Table 3.

Interventions for co-morbid depression and chronic physical disease

Principles for Intervention	Example 1: Diabetes and Depression	Example 2: Heart Disease and Depression
Integrate disease and depression management by recognizing that the physical illness and mood disorder influence one another.	Recognize that depression can exacerbate diabetes; In the winter months, depression may worsen and make diabetes harder to manage.	Recognize that CHD may heighten depression; Heart attack risk may increase stress, which can worsen depression.
Cognitive Representations:   Identify and modify maladaptive disease cognitions.	Reduce self-blame for onset of diabetes; modify time course as chronic but controllable.	Reduce catastrophizing about potential consequences of returning to work after a heart attack; increase sense of personal control.
Behavioral Responses:   Link behavioral functioning and engage in behaviors that perpetuate better self-regulation of both conditions.	Become aware that managing diabetes can be depressing; Incorporate pleasurable activities into one’s daily routine to counterbalance this.	Become aware that depression reduces one’s motivation to engage in activities that control disease; Recognize the multiple benefits of exercise.
Social Functioning:   Enlist the aid of one’s social network in adopting coping responses consistent with both conditions.	Encourage family members to have celebratory dinners, but also to include healthy food choices.	Arrange for a conference call with one’s physician, psychologist, and spouse to discuss reasonable treatment-related goals.