Dignity Therapy for Major Depressive Disorder: A Case Report

Dear Editor:

Dignity therapy is a psychotherapeutic intervention that has primarily been studied and used with terminally ill patients.^1–3 In this therapy, clinicians help a patient generate a document that can be passed on to loved ones by recording a patient's life story and then transcribing the patient's words. The document created usually contains the details of a patient's life, life lessons the patient has learned, and declarations of affection towards loved ones. We report the case of a 61-year-old woman with major depressive disorder who participated in dignity therapy while hospitalized for a major depressive episode.

Mrs. S is a 61-year-old Caucasian female who was brought into the hospital by her family for four weeks of severe depression in the setting of losing her job. Mrs. S was placed on citalopram, and gradually her mood improved. She remained hopeless, however, and wondered how she could find meaning in her life without her job. She agreed to participate in dignity therapy in order to “gain a fresh perspective on things.” Mrs. S was interviewed using the Dignity Psychotherapy Question Protocol, ¹ and her answers were recorded and then transcribed. She then edited the document. The final product was a 10-page life history which focused more on her children and her volunteer projects than on her work life. Mrs. S was given ten copies of her story, which she distributed to her family and friends. She reported that dignity therapy had helped her “find hope” and further improved her mood.

This is the first documented report of the use of dignity therapy with a patient with only major depressive disorder. Dignity therapy was used to help this patient face a major life event much in the way it helps those facing a terminal illness. In end-of-life care, dignity therapy has helped patients achieve a heightened sense of dignity, purpose, and meaning, and an increased will to live; it has also been shown to decrease suffering and depressive symptoms. ¹ In individuals with depression, one might expect similar gains, especially since therapies that focus on narrative have been effective for individuals with depression, as they can help repair a damaged sense of self and aide a patient in making sense of an altered life course.^4–7 Further, just as dignity therapy has been shown to moderate the bereavement experience and decrease suffering and distress in the relatives of terminally ill patients, ⁸ one might expect it to have similar positive effects on the relatives of individuals who are experiencing a mental illness, as mental illness impacts the whole family. ⁹ Future work is needed to adapt dignity therapy for people with depression and other mental illnesses and to identify which patients would benefit from such an intervention.