PPRNet Clinical summary: Improvements in Interpersonal Problems are Key to Treating Depression

There are multiple theories of the role of interpersonal problems in depression. One theory holds that interpersonal vulnerabilities (relational dependency and self-criticism) are at the core of depressive experiences. In this theory, interpersonal vulnerabilities cause depressive experiences. Another prominent theory holds that depression leads to engagement in maladaptive interpersonal behaviours that are aversive to others, who distance themselves from the depressed person. In this theory, depression causes interpersonal problems. The two theories suggest different therapeutic foci. The first theory indicates that addressing core interpersonal problems would result in substantial therapeutic benefit. The second theory indicates that addressing depressive symptoms directly in therapy would secondarily alleviate the interpersonal problems. In this study, Hostmaelingen and colleagues examined the potential reciprocal effect of change in interpersonal distress on change in subsequent depressive symptoms (to test the first theory) and change in depressive symptoms on subsequent change in interpersonal distress (to test the second theory). The study included 184 adult patients with a depressive disorder. The patients were recruited from the public health system in Norway and treated by 88 experienced psychotherapists in open-ended non-manualized psychotherapy for up to 40 sessions. On average, patient depression scores and interpersonal problem scores on standardized measures decreased significantly and remained stable up to 2.5 years post-treatment. When patients reported less interpersonal distress at a given time, they also reported fewer depressive symptoms at the following session. This finding supported the first theory. However, depressive symptoms at a given time did not predict less interpersonal distress at the following session, thus not supporting the second theory.

Practice Implications

As is well known, interpersonal distress is related to depressive symptoms. This study suggests that improvement in interpersonal distress precedes improvements in depressive symptoms, but not the other way around. Perhaps psychotherapy for depression should focus on assessing interpersonal distress and including this information in a case formulation that outlines how a patient should be treated. Therapists should address interpersonal problems as key determinants of depression in their patients. As the first theory suggests, interpersonal functioning lies at the core of depression and improving interpersonal dysfunction will lead to improved depressive symptoms.

Høstmælingen, A., Nissen-Lie, H. A., Monsen, J. T., & Solbakken, O. A. (2025). Interrelationships of symptomatic and relational distress: Improvements in interpersonal problems predict subsequent improvement in depressive symptoms during open-ended psychotherapy for adults with depression. Journal of Consulting and Clinical Psychology, 93(6), 457–470. https://doi.org/10.1037/ccp0000956