Korean Clinical Psychology Association

Current Issue

Korean Journal of Clinical Psychology - Vol. 39 , No. 2

[ Review Article ]
Korean Journal of Clinical Psychology - Vol. 38 , No. 4 , pp.388-399
ISSN: 2733-4538 (Online)
publication date 30 Nov 2019
Received 03 Sep 2019 Revised 27 Nov 2019 Accepted 27 Nov 2019
DOI: https://doi.org/10.15842/kjcp.2019.38.4.005

우울증의 근거기반치료에 대한 고찰
김지인 ; 권호인
전주대학교 상담심리학과

Evidence-Based Treatments of Depression
Ji In Kim ; Ho In Kwon
Departement of Counseling Psychology, Jeonju University, Jeonju, Korea
Correspondence to : Ho In Kwon, Department of Counseling Psychology, JeonJu University, 303 Cheonjam-ro, Wansan-gu, Jeonju, Korea; E-mail: hikwon14@jj.ac.kr

© 2019 Korean Clinical Psychology Association


우울증은 만성적이고 재발적인 경과뿐 아니라 자살의 영향력과 관련하여 중요한 사회적 문제로 간주되고 있다. 전 세계의 여러 연구자들은 우울증의 심각성을 인식하고, 다양한 치료의 개발과 그 효과 검증에 관심을 집중하고 있다. 본 연구에서는 그동안의 연구를 통해 우울증 치료에 있어서 그 효과가 강력하게 지지된 인지치료, 행동활성화치료, 대인관계치료, 문제해결치료의 치료 요인과 과정, 국내 치료효능 연구를 개관하였다. 또한 국내 우울증의 심리치료 결과를 요약하여, 이를 바탕으로 우울증에 대한 근거기반치료의 권고안을 제시하였다. 본 연구에서는 국내 연구결과를 기반으로 인지행동치료와 수용전념치료, 마음챙김에 기반한 인지치료를 효과가 있음직한 치료로 제안하였다. 이를 통해 향후 심리치료 연구에 대한 제언을 하였으며, 국내의 근거기반 우울증 치료의 연구 및 보급을 촉진하고자 하였다.


Depression is of great individual and social importance because of its devastating course and risk for future suicide attempts. Researchers globally have recognized the seriousness of depressive disorder and thus have participated in the development and evaluation of treatments. In this study, we reviewed the basic assumptions, treatment factors, and efficacy trials of cognitive therapy, behavior activation therapy, interpersonal therapy, and problem-solving therapy. In addition, the results of psychological treatment of depression in Korea are summarized, based on which recommendations for evidence-based treatment for depression are suggested. In this study, based on the results of a domestic study, cognitive behavioral therapy, acceptance commitment therapy, and mindfulness-based cognitive therapy are proposed as treatments that might be effective. Finally, this article highlights future directions for evidence-based depression treatment research in Korea.

Keywords: evidence-based psychotherapy, cognitive therapy, behavior activation therapy, interpersonal therapy, problem-solving therapy
키워드: 근거기반치료, 인지치료, 행동활성화치료, 대인관계치료, 문제해결치료

