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

ABSTRACT 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 Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or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exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different.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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    ABSTRACT: Background Depression is associated with physical inactivity, which may mediate the relationship between depression and a range of chronic physical health conditions. However, few interventions have sought to combine a psychological intervention for depression with behaviour change techniques to promote increased physical activity such as behavioural activation (BA) Methods To determine the feasibility and acceptability of the trial methods and intervention, a pilot parallel group randomised controlled trial (RCT) was undertaken within two Improving Access to Psychological Therapies (IAPT) services in the South West of England. We aimed to recruit 80 adults with depression, randomised to a supported written self-help programme based on either BA alone or BA plus physical activity promotion (BAcPAc). Data were collected at baseline and 4 months post-randomisation to evaluate trial retention, intervention uptake and intervention engagement. Qualitative data were collected from participants and Psychological Wellbeing Practitioners (PWPs) to assess acceptability and feasibility of the trial methods and intervention. Results Sixty people with a clinical diagnosis of depression were recruited with a 73% follow-up rate (21/30 BAcPAc; 23/30 BA) and accelerometer physical activity data collected for 64% of those followed up. Twenty of those recruited (33%) received at least one treatment appointment (10/30 BAcPAc; 10/30 BA). Interviews were conducted and analysed for 15 participants and 9 study PWPs. The study highlighted the challenges of conducting a RCT within existing IAPT services with high staff turnover and absence, patient scheduling issues, PWP and patient preferences for cognitive focussed treatment and deviations from BA delivery protocols. The BAcPAc intervention however was generally acceptable.
    Trials 01/2015; · 2.12 Impact Factor
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    ABSTRACT: Cómo Referenciar este artículo/How to reference this article: Basto, I. y Salgado, J. (2014). La investigación sobre el proceso de cambio en psicoterapia y los diferentes enfoques terapéuticos: un análisis de los mecanismos cognitivos y emocionales. Revista de Psicoterapia, 25(99), 31-47. Resumen Actualmente, la investigación sobre la efectividad de los diferentes tipos de psicoterapia demuestra que la psicoterapia funciona para distintos tipos de trastornos. Sin embargo, todavía hay varios problemas que siguen sin resolverse, por ejemplo, los casos que no responden al tratamiento así como casos de deterioro. Con esta finalidad, es necesario complementar la investigación de eficacia con estudios de proceso (investigación de proceso y proceso-resultado). Así este trabajo tiene como objetivos: efectuar una breve síntesis del estado actual de la investigación sobre los mecanismos de cambio (emocio-nales y cognitivos) en la psicoterapia; y w. El análisis de los diferentes estudios parece validar empíricamente el papel mediador de diferentes mecanismos en la promoción del cambio terapéutico. Sin embargo, parece ser más difícil confirmar la especificidad de los mecanismos a las terapias que los suscitan específicamente. Se discutirá las implicaciones de estos resultados para investigaciones futuras sobre el cambio terapéu-tico. Palabras Clave: Psicoterapia; Cambio terapéutico; Investigación Proceso-resul-tado; mecanismos de cambio.
  • 01/2012; 10(4):434-441. DOI:10.1176/appi.focus.10.4.434

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