Although the majority of acutely depressed patients are successfully treated either pharmacologically or psychologically, or with a combination of both, the current concern is that many of these successfully treated patients will relapse in the future. Follow-up research from across the globe is showing a return of new episodes of depression in people with a history of depression (Segal, Williams, & Teasdale, 2002) and the current alarming consensus is that relapse and recurrence is common among successfully treated depressed patients. For example, Paykel et al. (1995) found at least 50% of patients who recover from an initial episode of depression will have at least one subsequent depressive episode, and those patients with a history of two or more past episodes will have a 70% to 80% likelihood of recurrence in their lives (Consensus Developmental Panel, 1985). These findings led Judd (1997) to conclude that “unipolar depression is a chronic, lifelong illness, the risk for repeated episodes exceeds 80%, patients will experience an average of four lifetime major depressive episodes of 20 weeks’ duration each” (p. 990).

These findings draw attention to the fact that relapse and recurrence following successful treatment of depression is common. Prior to these findings, relatively little attention was paid to depressed patients’ ongoing risk. Now clinicians and therapists are beginning to make concerted effort to prevent recurrence and relapse in their depressed patients. Continuation treatment and ongoing education regarding warning signs of relapse or recurrence are considered essential in ongoing clinical care. From the review of the literature, Dobson and Ottenbreit (2004) have identified three approaches for relapse prevention: (a) optimizing acute-phase treatment, (b) treating residual symptoms and maintenance treatment, and (c) developing specific relapse-prevention programs. Both pharmacological and psychotherapeutic strategies are used to optimize treatment during the acute phase in order to reduce the risk of relapse. Recently, hypnotherapy (see Alladin, 2006a) has been utilized to prevent relapses in depression. Encouraged by the findings (Alladin, 2005, 2006; Alladin & Alibhai, 2007) that cognitive hypnotherapy (CH) produces larger effect size than cognitive behavioral therapy (CBT) in the management of acute-phase depression and that patients from the CH group continue to improve after discharge, I (Alladin, 2006a) expanded the CH approach to actively deal with relapse prevention. I call this approach experiential cognitive hypnotherapy (ECH) because it uses hypnosis and mindful techniques to help depressed patients decenter from negative feelings, images, and thoughts and search for nondepressive (mainly pleasant) affect. The rest of the chapter will describe how ECH strategies are used to
(a) optimize acute-phase treatment, (b) treat residual symptoms, and (c) provide maintenance treatment. The role pharmacological and other psychotherapeutic approaches is also highlighted.