1. Alexopoulos, G. S., Raue, R., & Arean, P. (2003). Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. American Journal of Geriatric Psychiatry, 11, 46-52.
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric.
3. American Psychological Association Presidential Task force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285.
4. Bae, E. S., & Yeum, D. M. (2015). Effects of a telephone-administered cognitive behavioral therapy for the management of depression, anxiety, and chronic illness anticipated stigma in Parkinson’s disease. Korean Journal of Adult Nursing, 27, 223-232.
5. Bell, A. C., & D’Zurilla, T. J. (2009). Problem-solving therapy for depression: A meta-analysis. Clinical Psychology Review, 29, 348-353.
6. Chambless, D. L., Baker, M. J., Baucom, D. M., Beutler, L. E., Calhoun, K. S., Crits-Chritoph, P., . . . Woody, S. (1998). Update on empirically validated therapies. II. The Clinical psychologist, 51, 3-16.
7. Chambless, D., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7-18.
8. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported interventions: Controversies and evidence. Annual Review of Psychology, 52, 658-716.
9. Cho, J. H., & Son, C. N. (2013). Effects of the mindfulness-based cognitive therapy(MBCT) program on depression, impulsivity, and drug abstinence self-efficacy of drug addicts. Korean Journal of Clinical Psychology, 32, 13-31.
10. Cho, Y. R. (2017). Evidence-based treatments of anxiety and anxiety-related disorders: Criteria, research issues, comments, and suggestions. Korean Journal of Clinical Psychology, 36, 449-457.
11. Choi, Y. H., & Byun, S. H. (2017). Therapeutic mechanism of MBCT and clinical application of MBCT(mindfulness-based cognitive therapy) program on chronic depression. Korea Academy Industrial Cooperation Society, 7, 237-248.
12. Choi, Y. S., & Kim, M. A. (2019). The effects of mindfulness-based cognitive therapy program on stress, self-esteem and depression of nursing students. Journal of the Korea Contents Association, 19, 210-222.
13. Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive behavioral therapy for adult depression, alone in comparison with other treatments. Canadian Journal of Psychiatry, 58, 376-385.
14. Cuijpers, P., Geraedts, A. S., van Oppen, P., Andersson, G., Markowitz, J. C., & van Straten, A. (2011) Interpersonal psychotherapy for depression: A meta-analysis. American Journal of Psychiatry, 168, 581-592.
15. Cuijpers, P., deWit, L., Kleiboer, A., Karyotaki, E., & Ebert, D. D. (2018). Problem-solving therapy for adult depression: An updated meta-analysis. European Psychiatry, 48, 27-37.
16. Cuijpers, P., Van Straten, A., & Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27, 318-326.
17. De Mello, M. F., de Jesus, M. J., Bacaltchuk, J., Verdeli, H., & Neugebauer, R. (2005). A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. European Archives of Psychiatry and Clinical Neuroscience, 255, 75-82.
18. DeRubeis, R. J., & Crits-Christoph, P. (1998). Empirically supported individual and group psychological treatments for adult mental disorders. Journal of Consulting and Clinical Psychology, 66, 37-52.
19. DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., . . . Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409-416.
20. Dobson, K. S. (2014). Handbook of cognitive-behavioral therapies (E. J. Kim & S. D. Won, Trans). New York, NY: Guilford Press. (Original work published in 2012).
21. Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R., . . . Jacobson, N. S. (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76, 468-477.
22. D’Zurilla, T. J., & Goldfried, M. R. (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78, 107-126.
23. D’Zurilla, T. J., & Nezu, A. M. (1999). Problem-solving therapy: A social competence approach to clinical intervention (2nd ed.). New York, NY: Springer.
24. D’Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. (2004). Social problem solving: Theory and assessment. In E. C. Chang, T. J. D’Zurilla, & L. J. Sanna (Eds.), Social problem solving: Theory, research, and training (pp. 11-27). Washington, DC: American Psychological Association.
25. Eker, A. M., Dikmen, M., Cambazoğlu, S., Düzgün, Ş. H., & Akgün, H. (2014). Evaluation and comparison of landslide susceptibility mapping methods: A case study for the Ulus district, Bartin, northern Turkey. International Journal of Geographical Information Science, 29, 132-158.
26. Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., . . . Parloff, M. B. (1989). NIMH Treatment of depression collaborative research program. Archives of General Psychiatry, 46, 971-982.
27. Fruzzetti, A. E., McLean, C., & Erikson, K. M. (2019). Mindfulness and acceptance interventions. In K. S. Dobson & D. J. A. Dozois (Eds.), Handbook of cognitive-behavioral therapies (4th ed., pp. 271-296). New York, NY: Guilford Press.
28. Gawrysiak, M., Nicholas, C., & Hopko, D. R. (2009). Behavioral activation for moderately depressed university students: Randomized controlled trial. Journal of Counseling Psychology, 56, 468-475.
29. Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008). GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. British Medical Journal, 336, 924-926.
30. Hamilton, K. E., & Dobson, K. S. (2001). Empirically supported treatments in psychology: Implications for international promotion and dissemination. International Journal of Clinical and Health Psychology, 1, 35-51.
31. Hayes, S. C. (2004). Acceptance and commitment therapy and the new behavior therapies: mindfulness, acceptance and relationship. In S. C. Hayes, V. M. Follette, & M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition (pp.1-29). New York, NY: Guilford.
32. Health Insurance Review & Assessment Service. (2007, June 17). Retrieved from https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020045020000&brdScnBltNo=4&brdBltNo=2300#none.
33. Hollen, S. D., DeRubies, R. J., Fawcett, J., Amsterdam, J. D., Shelton, R. C., Zajecka, J., . . . Gallop, R. (2014). Effective of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder. JAMA Psychiatry, 71, 1157-1164.
34. Hollen, S. D., & Dimidjian, S. (2009). Cognitive and behavioral treatment of depression. In I. H. Gotlib & C. L. Hammen (Eds.), Handbook of depression (pp. 586-603). New York, NY: The Guilford Press.
35. Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardom, J. P., . . . Gallop, R. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62, 417-422.
36. Jaekal, E. J., Jang, S. K., Lee, G. Y., & Choi, K. H. (2014). Systematic review of randomized controlled trials of psychotherapy in Korea. Korean Journal of Clinical Psychology, 33, 943-961.
37. Jarrett, R. B., Schaffer, M., Mclntire, D., Witt-Browder, A., Kraft, D., & Risser, R. C. (1999). Treatment of atypical depression with cognitive therapy or phenelzine: A double-blind, placebo-controlled trial. Archives of General Psychiatry, 56, 431-437.
38. Jo, E. J., & Son, C. N. (2016). Effects of cognitive behavioral group therapy (CBT) on employment stress, dysfunctional attitude, and depression of college students. Korean Journal of Clinical Psychology, 35, 121-138.
39. Kazdin, A. E. (2003). Research design in clinical psychology (4th ed.). Boston, MA: Allyn & Bacon.
40. Kim, H. E., & Park, K. (2014). The effects of process variables in acceptance commitment therapy for women’s depression. Korean Journal of Clinical psychology, 33, 429-460.
41. Kim, J. J., & Hyun, M. S. (2016). The effects of a reality therapy program for the elderly with depressive disorder. Journal of East-West Nursing Research, 22, 96-103.
42. Kim, M. Y., & Jeong, H. H. (2003). The effects of cognitive-behavioral group counseling on elderly depression, loneliness, and dysfunctional attitude. The Korean Journal of Counseling and Psychotherapy, 15, 477-490.
43. Klerman, G. L., & Weissman, M. M. (1986). The interpersonal approach to understanding depression. In T. E. Millon & G. L. Klerman (Eds.), Contemporary directions in psychopathology: Toward the DSM-IV (pp. 429-456). New York, NY: Guilford Press.
44. Kleman, G. L., Weissman, M. M., Rounsaville, B. J., & Chevron, E. S. (1984). Interpersonal psychotherapy of depression. New York, NY: Basic Books.
45. Ko, Y. J., & Kim, J. M. (2011). The effects of cognitive behavioral therapy using books on depression and social skills of adolescents from single-parent low-income families. The Journal of Play Therapy, 15, 35-51.
46. Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., . . . Byford, S. (2015). The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compare with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomized controlled trial ( the PREVENT study). Health Technology Assessment, 19, 1-124.
47. Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., . . . Dalgleish, T. (2016). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse an individual patient data meta-analysis from randomized trials. JAMA Psychiatry, 73, 565-574.
