Rehm’s Self-Control Therapy

A type of psychotherapy designed to intervene in cases of major depression in patients.

Major depression is one of the most frequent mental disorders worldwide, causing great suffering to the sufferer and his or her environment. Due to its high prevalence and the high level of vital discomfort and incapacitation that it is capable of causing, there have been multiple approaches that have tried to provide an explanation and an effective treatment. Numerous therapies have been developed to treat this condition.

Major depression is considered to be the continuous presence throughout the day, for at least two weeks, of a series of symptoms including 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 stimuli and situations that are generally appetizing for the subject, together with other elements such as weight or sleep disturbances, vital passivity, progressive isolation, feelings of guilt or suicidal thoughts.

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

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

Rehm's self-management therapy is a psychological treatment coming from the cognitive behavioral paradigm and specifically focused on the treatment of major depression. and focused specifically on the treatment of depression. It is a therapy of well-established efficacy based on the concept of self-control and the importance that the author gives to this aspect in behavioral self-management. In his model, the origin of depressive symptoms can be found in an imbalance between rewards and punishments.

Depression according to Rehm's model

Rehm's self-control therapy is based on the model that the author developed in order to explain depressive disorder. According to this model, depression is mainly caused by the lack of consistent behavioral reinforcement. In other words, the main problem lies in the fact that depressed people are unable to obtain elements or stimuli for their behavior. are unable to obtain positive elements or stimulation 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 able to ensure his behavior in such a way that he can obtain them, or that he is not able to self-manage. Thus, the person with depression would have a series of internal characteristics that would make self-control and self-management difficult. would make self-control and the adaptation of one's own behavior to reality difficult, so that in the face of the loss of self-control, the individual would be unable to control his or her own behavior.The problem that leads to depression is that the person with depression is not able to control his or her own behavior and adapt it to reality.

Thus, the problem that leads to depression is that the individual is not able to adequately manage his own behavior. Thus, the main objective of this therapy is the improvement of mood 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 basic processes: self-monitoring or self-control. self-monitoring or self-observation, self-evaluation and self-reinforcement or self-punishment according to the self-evaluation carried out.

1. Self-monitoring

In depressed people, it can be observed that in the self-monitoring process, the attention tends to be focused on the following tends to focus attention on the immediate consequences of the behavior. of the behavior, in addition to the fact that they generally pay more attention to negative information than to positive information.

2. Self-assessment

Regarding self-evaluation, from the model of Rehm's self-control therapy, this is usually biased towards the negative. is usually biased towards the negative by creating exaggeratedly high objectives and goals, which as a rule cannot be achieved. 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 achieving the proposed objectives, depressed people tend to self-punish themselves. tend to punish themselves or, failing that, they do not see their behavior reinforced when they achieve their objectives.

Profile of the person vulnerable to depression

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

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

1. Self-observation phase

This part of the therapy is fundamentally cognitive. Throughout the sessions, the therapist helps and trains the patient to become aware of the existence of positive and pleasant experiences, which the patient must register and try to associate with the mood.

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

2. Self-evaluation phase

As mentioned above, in Rehm's theory of self-control, individuals tend to set goals with very high standards, generally unattainable, which end up provoking feelings of helplessness. 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. The aim is for individuals to have a positive self-assessment of their own capabilities by being able to achieve their objectives.

3. Self-reinforcement phase

The last phase of self-control therapy has to do with reinforcement, which in subjects suffering from depression tends to be insufficient. The work focuses on training the patient to identify various reinforcers that are important to him/her, as well as that are important for him/her, as well as to apply them in a contingent manner according to the objectives that he/she has set for him/herself.

Effectiveness of the technique

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

In addition, several studies show that each of the components or phases into which Rehm's self-management therapy is divided is equally effective on its own, with some of its elements being applied in different techniques. An example of this is Stark and Kendall's cognitive-behavioral Action program for childhood depression, which is based on self-management 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 de psicopatología. 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. ; Román, P. ; Hernangómez, L. ; Navas, E. ; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Psicología Clínica. Manual CEDE de Preparación PIR, 02. CEDE. Madrid.