Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Prevention of Relapse and Recurrence in Major Depression

Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 07/2008; 76(3):468-77. DOI: 10.1037/0022-006X.76.3.468
Source: PubMed


This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy and that both psychotherapies are less expensive and longer lasting alternatives to medication in the treatment of depression.

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Available from: Jackie K Gollan, Feb 11, 2014
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    • "The 50%– 80% rate of depression relapse (Judd, 1997) has prompted a focus on treatments aimed at preventing relapse/recurrence. Maintenance antidepressant medication (mADM) is the most common strategy to prevent relapse and recurrence but is associated with poor adherence (ten Doesschate, Bockting, & Schene, 2009), side effects (Kelly, Posternak , & Alpert, 2008), and modest clinical benefits after discontinued use (Dobson et al., 2008; Hollon, Stewart, & Strunk, 2006). "
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    ABSTRACT: Objective: We evaluated the comparative effectiveness of mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction. Method: Ninety-two participants in remission from major depressive disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for nonspecific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals. Results: Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (Group × Time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction postintervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant. Conclusions: MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions. (PsycINFO Database Record
    Journal of Consulting and Clinical Psychology 09/2015; 83(5):964-75. DOI:10.1037/ccp0000050 · 4.85 Impact Factor
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    • "However, we note that results from a recent meta-analysis of FDA clinical trials for multiple antidepressants (Kirsch et al. 2008) suggest that positive results in medication treatment effectiveness studies have largely been due to clinically significant effects above the placebo response only at the most severe levels of depression. Consistent with this view, Dobson et al. (2008) suggest that: " Antidepressant medication (ADM) has been shown to prevent the return of symptoms associated with major depression for as long as it is continued or maintained. However, there is little evidence that having taken medication does anything to alter the risk factors that lead to subsequent relapse and recurrence, and most patients with chronic or recurrent depression are encouraged to stay on medication indefinitely " (p. "

    • "Parsimony is also reflected in the nature of the treatment techniques (BA and BATD) and this technical parsimony may be a primary driver of the increasing interest in these treatments as suitable candidates for large scale dissemination across diverse mental health care settings and cultural contexts. As described in detail above, empirical studies have indicated that BA is as effective as gold standard psychotherapy and medication (Dimidjian et al., 2006; Dobson et al., 2008; Ekers et al., 2014; Mazzuchelli et al., 2009) and perhaps particularly efficacious in more severe cases (Dimidjian et al., 2006; Moradveisi et al., 2013). The parsimonious nature of BA (Jacobson et al., 1996), however, suggests that BA may hold advantages over other empirically supported psychotherapy approaches in that training may be completed within a highly restricted time-frame (Puspitasari, Kanter, Murphy, Crowe & Koerner, 2013) with retained efficacy and cost effectiveness (Ekers, Godfrey, Gilbody et al., 2011; Ekers, Richards, McMillan, Bland & Gilbody, 2011). "
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    ABSTRACT: Learning theory provides a foundation for understanding and deriving treatment principles for impacting a spectrum of functional processes relevant to the construct of depression. While behavioral interventions have been commonplace in the cognitive behavioral tradition, most often conceptualized within a cognitive theoretical framework, recent years have seen renewed interest in more purely behavioral models. These modern learning theory accounts of depression focus on the interchange between behavior and the environment, mainly in terms of lack of reinforcement, extinction of instrumental behavior, and excesses of aversive control, and include a conceptualization of relevant cognitive and emotional variables. These positions, drawn from extensive basic and applied research, cohere with biological theories on reduced reward learning and reward responsiveness and views of depression as a heterogeneous, complex set of disorders. Treatment techniques based on learning theory, often labeled Behavioral Activation (BA) focus on activating the individual in directions that increase contact with potential reinforcers, as defined ideographically with the client. BA is considered an empirically well-established treatment that generalizes well across diverse contexts and populations. The learning theory account is discussed in terms of being a parsimonious model and ground for treatments highly suitable for large scale dissemination.
    Scandinavian Journal of Psychology 06/2015; DOI:10.1111/sjop.12233 · 1.29 Impact Factor
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