Case Studies On Treatment Of Major Depression Disorder By Thought Imprint Psychotherapy(TIP) In Lower Resistance State

Depression is one of the most commonly seen mental illnesses,with visible and long lasting clinical symptoms such as feeling down,loss of interest,fatigue,and decline of energy.Deoression is characterized by high prevalence rate,low cure rate,high rates of suicide and recurrence,and heavy health cost.Epidemiology studies have shown there are at least 50 to 60 million depression patients in China,whose life quality have been severely affected,and also have created enormous health care burden for their families and the society as a whole.How to improve the cure rate of depression patients,especially those with the most severe and difficult-to-treat depression——major depression disorder(MDD),and reduce the recurrence rate,are the most pressing challenges for the medical professionals.As a highly complex mental issue,the causes and pathogenesis of depression haven’t been completed identified yet.With the further development of clinical studies,nowadays researchers realize that besides biological factors,social and psychological factors are also closely related to the occurrence,development and recurrence of depression.Treatment guidelines and relevant research findings from various countries have shown that for any depression,antidepressant and psychotherapy are commonly used treatments.It has been clinically shown that psychotherapy plays a positive role in improving the treatment effectiveness and reducing the recurrence chance among depression patients.Psychotherapy could reduce causal factors among depression patients,and its long-term efficacy may be better than drug treatments.Therefore,psychotherapy for depression is getting wide attention.It should be noted,psychotherapy is closely associated with cultural factors,and varies with regions.Due to the culture differences between Western countries and China,Western psychotherapy method shows its limitations in treating Chinese patients.Therefore,it is a top priority for medical professionals to develop our own psychotherapy applicable to Chinese depression patients.1.PurposeBased on the Personality Lifelong Development Hypothesis developed by professor Weidong Wang,and the "Wang’s Memory-Tracing Personality Development Inventory"(WMPI)assessment with a large sample.It aimed at exploring the personality development differences between non-patients and depression patients,analyzing relationships between "courage"(Dan Qi in Chinese,)and various personality elements,revealing the differences in courage between non-patients and depression patients,,and exploring the significance of "courage" in pathogenesis and treatment of depression.More specifically,this study discussed the clinical efficacy of Low Resistance Thought Imprint Psychotherapy(TIP)combined with antidepressant drug Escitalopram Oxalate Tablets in the treatment of MDD,followed by the effect of TIP on the improvement of "courage",andTIP’s clinical advantages and significance.2.MethodologyThis study is divided into three sections:literature review,survey research,and clinical research.2.1 Theoretical studyThis section focused on the correlation between MDD and personality.Through reviewing,analyzing,and organizing of the literature,especially studies by professor Weidong Wang on Personality Lifelong Development Hypothesis,the author examined the relationships among MDD,the traditional Chinese medicine,and personality development,and explored the impact and significance of courage in MDD pathogenesis and treatment.2.2 Survey researchThe author administered the WMPI instrument in a cross-sectional survey to non-patients,patients with diagnosed psychological illness and people with MDD.The questionnaire was designed to assess:①correlations between the courage measurement and other sub-measurements,and the total scores of WMPI;②courage difference between depression patients and non-patients;③the importance of courage,its impact and usefulness.2.3 Clinical researchForty MDD patients were randomly assigned into two groups.The control group patients were treated with antidepressant drug Escitalopram combined with supportive psychotherapy.The treatment groups were treated with antidepressant drug Escitalopram combined with TIP.The Hamilton Depression Rating Scale(HAMD),the WMPI DQ subscale,and the Morisky Medication Adherence Scale(MMAS-8)were administrated for the pre-and post-tests to assess the before and after treatment efficacy.Through the comparison of the clinical efficacy between two groups,this study explored the clinical advantage of the TIP technique in treating MDD patients,and its impact on improving personality factor courage.3.Results3.1 Literature review3.1.1 Inappropriate coping approach,passive defense mechanism and attribution style were found to be high risk depression casual factors.Being high neuroticism,high introversion,reliance,self-criticism,alexithymia,negative perfectionism were all important personality susceptible factors.These factors resulted in difficulty in building interpersonal relationships,lack of confidence,excessive feeling of inferiority,and poor assessment of self-image and ego strength among patients,which more likely to lead to depression.3.1.2 Professor Weidong Wang proposed the Personality Lifelong Development Hypothesis,also called the Silkworm Cocoon Theory.He views that the occurrence and development of personality is a three-dimensional spiral process,in which time is the "trunk",and development factors are "branches." In this process,the dynamic equilibrium between senses of security and insecurity is the core element.3.1.3 Personality development starts with bravery and timidity,then developing into courage,which is the most important personality elements.Bravery and timidity stem from parents-children relationships.There is a dynamic dialectical relationship between bravery and timidity which determines a person’s strength