[Place of cognitive-behavioral therapies in resistant depressions]

Several behavioural models have been proposed to explain the psychopathology of depression. One of these models, the cognitivo-behavioural approach developed by Beck since 1963, seems to be gaining a renewed interest in psychiatric circles, especially in North America. This model postulates the predominant role of thought content and thought processes in the psychopathology of affective disorders. In depression, there is activation of certain idiosyncratic cognitive structures (schemes) which dominate the thought processes and lead to cognitive distorsions. The therapeutic techniques proposed by Beck involve the identification and correction of these distorsions and the schemes responsible for them. This therapy is directive and structured, involving about 20 sessions over a period of three months. Three phases can be defined corresponding to the course of the depressive manifestations: The first phase involves the use of behavioural techniques such as self-recording and the prescription of tasks designed to increase the patient's activities and to test the validity of the patient's judgement of himself, on the basis of experience. The second phase involves identification and critical evaluation of the characteristic automatic thoughts in depressed patients. They reflect the combination of themes with a negative content and certain systematic errors in the thought process. In the third phase, when the patient has a sufficient behavioural and cognitive repertoire, the treatment focuses on the "silent postulates" (contents of the schemes), which are the basis for the depressive manifestations.(ABSTRACT TRUNCATED AT 250 WORDS)