research clearly shows that that talk therapy can be useful for people with a number of emotional difficulties, it is not always easy to find a therapist who you can talk to. If you live in an area where there aren’t many professional therapists or where it’s not considered the thing to do, then up until now you have pretty much had to live with your symptoms or try to deal with them with drugs (prescription or not), alcohol, food, sex, shopping, gambling…or something else.

A study recently published in the Journal of the American Medical Association suggests an interesting alternative. In rural parts of the southern African country of Zimbabwe, nurses and other community health workers, called “Grandmothers,” were taught to listen to and support people living with anxiety, depression and other common mental disorders. The project is called “The Friendship Bench,” which is the name given to the simple wooden bench on the grounds of these facilities where therapy takes place. The results are pretty impressive.

The therapy is short-term, consisting of six weekly 45-minute sessions, with an optional follow-up group support program of six sessions. The “grandmothers” had support from trained professionals via mobile phones and tablets. After the first three individual sessions, participants were invited to join a peer group of men and women who had participated in the Friendship Bench previously. The group, called “Circle Kubatana Tose,” which means “holding hands together,” met weekly to discuss personal experiences. 

After participating in problem-solving therapy via the Friendship Bench, individuals who suffered from depression, anxiety and/or suicidal ideation were found to have a significant decrease in their symptoms after six months. Those with depression described three times less than a control group of individuals with similar symptoms who received other treatment but did not go to the Friendship Bench. Those with anxiety were four times less likely to have the symptoms after their work with the Friendship Bench, and suicidal thoughts were five times less likely.

These results are so impressive that health workers in other communities, for example parts of India where there is a stigma against going to see a therapist, are following the thinking and modeling practices on the Friendship Bench.

Collaborating also with Médecins Sans Frontières (Doctors Without Borders), the Friendship Bench is working to create a comprehensive mental health program in places where depression and anxiety are high but services are limited.

In her book The Talking Cure, Dr. Susan Vaughan explains how a trained psychotherapist helps clients make actual physiological changes in her or his brain, “changing ingrained neural patterns.” Marsha Linehan, who developed DBT (Dialectical Behavioral Therapy), notes that therapy works best when it combines validation and acceptance of who a person is with teaching tools for managing difficult feelings and behaviors. Linehan, like Stephen Hayes, who developed ACT (Acceptance and Commitment Therapy), agrees that short term, focused psychotherapy works best in the context of a positive connection with a therapist.

While there is concern among some researchers that such interventions, often called “evidence-based,” have significant short-term positive results but don’t have the same staying-power that long-term talk therapy can have, it is clear that this short-term work with positive consequences is far more beneficial than no intervention at all.

Furthermore, the long-term support of the “Circle Kubatana Tose” could be a helpful tool for maintaining the gains made by the initial therapeutic experience, along the lines of ongoing membership in a twelve-step program like Alcoholics Anonymous.

One of the important skills that psychotherapists learn in their training is how to keep such a relationship professional yet caring. Yet research has not yet determined how much impact the relationship itself has on clients. What we do know is that just talking about something that is bothering you to another person who listens carefully and without judgment can make a difference. We also know that it can also make a difference when such a person makes suggestions about how you might alter your behavior or look at a situation from a different perspective.

More research into what happens on these Friendship Benches is clearly needed. What we learn will impact not only the availability of help for people who are struggling with depression, anxiety, and/or suicidal thoughts in areas where professional psychotherapy is unavailable. It will also expand our broader understanding of how psychotherapeutic interventions work across the board.     


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Stephen C. Hayes. (2005). Get out of Your Mind and into your Life.

Marsha Linehan (1993) Cognitive-Behavioral Treatment of Borderline Personality Disorder.

Jonathan Shedler (2010)  “The efficacy of psychodynamic psychotherapy.” American Psychologist, 65, 98-109.

Susan C. Vaughan, 1998.The Talking Cure: The Science Behind Psychotherapy

Chibanda D, Weiss HA, Verhey R, et al. Effect of a Primary Care–Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe: A Randomized Clinical Trial. Journal of the American Medical Association. 2016.  December 27, 2016

JAMA. 2016;316(24):2618-2626. doi:10.1001/jama.2016.19102

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