First Aid for Depression is an innovative brief clinical intervention for dealing with acute symptoms of depression. When faced with a stressor, depressed patients tend to become overwhelmed with feelings of low mood, hopelessness, and a sense of pessimism. Any immediate relief from these feelings provides a sense of hope, promotes positive expectancy of treatment, and strengthens the therapeutic alliance. Overlade (1986) described a First Aid technique for producing immediate relief from the depressive mood. The technique utilizes ventilation, education, alteration in posture, and active imagery to reduce the depressive affect. The importance of the imaginal processes has been increasingly recognized in the clinical field, and numerous imagery techniques are utilized in the treatment of various medical and psychiatric disorders (Sheikh, 2003). Velton (1968) and Sirota and Schwartz (1982) demonstrated that different affective states can be induced and altered by various imagery procedures. Schultz (1978, 1984, 2003) provided empirical evidence that directed (aggressive, socially gratifying, and positive) imagery can break the “depressive loop” and produce temporary relief in depressed psychiatric patients. Similarly, Burtle (1975) produced immediate changes in the level of depression in eight depressed patients with psychomotor retardation by providing positive imagery training. These findings clearly demonstrate that directed imagery can help severely depressed patients reduce their level of depression for brief periods of time.

The First Aid technique is particularly indicated when the depression is of recent onset and the precipitant is clearly identified as accounting for the escalation of the depressed mood. This technique will not be appropriate for chronic depression and where depression is considered to be secondary to substance abuse or pathological conditions. I (Alladin, 1989, 1992, 1992a, 1994, 2006; Alladin & Heap, 1991) have expanded this technique into seven phases:

The First Aid Technique for depression is described and illustrated by a Case Example: Patty, a 37-year-old housewife, was in therapy with me for about 6 months for dysthymic disorder. She did very well with cognitive hypnotherapy (CH), so she was
discharged after twelve sessions. Eight months after discharge, Patty arranged for an urgent appointment to see me. She had an acute situational depression precipitated by her husband’s unjustified anger and very cutting remarks. Patty is married to Brent, a very ambitious and workaholic business man. Brent has a tendency to undermine psychological difficulties; his philosophy is that one should be able to lead a productive and successful life in this world if one chooses to and works hard to get it. He finds it hard to tolerate people who feels depressed and “mope about.” Patty, on the other hand, is very sensitive to people with emotional problems, and she strongly believes that in a marital relationship one should be able to communicate freely and be able to express one’s feelings easily. Although Brent was supportive of Patty while she was depressed and undergoing psychotherapy, he sincerely believes that Patty can make a greater difference to her life “if she gives up her pessimistic and gloomy views of life.”

Patty became very depressed because Brent accused her of “always moping” and being “stupid” and “useless.” Patty and Brent have two children (Becky, 6 and Adam, 10) from their 12-year marriage. Recently Adam was having some difficulties at school; he was not attentive in class and was oppositional to his teacher. Matters came to a head when Mr. Smith, the principal of the school, telephoned Patty to report that Adam had been swearing at his teacher. He is thinking of suspending Adam from school and wanted to meet with the parents urgently before making the final decision. Because Brent was out of town on business, Patty went to meet with the principal. Patty convinced Mr. Smith to give Adam a chance since it was his first offense, and Patty promised that she and her husband would keep a close eye on Adam. Although the situation was satisfactorily resolved, Patty started to feel guilty that it might be her fault that Adam has been presenting behavioral problems at school. Patty became so upset that she called her husband out of town to communicate her distress. Brent was in the middle of a tough business negotiation when Patty called, so he reassured her that he would call back as soon as the meeting was over. Patty expressed anger that she could not talk to her husband whenever she wishes and stated that he does not care for the family and is more interested in his business. An hour later, Brent called and expressed his anger and frustration at Patty. Brent indicated that she is selfish, useless, and unable to resolve the slightest difficulty in his absence, and he could not understand why she was making such a big deal about Adam when the matter was resolved. Following the telephone conversation, Patty became very upset and started to ruminate on the belief that she is useless and incompetent. She was not able to sleep that night, so the next day she arranged for her appointment with me.