Psychosocial intervention development for the prevention and treatment of depression: Promoting innovation and increasing access

Department of Psychology, Boston University, Boston, Massachusetts, United States
Biological Psychiatry (Impact Factor: 10.26). 10/2002; 52(6):610-30. DOI: 10.1016/S0006-3223(02)01384-7
Source: PubMed


Great strides have been made in developing psychosocial interventions for the treatment of depression and bipolar disorder over the last three decades, but more remains to be done. The National Institute of Mental Health Psychosocial Intervention Development Workgroup recommends three priorities for future innovation: 1) development of new and more effective interventions that address both symptom change and functional capacity, 2) development of interventions that prevent onset and recurrence of clinical episodes in at-risk populations, and 3) development of user-friendly interventions and nontraditional delivery methods to increase access to evidence-based interventions. In each of these areas, the Workgroup recommends systematic study of the mediating mechanisms that drive the process of change and the moderators that influence their effects. This information will highlight the elements of psychosocial interventions that most contribute to the prevention and treatment of mood disorders across diagnostic groups, populations served, and community settings. The process of developing innovative interventions should have as its goal a mental health service delivery system that prevents the onset and recurrence of the mood disorders, furnishes increasingly effective treatment for those who seek it, and provides access to evidence-based psychosocial interventions via all feasible means.