of courage in making decisions.Bravery and timidity in courage are closely corrected with emotional activities.Improvements on courage is of great significance for the treatment of depression and other mental illnesses.3.2 Survey research3.2.1 The correlation coefficient between the total WMPI score and courage had the highest score,0.837;followed by its correlation with ego consciousness,0.805,both with statistical significance.The study found statistical difference between non-patients and patients in terms of the total WMPI score,score of courage,interpersonal relationship,world conception,way of thinking,sex development,parenting style,life events,and volition.3.2.2 Courage subscale comparison between depression patients and non-patients showed that depression patients had lower total WMPI score and other four subscale scores during their childhood than non-patients(P<0.05).During their youth,depression patients had lower score in courage,interpersonal fear,and adaption ability(P<0.05)than non-patients.There was no statistical difference between two groups in natural fear and inexplicable fear.The research showed that courage training and cultivating during childhood years were vital.Depression treatment should focus on courage and improvement of interpersonal fear and adaption ability..3.2.3 Bravery and timidity in courage can adjust emotions,maintain individual mental health,and promote personality development and perfection.Courage impacts internal organs through its influence on emotion.To some extent,this could be viewed as a testimony of the old Chinese proverb,"the eleven organs all depend on gallbladder(Dan in Chinese)" and "illness comes from Qi".The survey research showed that lack of courage could be the most core casual factor of depression.Therefore,courage in vital to mental health.3.3 Clinical study3.3.1 Effective rate of treatment and improvement of HAMD scoreThe intra-group comparison revealed that the before and after treatment HAMD scores decreased significantly(P<0.05)for both groups,in which depression symptoms showed the most obvious improvement at the eighth week.This indicates both two treatments were effective.The inter-group comparison showed on the eight wee,the scores of the TIP group were significantly better than those in the control group(P<0.05),and the difference was statistically significant.Using the reduction rate as the therapeutic index,the TIP group showed statistically significant higher efficacy rate than the control group.Multiple linear regression stepwise method(α1=0.05,α1=0.10)was used to screen the factors that influenced the score of HAMD for 8 weeks.The determining factors include baseline score,age,and assignment of the treatment.After controlling for other factors,the more serious illness before the treatment,and the older the patient was,the better the therapeutic effect of TIP technique had.For severe depressive episodes,the TIP technique combined with Escitalopram Oxalate Tablets had significantly better impact than the combination of supportive psychotherapy and Escitalopram(P<0.05).3.3.2 Improvement of WMPI courage subscaleThe intra-group comparison indicated that in the control group,the total score and individual factor score of 4 weeks,and individual factor score of 8 weeks had no obvious change from the before treatment measurements.There was no apparent difference between the score after 8 weeks of treatment and the score after 4 weeks of treatment.Except for the factor inexplicable fear,the TIP group scored significantly lower for the 4 week and the 8 week total scores and individual scores than before treatment measurement.Again,except for the factor inexplicable fear,the total score and individual factor score after 8 weeks treatment had significant decrease than those scores after 4 weeks treatment(P<0.05).Inter-group comparison showed that except for the factor inexplicable fear,the TIP group scored higher both on the total courage score and individual factor score after 4 weeks and 8 weeks of treatment than the control group(P<0.05).In the TIP group,except for the factor inexplicable fear,courage total score and individual factor score decreased along with the treatment,and the improvement on courage abnormal strengthen continuously.4.Conclusion4.1 Depressive episode is a complicated process,closely correlated with weak natural endowment,stimulation from traffic events,inappropriate copying approach,and negative psychological defense mechanisms,and attribution style.The imbalance between bravery and timidity,or the malfunction of "courage determines decision," is one important causal factor of depression.The literature review suggests that timidity in courage probably is the most core causal factor of depression.4.2 The WMPI personality survey shows that DQ has the highest correlation coefficient with the total personality score.As the old Chinese proverb says,"the eleven organs all depend on gallbladder." Courage is highly associated with emotions.Courage can adjust emotion,maintain mental health and promote development and perfection of personality.Courage score analysis shows that depression patients had lower scores in courage and the four demission of courage than non-patients.The study also shows that courage training and cultivating during childhood is very important.The survey research verified that timidity in courage is probably the most core casual factor of depression.Therefore,depression treatment should focus on the courage treatment.4.3 Chinese medicine psychotherapy(or TIP technique)can significantly improve the efficacy of MDD patients.It can correct timidity in courage.TIP technique is an innovative Chinese psychotherapy for mental illness treatment that targets the core causal factors of depression.It shows a positive effect in increasing the clinical cure rate of MDD and reducing its recurrence rate.Therefore,there are important clinical and practical significance of adopting TIP in treating MDD patients.