48. Lee, K. H. (2017). Vulnerability, depression, and anxiety: A preliminary comparison of CBT and ACT interventions. The Korean Journal of Counseling and Psychotherapy, 29, 33-53.
49. Lee, G. Y., Cha, Y. J., Seo, H. J., & Choi, K. H. (2016). Feasibility of behavioral activation therapy for depression in Korea: A case study. Cognitive Behavior Therapy in Korea, 16, 299-322.
50. Lee, G. Y., Jang, S. K., Jaekal, E. J., Koo, H. J., & Choi, K. H. (2017). Randomized controlled trials of psychological treatment in Korea: A systematic analysis by journals and periods. Korean Journal of Clinical Psychology, 36, 434-447.
51. Malouff, J. M., Thorsteinsson, E. B., & Schutte, N. S. (2007). The efficacy of problem-solving therapy in reducing mental and physical health problems: A meta-analysis. Clinical Psychology Review, 27, 46-57.
52. Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2012). Behavioral activation for depression: A clinician’s guide (B. S. Kim & H. J. Seo, Trans). New York, NY: Guilford Press. (Original work published in 2010).
53. Mazzucchlli, T., Kane, R., & Rees, C. (2009). Behavioral activation treatments for depression in adults: A meta analysis and review. Clinical Psychology: Science and Practice, 16, 383-411.
54. Murray, C. J. L., & Lopez, A. D. (1996). The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press.
55. Na, J. Y. (2012). The effect of cognitive behavioral therapy program on the automatic thoughts, depression and stress coping style in depressive patients (unpublished master’s thesis). Chonnam National University, Korea.
56. Nezu, A. M. (2004). Problem solving and behavior therapy revisited. Behavior Therapy, 35, 1-33.
57. Park, H. S., & Son, C. (2007). The effect of cognitive therapy and psychodrama for depressed group. The Korean Journal of Health Psychology, 12, 411-437.
58. Park, J. H., & Kim, K. W. (2011). A review of the epidemiology of depression in Korea. Journal of Korean Medical Association, 54, 362-369.
59. Saatsi, S., Hardy, G. E., & Cahill, J. (2007). Predictors of outcome and completion status in cognitive therapy for depression. Psychotherapy Research, 17, 185-195.
60. Segal, Z. V., Williams, M. G., & Teasdale, J. D. (2001). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York, NY: The Guilford Press.
61. Selligman, M. E. P., Schulman, P., DeRubies, R. J., & Hollon, S. D. (1999). The prevention of depression and anxiety. Prevention & Treatment, 2, Article ID 8a..
62. Shapiro, D. A., Barkham, M., Rees, A., Hardy, G. E., Reynolds, S., & Startup, M. (1994). Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. Journal of Consulting and Clinical Psychology, 62, 522-534.
63. Shin, K. M. (2018). Evidence-based treatments for depression in children and adolescents. Korean Journal of Clinical Psychology, 37, 595-604.
64. Simons, A. D., Murphy, G. E., Levine, J. L., & Wetzel, R. D. (1986). Cognitive therapy and pharmacotherapy for depression: Sustained improvement over one year. Archives of General Psychiatry, 43, 43-48.
65. Stuart, S., & Robertson, M. (2016). Interpersonal psychotherapy: A clinician’s guide (K. Y. Im & J. H. Kim, Trans). London, UK: Edward Arnold (Original work published in 2003).
66. Tolin, D. F., Mckay, D., Forman, E. M., Klonsky, E. D., & Thombs, B. D. (2015). Empirically supported treatment: Recommendations for a new model. Clinical Psychology: Science and Practice, 22, 317-338.
67. Twohig, M. P., & Levin, M. E. (2017). Acceptance and commitment therapy as a treatment for anxiety and depression: a review. Psychiatry Clinics of North America, 40, 751-770.
68. World Health Organization. (2017). Depression and other common mental disorders: Global health estimates. Geneva: World Health Organization.
69. Yim, M. K., Lee, J. H., Lee, H. N., Kim, T. D., & Choi, K. H. (2013). Evidence-based practice in psychotherapy. The Korean Journal of Psychology: General, 32, 251-270.
70. Yoon, H. S., Koo, B. M., Lee, K., & Lee, J. Y. (2010). The effectiveness of problem-solving treatment on geriatric depression. Journal of the Korean Gerontological Society, 30, 871-894.
71. Zhang, Z., Zhang, L., Zhang, G., Jin, J., & Zheng, Z. (2018). The effect of CBT and tis modifications for relapse prevention in major depressive disorder: A systematic review and meta-analysis. BMC Psychiatry, 18, 50..