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 Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or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exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different.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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    • "A large clinical trial demonstrated comparable effects of BA to pharmacotherapy (paroxetine) and superior effects to cognitive therapy, particularly among more severely depressed patients (Dimidjian et al., 2006). Follow-up work showed BA may also prevent relapse better than pharmacotherapy over the long-term (Dobson et al., 2008). Efforts are in place to translate this BA approach for adolescents (McCauley et al., 2011; Ritschel & Craighead, 2011) while incorporating key adaptations, including, flexible sequencing and duration of components, greater parental involvement, and attention to suicidal risk. "
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    ABSTRACT: Anxiety and depression are debilitating and commonly co-occurring in young adolescents, yet few interventions are designed to treat both disorder classes together. Initial efficacy is presented of a school-based transdiagnostic group behavioral activation therapy (GBAT) that emphasizes anti-avoidance in vivo exposure. Youth (N=35; ages 12-14; 50.9% male) were randomly assigned to either GBAT (n = 21) or WL (n = 14) after completing a double-gated screening process. Multi-reporter, multi-domain outcomes were assessed at pretreatment, posttreatment, and four-month follow-up (FU). GBAT was associated with greater posttreatment remission rates than WL in principal diagnosis (57.1% vs. 28.6%; Χ2 = 2.76, p = .09) and secondary diagnosis (70.6% vs. 10%; X2 = 9.26, p = .003), and greater improvement in Clinical Global Impairment – Severity ratings, B = -1.10 (0.42), p = .01. Symptom outcomes were not significantly different at posttreatment. GBAT produced greater posttreatment behavioral activation (large effect size) and fewer negative thoughts (medium effect), two transdiagnostic processes, both at the trend level. Most outcomes showed linear improvement from pretreatment to FU that did not differ depending on initial condition assignment. Sample size was small, but GBAT is a promising transdiagnostic intervention for youth anxiety and unipolar mood disorders that can feasibly and acceptably be applied in school settings.
    Full-text · Article · Jan 2016 · Behaviour Research and Therapy
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    • "Distintos paradigmas han ofrecido explicaciones sobre la depresión, como la teoría de la desesperanza (abramson, seligman y teasdale, 1978) o los estilos de respuesta (NolenHoeksema, 1991), entre otros. No obstante, la propuesta de Beck es especialmente relevante debido al sustento empírico del que goza, proporcionado por la eficacia comprobada de las intervenciones clínicas basadas en sus supuestos teóricos, dirigidas tanto a población clínica como general, así como a adultos y adolescentes (Butler, chapman, Forman y Beck, 2006;clark y Beck, 2010;Derubeis et al., 2005;Dobson et al. 2008;lakdawalla, Hankin y Mermelstein, 2007). De acuerdo con Beck (1967), la depresión se caracteriza por tristeza, apatía, concepto negativo de sí mismo, autorreproches , culpa, conductas de evitación, síntomas somáticos y cambios en el nivel de actividad física. "

    Preview · Article · Dec 2015
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    • "Although the first step in alcohol abuse treatment is straightforward (detoxification course), the main problem for clinicians concerns the prevention of relapse: (1) 40–70% of patients that follow psychosocial therapy alone typically resume alcohol use within 1 year posttreatment (Finney et al., 1996) and (2) there is little convincing evidence of significant cognitive-enhancing benefits of pharmacological agents, or the reported gains are poor or imperceptible on a clinical and functional level (e.g., Laroi and Raballo, 2010 Q5 ). There is currently strong interest in the development of alternative treatments to psychotherapy and medication (Dobson et al., 2008). "
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    ABSTRACT: Currently, relapse prevention remains the main challenge in addiction medicine, indicating that the established treatment methods combining psychotherapy with neuropharmacological interventions are not entirely effective. Therefore, there is a push to develop alternatives to psychotherapy- and medication-based approaches to addiction treatment. Two major cognitive factors have been identified that trigger relapse in addicted patients: attentional biases directed toward drug-related cues, which increase the urge to consume, and impaired response inhibition toward these cues, which makes it more difficult for addicted people to resist temptation. Recent studies on newly detoxified alcoholic patients have shown that by using the appropriate tasks to index these cognitive functions with event-related potentials (ERPs), it is possible to discriminate between future relapsers and nonrelapsers. These preliminary data suggest that the ERP technique has great clinical potential for preventing relapse in alcohol-dependent patients, as well as for addictive states in general. Indeed, ERPs may help to identify patients highly vulnerable to relapse and allow the development of individually adapted cognitive rehabilitation programs. The implementation of this combined approach requires an intense collaboration between psychiatry departments, clinical neurophysiology laboratories, and neuropsychological rehabilitation centers. The potential pitfalls and limitations of this approach are also discussed.
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