Behavioral Treatment For Depression Research Articles

Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: Pilot Randomized Controlled Trial.

There are a range of effective pharmacological and behavioral treatments for depression. However, approximately one-third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side effect burden, patients experiencing that the medications were not working, and patients wanting to resolve their depression without using medication. This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS messaging intervention designed to improve antidepressant adherence and depression outcomes in veterans. The intervention specifically targeted the key reasons for antidepressant discontinuation. For example, the secure message included reminders that it can take up to 6 weeks for an antidepressant to work, or prompts to call their provider should the side effect burden become significant. This pilot was a 3-armed randomized controlled trial of 53 veterans undergoing depression treatment at the Iowa City Veterans Affairs Health Care System. Veterans starting a new antidepressant were randomized to secure messaging only (SM-Only), secure messaging with coaching (SM+Coach), or attention control (AC) groups. The intervention lasted 12 weeks with follow-up assessments of key outcomes at 6 and 12-weeks. This included a measure of antidepressant adherence, depressive symptom severity, and side effect burden. The 2 active interventions (SM-Only and SM+Coach) demonstrated small to moderate effect sizes (ESs) in improving antidepressant adherence and reducing side effect burden. They did not appear to reduce the depressive symptom burden any more than in the AC arm. Veteran participants in the SM arms demonstrated improved medication adherence from baseline to 12 weeks on the Medication Adherence Rating Scale compared with those in the AC arm, who had a decline in adherence (SM-Only: ES=0.09; P=.19; SM+Coach: ES=0.85; P=.002). Depression scores on the 9-Item Patient Health Questionnaire decreased for all 3 treatment arms, although the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC arm. The 2 intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings, whereas the side effect burden for the AC arm increased. These differences indicated moderate ES (SM-Only vs AC: ES=0.40; P=.07; SM+Coach: ES=0.54; P=.07). A secure messaging program targeting specific reasons for antidepressant discontinuation had small-to-moderate ES in improving medication adherence. Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have a greater benefit than the SMS-alone intervention. Veterans consistently engaged with the SMS messaging in both treatment arms throughout the study period. They additionally provided feedback on which texts were most helpful, tending to prefer messages providing overall encouragement rather than specific wellness recommendations. ClinicalTrials.gov NCT03930849; https://clinicaltrials.gov/study/NCT03930849.

Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial

ABSTRACT Depression is most often treated in primary care, where the prevailing treatment is antidepressant medication. Primary care patients with depression are less likely to be exposed to psychosocial interventions, despite evidence suggesting many of these treatments are effective. An example is acceptance and commitment therapy (ACT), a behavioral treatment for depression with a growing evidence base. A self-guided ACT intervention with a peer narrative (i.e. storytelling) format was developed with the intention of creating a treatment option for primary care patients that was more accessible than traditional psychotherapy. Titled LifeStories, the online program features videos of real individuals sharing coping skills for depression based on lived experiences and key ACT principles. A total of 93 primary care patients taking antidepressants were randomized to either continued antidepressant treatment alone or antidepressant treatment plus LifeStories for 4 weeks. There were no differences over time on depression severity and psychological inflexibility. However, LifeStories led to greater improvements in quality of life and increased patients’ interest in additional treatment compared to antidepressant medication alone.Clinical trial pre-registration: ClinicalTrials.gov (NCT04757961)

Virtual versus Face-to-Face Cognitive Behavioral Treatment of Depression: Meta-Analytic Test of a Noninferiority Hypothesis and Men's Mental Health Inequities.

Global rates of depression have increased significantly since the beginning of the COVID-19 pandemic. It is unclear how the recent shift of many mental health services to virtual platforms has impacted service users, especially for the male population which are significantly more likely to complete suicide than women. This paper presents the findings of a rapid meta-analytic research synthesis of 17 randomized controlled trials on the relative efficacy of virtual versus traditional face-to-face cognitive behavioral therapy (CBT) in mitigating symptoms of depression. Participants' aggregated depression scores were compared upon completion of the therapy (posttest) and longest follow-up measurement. The results supported the noninferiority hypothesis indicating that the two modes of CBT delivery are equally efficacious, but the results proved to be significantly heterogeneous indicating the presence of moderating effects. Indirect suggestive evidence was found to support moderation by gender; that is, depressed males may benefit more from virtual CBT. Perhaps, this field's most telling descriptive finding was that boys/men have been grossly underrepresented in its trials. Future trials ought to oversample those who have been at this field's margins to advance the next generation of knowledge, allowing us to best serve people of all genders, those who live in poverty, Indigenous, Black, and other Peoples of Colour, as well as any others at risk of being marginalized or oppressed in contemporary mental health care systems.

