Rehm's Self-Control Therapy

The major depression It is one of the most frequent mental disorders worldwide, causing great suffering to those who suffer from it and to their environment. Due to its high prevalence and the high level of vital discomfort and incapacitation that it is capable of provoke, there have been multiple approaches that have tried to give an explanation and a treatment effective. In order to treat this condition, numerous therapies have been developed.

One of the most effective forms of psychotherapy in treating depression is Rehm's self-control therapy, through which it is proposed to improve symptoms through work in various aspects related to self-control and self-management.

• Related article: "Types of psychological therapies"

The problem to be treated: major depression

Major depression is considered to be the continued presence throughout the day, for at least two weeks, of a series of symptoms, among which the presence of a sad mood characterized by high negative affect and a low level of positive affect and / or lack of interest and pleasure in the face of generally appetizing stimuli and situations for the subject, along with other elements such as weight or sleep alterations, vital passivity, progressive isolation, feelings of guilt or thoughts suicidal.

They often feel powerless and defenseless in the face of life events, being in a state of despair that reduces their participation in the environment and their activity at a general level.

The symptoms of major depression involve a severe impairment in the normal functioning of the person, invalidating it or impairing the performance of it in one or more vital domains. It also supposes a source of psychic suffering that makes the person who suffers it feel a continuous discomfort over time. That is why its treatment is of special importance, even more taking into account the high percentage of the population that has suffered or suffered some type of depressive episode throughout their lifetime.

• Related article: "The 6 differences between sadness and depression"

Rehm's Self-Management Therapy

As we have said, there have been multiple perspectives and authors who have dealt with the subject of major depression in order to explain it and try to treat it successfully. One of the many treatments that have been developed for this is Rehm's self-management therapy.

Rehm's self-control therapy is a psychological treatment derived from the cognitive-behavioral paradigm and specifically focused on treating depression. It is a well-established efficacy therapy based on the concept of self-control and the importance that the author places on this aspect in behavioral self-management. And it is that in the model from which it starts, the origin of depressive symptoms can be found in an imbalance between rewards and punishments.

Depression according to Rehm's model

Rehm's self-management therapy is based on the model that the author developed for the purpose of explaining depressive disorder. According to this model, depression is mainly caused by a lack of consistent reinforcement of behavior. That is, the main problem is that depressed people they are unable to obtain positive elements or stimulations from the environment.

However, the origin or the progressive worsening of this lack of reinforcers can be found in the fact that the individual is not capable of ensuring her behavior in such a way that he can obtain them, or that he is not capable of self-management. Thus, the person with depression would have a series of internal characteristics that would make self-control and the adaptation of one's own behavior to reality difficult, so that in the event of loss of reinforcement, they can lead to depressive symptoms.

Thus, the problem that leads to depression is that the individual is not able to properly manage their own behavior. Thus, the main objective of this therapy is the improvement of the state of mind through the development and training of the different aspects of self-control.

Components of self-control

Rehm's self-control therapy is based on the training and strengthening of a series of basic self-control skills that tend to be deficient in the depressed subject.

Specifically, Rehm considers that people control their behavior through three processes basic: self-monitoring or self-observation, self-assessment and self-reinforcement or self-punishment according to the self-assessment carried out.

1. Self-monitoring

In depressed people, it can be observed as in self-monitoring processes attention tends to be focused on the immediate consequences behavior, in addition to generally paying more attention to negative information than to positive

2. Self appraisal

Regarding self-evaluation, from the model from which Rehm's self-control therapy starts, this is often biased towards the negative by creating excessively high objectives and goals, which as a general rule cannot be met. This, together with the fixation on the immediate and the negative, causes the person to feel frustrated in general.

3. Self reinforcement

Finally, due to the impossibility of carrying out the proposed objectives, depressed people they tend to punish themselves or, failing that, not seeing their behavior reinforced when achieving objectives.

Profile of the person vulnerable to depression

According to this model, depressed people they tend to be perfectionists and excessively self-demanding, creating very high expectations and goals that tend not to be achievable. For this reason, they usually fail to achieve them, so the non-fulfillment of objectives causes them to criticize and punish themselves.

The depressive would thus have high rates of self-punishment and low rates of reinforcement, which in the long run causes a decrease in the emission of behaviors that in turn feeds back the absence of reinforcement. They tend to focus on negative elements, which causes them to end up evaluating themselves negatively and that selfconcept Y self-esteem are reduced. It is on these aspects that Rehm's self-control therapy will focus in order to improve self-control and fill the deficits that induce vulnerability to major depressive disorder.

• You may be interested: "The 5 differences between self-concept and self-esteem"

Structure of self-management therapy

Rehm's self-management therapy is carried out over twelve sessions, divided into three phases in which the three skills that allow proper self-control and self-management are worked on.

1. Self-observation phase

This part of therapy is primarily cognitive. Throughout the sessions in which the therapist is carried out, he helps and trains the patient in becoming aware of the existence of positive and pleasant experiences, which the patient should register and try to associate with the state of mind.

Through this phase it is intended make the patient see positive aspects or pleasant situations and to reduce the focus on negative aspects.

2. Self-assessment phase

As we have mentioned previously, in Rehm's theory of self-control, individuals tend to set goals with very high standards, generally unattainable, which end up causing feelings of helplessness and frustration.

That is why in a second phase of therapy the objective will focus on teaching the subject to set more specific, concrete and achievable goals in a realistic way. This is intended for individuals to have a positive self-assessment of their own capabilities to achieve their goals.

3. Self-reinforcing phase

The last of the phases of self-control therapy has to do with reinforcement, which in subjects suffering from depression tends to be insufficient. The work focuses on train the patient to identify various reinforcers that are important to him, as well as in applying them contingently according to the objectives that are set and are met.

Technique effectiveness

Yes OK it is not one of the most applied therapies due to the predilection for other techniques also of the cognitive-behavioral, Rehm's self-control therapy is one of the treatments that have shown a high level of effectiveness, having a well-established efficacy.

In addition, various studies show that each of the components or phases into which the drug therapy is divided Rehm's self-control is just as effective on its own, some of its elements being applied in different techniques. An example of this is the cognitive-behavioral program Action by Stark and Kendall for childhood depression, which It is based on self-control therapy and is effective in the treatment of childhood and adolescent depression.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.

• Belloch, A.; Sandín, and Ramos (2008). Manual of psychopathology. Madrid. McGraw-Hill (vol. 1 and 2). Revised edition.

• Kahn, J.S.; Kehle, T.J.; Jenson, W.R. and Clark, E. (1990). Comparison of cognitive-behavioral, relaxation, and self-modeling interventions for depression among middle-school students. School Psychology Review, 19, 196-211.

• Rehm, L, P. (1977). A-self control model of depression. Behavior Therapy. 8, pp. 787-804.

• Santos, J.L.; García, L.I.; Calderón, M.A.; Sanz, L.J.; de los Ríos, P.; Izquierdo, S.; Roman, P.; Hernangómez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE Preparation Manual PIR, 02. CEDE. Madrid.