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    • "There are considerable benefits to understanding the processes that underlie symptomatic change in interventions because this facilitates intervention innovation (Hollon et al., 2002; Kraemer et al., 2002; Rutter, 2007). We sought to identify which cognitive risk-factors were changed by different types of universal preventive intervention (TRY, CBT and MBCT). "
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    ABSTRACT: Effective methods to prevent adolescent depressive symptoms could reduce suffering and burden across the lifespan. However, psychological interventions delivered to adolescents show efficacy only in symptomatic or high-risk youth. Targeting causal risk factors and assessing mechanistic change can help devise efficacious universal or classroom based prevention programs. A non-randomized longitudinal design was used to compare three classroom-based prevention programs for adolescent depression (Behavioral Activation with Reward Processing, "Thinking about Reward in Young People" (TRY); Cognitive Behavioral Therapy (CBT) and Mindfulness Based Cognitive Therapy (MBCT)), and determine cognitive mechanisms of change in these programs. Cognitive mechanisms examined were reward-seeking, negative self-beliefs (assessed with behavioral tasks) and over-general autobiographical memory. 256 healthy adolescents aged 13-14 participated with 236 (92%) and 227 (89%) completing the pre- and post-assessments. TRY was the only intervention associated with a reduction in depressive symptoms at follow-up. Reward-seeking increased following TRY. In the other programs there were non-significant changes in cognitive mechanisms, with more reflective negative self-beliefs in CBT and fewer over-general autobiographical memories in MBCT In the TRY program, which focused on increasing sensitivity to rewarding activities, reward seeking increased and this was associated with decreased depressive symptoms. Due to the infeasibility of a cluster randomized controlled trial, a non-randomized design was used. Increased reward-seeking was associated with decreased depressive symptoms and may be a mechanism of depressive symptom change in the intervention with a focus on enhancing sensitivity and awareness of reward. This study provides preliminary evidence to suggest that incorporating activities to enhance reward sensitivity may be fruitful in randomized controlled trials of universal prevention programs for depression. Copyright © 2015. Published by Elsevier B.V.
    Journal of Affective Disorders 07/2015; 186:320-327. DOI:10.1016/j.jad.2015.07.019 · 3.38 Impact Factor
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    • "With knowledge of such factors, interventions can be developed that effectively foster these factors and consequently enhance the efficacy of treatments for mental disorders (Laurenceau, Hayes, & Feldman, 2007). Throughout the past 20 years, deficits in emotion regulation (ER) have often been discussed as a putative maintaining factor in depression (Ehring, Tuschen-Caffier, Schnülle, Fischer, & Gross, 2010; Gross & Muñoz, 1995; Hollon et al., 2002; Mennin & Fresco, 2009). ER refers to the " extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal features, to accomplish one's goal " (Thompson, 1994, pp. "
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    ABSTRACT: Objective: Deficits in emotion regulation (ER) skills are considered a putative maintaining factor for major depressive disorder (MDD) and hence a promising target in the treatment of MDD. However, to date, the association between the successful application of arguably adaptive ER skills and changes in depressive symptom severity (DSS) has yet to be investigated over the course of treatment. Thus, the primary aim of this study was to clarify reciprocal prospective associations between successful ER skills application and DSS over the course of inpatient cognitive behavioral therapy for MDD. Additionally, we explored whether such associations would differ across specific ER skills. Method: We assessed successful ER skills application and DSS 4 times during the first 3 weeks of treatment in 152 inpatients (62.5% women, average age 45.6 years) meeting criteria for MDD. We first tested whether successful skills application and depression were cross-sectionally associated by computing Pearson's correlations. Then, we utilized latent curve modeling to test whether changes in successful skills application were negatively associated with changes in DSS during treatment. Finally, we used latent change score models to clarify whether successful skills application would predict subsequent reduction of DSS. Results: Cross-sectionally, successful ER skills application was associated with lower levels of DSS at all assessment times, and an increase of successful skills application during treatment was associated with a decrease of DSS. Moreover, successful overall ER skills application predicted subsequent changes in DSS (but not vice versa). Finally, strength of associations between successful application and DSS differed across specific ER skills. Among a broad range of potentially adaptive skills, only the abilities to tolerate negative emotions and to actively modify undesired emotions were significantly associated with subsequent improvement in DSS. Conclusions: Systematically enhancing health-relevant ER skills with specific interventions may help reduce DSS in patients suffering from MDD.
    Journal of Consulting and Clinical Psychology 02/2014; 82(2). DOI:10.1037/a0035828 · 4.85 Impact Factor
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    • "For example, despite the recent UK government initiative in England - ‘Improving Access to Psychological Therapies’ (IAPT: - no more than 15% of people with depression will receive National Health Service (NHS)-delivered CBT and only 50% will recover [12]. It is therefore important to continue to test promising new treatments, especially if: there are indications that such treatments reduce the risk of symptom return; are applicable to a wide range of depressed people including those with high severity; are easy to implement in clinical practice and are therefore potentially more accessible [13]; and are a cost-effective use of resources. Indeed, in order to meet public and professional expectations, health services require simple, equivalently effective, easily implemented psychological treatments for depression that can be delivered by less specialist (albeit appropriately competent) junior or para-professional health workers to treat many more people with depression in a more cost-effective manner. "
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    ABSTRACT: Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, CBT is a complex therapy that requires highly trained and qualified practitioners, and its scalability is therefore limited by the costs of training and employing sufficient therapists to meet demand. Behavioural activation (BA) is a psychological treatment for depression that may be an effective alternative to CBT and, because it is simpler, might also be delivered by less highly trained and specialised mental health workers. COBRA is a two-arm, non-inferiority, patient-level randomised controlled trial, including clinical, economic, and process evaluations comparing CBT delivered by highly trained professional therapists to BA delivered by junior professional or para-professional mental health workers to establish whether the clinical effectiveness of BA is non-inferior to CBT and if BA is cost effective compared to CBT. Four hundred and forty patients with major depressive disorder will be recruited through screening in primary care. We will analyse for non-inferiority in per-protocol and intention-to-treat populations. Our primary outcome will be severity of depression symptoms (Patient Health Questionnaire-9) at 12 months follow-up. Secondary outcomes will be clinically significant change and severity of depression at 18 months, and anxiety (General Anxiety Disorder-7 questionnaire) and health-related quality of life (Short-Form Health Survey-36) at 12 and 18 months. Our economic evaluation will take the United Kingdom National Health Service/Personal Social Services perspective to include costs of the interventions, health and social care services used, plus productivity losses. Cost-effectiveness will explored in terms of quality-adjusted life years using the EuroQol-5D measure of health-related quality of life. The clinical and economic outcomes of this trial will provide the evidence to help policy makers, clinicians and guideline developers decide on the merits of including BA as a first-line treatment of depression.Trial registration: Current Controlled Trials ISRCTN27473954.
    Trials 01/2014; 15(1):29. DOI:10.1186/1745-6215-15-29 · 1.73 Impact Factor
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