The Clinical Utility of the Concept of Mental Hygiene in the Behavioral Treatment of Depression

The Clinical Utility of the Concept of Mental Hygiene in the Behavioral Treatment of Depression

Recruitment effort and costs from a multi-center randomized controlled trial for treating depression in type 2 diabetes

BackgroundParticipant recruitment for clinical trials is a significant challenge for the scientific research community. Federal funding agencies have made continuation of funding of clinical trials contingent on meeting recruitment targets. It is incumbent on investigators to carefully set study recruitment timelines and resource needs to meet those goals as required under current funding mechanisms. This paper highlights the cost, labor, and barriers to recruitment for Program ACTVE II, a successful multisite randomized controlled trial of behavioral treatments for depression in adults with type 2 diabetes, conducted in rural and urban settings in three states.MethodsQuantitative and qualitative data on recruitment were gathered from study staff throughout the study recruitment period and were used to calculate costs and effort. The study utilized two main approaches to recruitment: (1) relying on potential participants to see ads in the community and call a toll-free number; and (2) direct phone calls to potential participants by study staff.ResultsContact was attempted with 18,925 people to obtain the enrolled sample of 140. The cost of recruitment activities during the 4.5-year recruitment period totaled $190,056, an average cost of $1358 per enrolled participant. Qualitative evaluations identified multiple barriers to recruitment.ConclusionsRecruitment for Program ACTIVE II exemplifies the magnitude of resources needed to reach recruitment targets in the current era. Continuous evaluation, flexibility, and adaptation are required on the part of investigators, community partners, and funding agencies to successfully reach high-risk populations in rural and urban areas.Trial registrationClinicalTrials.gov, NCT03371940. Registered on 13 December 2017.

Changes in depressed patients’ self-statements

Objective: Individuals’ use of self-statements reflecting self-criticism, a sense of inadequacy, and low self-worth has been linked to the incidence, severity, and recurrence of major depressive disorder [de Graaf, L. E., Huibers, M. J. H., Cuijpers, P., & Arntz, A. (2010). Minor and major depression in the general population: Does dysfunctional thinking play a role? Comprehensive Psychiatry, 51(3), 266–274. doi:10.1016/j.comppsych.2009.08.006; Riso, L. P., du Toit, P. L., Blandino, J. A., Penna, S., Dacey, S., Duin, J. S., … Ulmer, C. S. (2003). Cognitive aspects of chronic depression. Journal of Abnormal Psychology, 112(1), 72–80. doi:10.1037/0021-843X.112.1.72]. The present study used an observer-rated measure, the Structural Analysis of Social Behavior [Benjamin, L. S. (1974). Structural Analysis of Social Behavior. Psychological Review, 81(5), 392–425. doi:10.1037/h0037024], to examine patients’ self-directed communication over the course of psychotherapy.Method: Self-talk in early and late therapy sessions was examined using cases (N = 44) from the cognitive therapy arm of Jacobson and colleagues’ component study of cognitive therapy for depression [Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., … Prince, S. E. (1996). A component analysis of cognitive–behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295–304. doi:10.1037/0022-006x.64.2.295, Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., … Prince, S. E. (2000). A component analysis of cognitive–behavioral treatment for depression. Prevention & Treatment, 3(1). doi:10.1037/1522-3736.3.1.323a]. We identified changes at treatment termination, and used hierarchical multiple regression to examine whether improvements in patient self-talk influenced treatment outcome up to 24 months post-termination.Results: Trends indicate that patients used friendlier and less critical self-statements at the end of treatment. Decreased self-critical behaviour was associated with fewer symptoms at the end of treatment and up to one year later; increased self-acceptance was linked to symptom improvement a year and a half after termination.Conclusion: Consistent with cognitive theory, reduced self-criticism was associated with better treatment outcomes. Longer-term improvement was linked to the development of friendlier and more accepting self-referential behaviour.

