Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.

Abstract

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Potential Impact of Incorporating a Patient-Selected Support Person into mHealth for Depression

“…Notwithstanding, functional impairment remains a vitally important behavior to target, given that rigorous trials of behavioral activation indicate that even a few months of better functioning significantly improves the long-term course of depression. 22 The primary limitation of this study is its nonexperimental design, specifically that study group assignment was determined by patient preference rather than randomly. As such, we cannot draw definitive conclusions whether intensifying self-management support truly improves mHealth outcomes.…”

Effects of Rumination and Initial Severity on Remission to Cognitive Therapy for Depression

“…Evidence supports this conception, as possessing high levels of dysfunctional attitudes (i.e., negative beliefs about the self) in the absence of a negative life event (indicating entrenched negative core beliefs) is predictive of slower remission in CT (Simons, Gordon, Monroe, & Thase, 1995). Similarly, higher initial depressive severity is also associated with poorer and more delayed remission in CT (Coffman, Martell, Dimidjian, Gallop, & Hollon, 2007;Dimidjian et al, 2006). Rumination has specifically been associated with more severe and longer episodes of depression indicating rumination may also be associated with poorer and delayed remission .…”

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

“…In the general CBT literature, however, it is concluded that the evidence does not show that such change is necessary to achieve improvements in primary outcome measures from CBT. 8,15,45 Focusing on changing cognitive content, such as negative future expectations or critical self-evaluations, may fail in those whose problem is that they already focus on this content too much, such as those with problems with rumination. 24 Also, for some people, approaches that attempt to impose positive self-statements, especially where negative or self-critical thoughts have prevailed, may have the reverse of the intended effect, leaving them feeling more distressed and more self-critical.…”