Essential Fatty Acids for Childhood Mental Health Disorders

No child psychiatric disorder has a single treatment that is completely satisfactory. Combinations are sometimes more beneficial than single treatments. This is well established for medication + behavioral treatment for depression and ADHD. There is wide variability in the evidence base for various treatments, from FDA-approved RCTs to open pilots. In the search for additional or alternative treatments, essential fatty acids seem especially to pass the SECS criterion: a treatment that is safe, easy, cheap, and sensible does not need as much evidence to justify patient trials as one that is risky, unrealistic, difficult, or expensive (RUDE). Not only do omega-3 fatty acids have some RCT evidence for a small effect in several psychiatric disorders, but they also are believed useful in preventing cardiac morbidity and excessive inflammation. Therefore, for ADHD, we recommend a combination of behavioral treatment (e.g., parent training, cognitive-behavioral therapy (CBT) for older patients), FDA-approved medication, (primarily stimulants), an RDI/RDA multivitamin/mineral to compensate for stimulant appetite suppression, and about a gram a day of EPA/DHA, possibly supplemented with 50–100 mg GLA. For mood disorders, we recommend a combination of mood stabilizer or antidepressant (depending on which mood disorder), CBT, RDA/RDI multivitamin/mineral (in view of reported vitamin D deficiencies and vitamin wasting from some anticonvulsant mood stabilizers), and a gram per day of EPA/DHA. For autism, we recommend applied behavior analysis, RDA/RDI multivitamin/mineral in view of the often idiosyncratic unbalanced diet, ADHD medication if a problem with hyperactivity, antipsychotic if a problem with irritability/aggression, and omega-3 for anti-inflammatory effect. For learning disorder and developmental coordination disorder, we recommend remedial tutoring or occupational therapy and EPA/DHA. For children at high risk for psychosis or mood disorder, we recommend counseling, monitoring for early indication of low-dose antipsychotic, and general nutritional support, including EPA/DHA. For Tourette’s and aggression, EPA/DHA and other nutritional support can be added to standard treatment. When using fish oil, it is important to make sure it was refined to eliminate contaminants such as mercury. The effect accumulates gradually over months. There is no convincing evidence of greater benefit but some risk from amounts over a gram or two per day.

A longitudinal analysis of the relations among stress, depressive symptoms, leisure satisfaction, and endothelial function in caregivers.

Stress and depressive symptoms have been associated with impaired endothelial function as measured by brachial artery flow-mediated dilation (FMD), possibly through repeated and heightened activation of the sympathetic nervous system. Behavioral correlates of depression, such as satisfaction with leisure activities (i.e., leisure satisfaction), may also be associated with endothelial function via their association with depressive symptoms. This study examined the longitudinal associations between stress, depressive symptoms, leisure satisfaction, and endothelial function as measured by FMD. Participants were 116 older Alzheimer's caregivers (M age = 74.3 ± 8.1; 68% women; 87% white) who underwent 3 yearly assessments of FMD, stress, depressive symptoms, and leisure satisfaction. Mixed-regression analyses were used to examine longitudinal relationships between constructs of interest. A significant and positive association was found between leisure satisfaction and FMD (p = .050), whereas a negative relationship was found for stress (p = .017). Depressive symptoms were not associated with FMD (p = .432). Time (p < .001) and the number of years caregiving (p = .027) were also significant predictors of FMD, suggesting that FMD decreased over time and was worse the longer a participant had been a caregiver prior to study enrollment. These results suggest that behavioral correlates of depression (i.e., engagement in pleasurable activities) may be related to endothelial function in caregivers, and behavioral treatments for depression may be particularly useful in improving cardiovascular outcomes in caregivers.

The Impact of Cognitive Interventions in Treating Depressed Breast Cancer Patients

In behavioral medicine, there is adequate support for behavior modification strategies in reducing depression and anxiety in medical patients. There is comparably less support for cognitive interventions with these patients. Treatment outcome studies with cancer patients generally support the efficacy of cognitive–behavioral interventions, but studies have significant methodological limitations. Additionally, cognitive–behavioral therapy for depression incorporates numerous treatment components, and when examining data with nomothetic statistics, important individual differences may go unrecognized. With reference to the sudden gain literature on significant session-by-session treatment gains, this paper highlights the cognitive–behavioral treatment of two breast cancer patients with clinical depression. In addition to positive treatment outcome in which depression was significantly reduced and quality of life and medical outcomes improved, session-based sudden change data suggest that for these cancer patients, cognitive interventions were most significant in accounting for treatment gains. Findings are reviewed in the context of mechanism of change issues in the cognitive–behavioral treatment of depression.

Treating Depression in the Prison Nursing Home

We describe a theoretically grounded and empirically developed intervention for depression with older men in a state reformatory nursing home. As the number of prisoners “aging in place” rises, there is a critical need for research on mental health interventions in prison nursing homes where inmates may be at high risk for depression and suicide. The participants in this project were four male residents in the Kentucky state prison system nursing home; all four had diagnoses of major depressive episodes. BE-ACTIV, a behavioral treatment for depression, is a hybrid approach that combines one-to-one sessions with the depressed resident and work with staff. One-to-one sessions motivate the resident to engage in new activities, while meetings with nursing home staff break down barriers to completion of pleasant events. Over the 10-week treatment, depressive symptoms declined, and global functioning increased an average of 13 points per participant. Two of the participants showed improved self-reported negative affect. Study results suggest that BE-ACTIV is feasible in the prison nursing home and has the potential to improve the quality of life for medically frail prisoners by helping them to identify meaningful or pleasant activities. The cases illustrate importance of therapeutic relationships in the context of improving depressive symptoms, and the possibility of building effective relationships in a setting with multiple barriers to effective treatment.

Behavioral Activation for Latinos With Depression

Latinos are the fastest-growing ethnic minority group in the United States and face great environmental challenges (e.g., unemployment, loss of social support networks, displacement, and disruption of the family) as well as prejudice and discrimination. These contextual factors are significant risk factors for Latino depression. A behavioral treatment for depression, behavioral activation (BA), may be particularly relevant in treating Latino depression because of its emphasis on contextual factors. This case study presents a cultural modification of BA for Latinos with depression. The treatment of a 25-year-old Latina illustrates a successful application. It suggests that, with some modifications, BA may be a suitable treatment for this population.

Co‐occurring substance dependence and depression: practical implications and next questions

Co‐occurring substance dependence and depression: practical implications and next questions

The use of daily diaries to assess the relations among mood state, overt behavior, and reward value of activities

Recent data has sparked renewed interest in behavioral treatments for depression; however several fundamental questions remain regarding the mechanisms of such approaches. To this end, the current study directly tested the assumption that non-clinical mildly depressed individuals receive less response-contingent positive reinforcement than non-depressed individuals, indicated by less engagement in behaviors perceived as rewarding in terms of both immediate pleasure and potential for these behaviors to result in more distal rewards. The data presented support this assumption and provide support for the role of reinforcement-based strategies such as behavioral activation in the treatment of depression.

Mental Health Practice in Geriatric Health Care Settings

Mental Health Practice in Geriatric Health Care Settings

Treatment of late life depression: A response to the NIH consensus conference

Conclusions of the NIH Consensus Conference on treatment of late life depression, particularly with regard to their recommendations regarding cognitive behavioral therapies as those compare to a review of empirical findings, are examined. In contrast to the NIH recommendations, research demonstrates that psychotherapy is at least of equal effectiveness as compared to antidepressant medication for older depressed patients. Cognitive and behavioral approaches have not been shown to be more effective than other brief therapies, particularly interpersonal therapy and brief psychodynamic therapy. There are more studies, however, demonstrating the effectiveess of cognitive and behavioral therapies than any other approach. Older adults hold generally positive attitudes towards such treatments and may prefer them to medication treatment. Offering cognitive or behavioral therapy as a first line intervention for mild to moderately depressed older adults could be the most cost-effective approach in most settings. Promotion of cognitive and behavioral therapies for older depressed patients would be supported by involvement in the development of treatment guidelines at the national level, expansion of the work of the APA task force on empirically validated treatments to include therapies for older adults, and by the efforts of individuals to present information to older adults in the community on the potential benefits of cognitive and behavioral treatments for depression.

Behavioral Treatment of Depression in Predominantly African-American Medical Patients

The efficacy of behavioral treatment for depression in older adult medical rehabilitation inpatients was tested by comparing two groups that received behavioral treatment with a no treatment control group. In one treatment group an experienced geropsychologist provided behavioral treatment, whereas in the other treatmcnt group trained occupational therapists provided the behavioral treatment (n = 13 in each group). Compared to the no treatment group (n = 11) depression was significantly reduced in both treatment groups. In addition, functional recovery of ADL skills was significantly better in the occupational therapy led treatment group than in the no treatment group. The behavioral treatment protocol, method of training occupational therapists and significance of the results are discussed.

Behavioral Treatment of Depression in Patients with Dementia

This article provides an overview of the theory, clinical application, and research data on behavioral treatment of depression in dementia patients. Behavioral theory of depression in nondemented adults indicates that decreased positive person-environment interactions initiate and maintain a cycle of depression that may be amenable to treatment. This same cycle is discussed as it appears in demented adults, and treatment is suggested. This treatment focuses on altering the aversive events and interactions that maintain patient depression, by increasing pleasant events and interactions, maximizing cognitive abilities, and teaching caregivers strategies for behavior change and effective problem solving. A 9-week clinical research protocol is provided with specific session-by-session content. Preliminary data are presented from a controlled clinical trial of this approach. Results thus far indicate that behavioral treatment is effective in reducing depression in patients with Alzheimer disease and in reducing the level of depression in their caregivers. The implications of these findings on future clinical care of patients and research directions are discussed.

Behavioral Treatment of Depression in Patients with Dementia

Behavioral Treatment of Depression in Patients with Dementia

Experimental construct validity in the evaluation of cognitive and behavioral treatments for depression.

Experimental construct validity in the evaluation of cognitive and behavioral treatments for depression.

Experimental construct validity in the evaluation of cognitive and behavioral treatments for depression.

Experimental construct validity in the evaluation of cognitive and behavioral treatments for depression.