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CT is as Effective as Fluoxetine in Preventing Depressive Relapses

A recent study published in JAMA Psychiatry showed Cognitive Therapy (CT) to be as effective as medication (Fluoxetine) in reducing the risk of major depressive disorder (MDD) relapse. Participants in the current study included 523 adults with a diagnosis of MDD and a score of 14 or higher on the Hamilton Rating Scale for Depression. They were recruited from clinical referrals and advertisements during 2000 to 2008. Researchers employed a sequential, 3-stage design with an acute phase in which all patients received 12 weeks of CT; an 8-month experimental phase in which responders at higher risk were randomized to receive either a continuation of CT, fluoxetine, or a pill placebo; and a 24-month longitudinal, posttreatment follow up. At the end of the 8-month experimental stage, participants were assessed without treatment at 4 month intervals, continuing for 32 months. Results showed that CT and fluoxetine had almost equal relapse rates during the 8-month experimental phase, which were maintained during the assessment following termination of treatment. While further research is needed to fully understand the differences between psychopharmacological treatment and CT for depression, these finding suggest that CT is a valid alternative to drug therapies.

Jarret, R. B., Minhajuddin, A., Gershenfeld, H., Friedman, E. S., & Thase, M. E. (2013). Preventing depressive relapse and recurrence in higher-risk cognitive therapy responders: A randomized trial of continuation phase cognitive therapy, fluoxetine, or matched pill placebo. JAMA Psychiatry, 70(11), 1152-1160. doi:10.1001/jamapsychiatry.2013.1969

CBT Improves Adherence and Depression in Patients with Uncontrolled Type 2 Diabetes

According to a new study published in Diabetes Care, cognitive behavior therapy (CBT) may be an effective intervention for medication adherence, depressive symptoms, and glycemic control in adults with type 2 diabetes and depression.  In the current study, 87 adults with unipolar depression and uncontrolled type 2 diabetes were randomized to receive either enhanced treatment as usual (ETAU) (medication adherence, self-monitoring of blood glucose, and lifestyle counseling) or ETAU plus 9 to 11 sessions of CBT for adherence and depression (CBT-AD). At four months, immediately following treatment, the CBT-AD group showed greater improvements in medication adherence, depressive symptoms, and glycemic control than the ETAU group.  At 8- and 12-month follow ups, CBT-AD remained superior to ETAU on adherence and glycemic control. There was no between group difference on depression, though some evidence of continued improvement was noted for both groups. These findings suggest that CBT is an effective intervention for medication adherence, glycemic control, and depression with lasting benefits for self-management and control among patients with type 2 diabetes and depression.

Safren, S. A., Gonzalez, J. S., Wexler, D. J., Psaros, C., Delahanty, L. M., Blashill, A. J., Margolina, A. I., … Cagliero, E. (January 01, 2014). A Randomized Controlled Trial of Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in Patients With Uncontrolled Type 2 Diabetes. Diabetes Care, 37, 3, 625-33.

CBT with Depressed Caregivers

In this video from a recent Beck Institute workshop, Dr. Aaron Beck discusses how to structure treatment with depressed caregivers under a limited number of sessions. Dr. Beck explains that depressed caregivers often have negative beliefs about illness, and that they often withdraw from others and from pleasurable activities. When time is limited to just a few sessions with this type of client, it may be helpful to spend time explaining and teaching the client to use a Thought Record, to engage in Activity Scheduling, and to develop a plan to continue to use these tools into the future.

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CBT for Patients with Epilepsy and Depression

A recent literature review published in Epilepsia examined the effectiveness of cognitive behavior therapy (CBT) as a treatment for depression in individuals with epilepsy (PWE). The systematic and qualitative review investigated both randomized controlled trials (RCTs), as well as case series via OVID. Databases utilized in this review included MEDLINE, PsychINFO, and the Cochrane EBM Reviews. All of the studies featured subjects with epilepsy, employed CBT, included a valid outcome measure for depression, and had been published in the English language, in a peer-reviewed journal. Two different researchers worked independently to determine if studies met the above inclusion criteria.

The researchers analyzed 14 distinct outcome papers in the literature review. These included 13 CBT trials, of which 6 were randomized controlled trials and 7 were case series. In half (3 of 6)of the RCTS, positive effects of CBT on depression were reported. A review of content revealed that the effective RCTs specifically tailored CBT to improve depression. Two of three RCTs that failed to find depression-related effects focused on improving seizure-control. This pattern was also observed in the case series investigated in this review. Overall this review suggests that CBT may be an effective treatment for depression in patients with Epilepsy. Given the small number of studies included in this review and methodological limitations, further research is warranted.

Source:

Gandy, M., Sharpe, L., & Perry , K. (2013). Cognitive behavior therapy for depression in people with epilepsy: a systematic review. Epilepsia, 54(10), 1725-34. doi: 10.1016/j.juro.2013.06.096

CBT Helps Prevent Depression in At-Risk Adolescents

Research from a randomized clinical trial recently published in JAMA Psychiatry indicates that group cognitive-behavioral prevention (CBP) may help prevent depression in at-risk adolescents. Participants included 316 adolescents with current or past elevated depressive symptoms and whose parents experienced current and/or prior depression. They were randomly assigned to either the CBP group or care as usual (CU). The CBP intervention consisted of eight weeks of weekly 90-minute group sessions, as well as six monthly 90-minute booster sessions. Cognitive restructuring and problem solving were emphasized throughout the course of treatment.

Participants were assessed pre-intervention, after the acute intervention, after the booster sessions, and at one year (21 months) and 2 years (33 months) post intervention. Results showed that adolescents in the CBP group had significantly fewer onsets of depressive episodes than the care as usual group. However, parental depression significantly moderated the effect of the intervention. That is, when parents were depressed at baseline, average onset of depression between the CBP group and usual care did not differ. These results indicate that CBPs may be an evidence-based alternative to preventing depression, and that improvements are needed to strengthen the CBP intervention particularly when active parental depression is involved.

Beardslee, W. R., Brent, D. A., Weersing, V. R., Clarke, G. N., Porta, G., Hollon, S. D., … & Garber, J. (2013). Prevention of Depression in At-Risk Adolescents: Longer-term Effects. doi:10.1001/jamapsychiatry.2013.295

The Cognitive Model and Case Formulation

In this video from Beck Institute’s 4th Annual Student Workshop, Dr. Aaron Beck discusses how the cognitive model can be applied to various psychiatric disorders and psychological problems. Dr. Beck provides an example of a client with several problems including back pain, panic attacks, generalized anxiety, and depression to illustrate how the cognitive model is used to inform case formulation.

For more information on Beck Institute’s Student Workshop, visit our website.

Telephone-Administered CBT is Effective for Depressed MS Patients with High Social Support

A study published in the Journal of Behavioral Medicine demonstrates that individuals with multiple sclerosis (MS) who have high levels of social support receive significant benefits from telephone-administrated cognitive behavioral therapy (T-CBT). The current study compared T-CBT to telephone-administered emotion-focused therapy (T-EFT) among depressed MS patients with both high and low levels of social support.

Participants (n=127) were randomized to receive either T-CBT (n=62) or T-EFT (n=65).  Both treatments were delivered over 16 weekly, 50-minute sessions. The T-CBT group participated in a manualized treatment approach, including 5 chapters focused on identifying and modifying depressogenic thoughts, increasing the number of pleasant activities, enhancing problem solving and managing interpersonal difficulties. The T-EFT group emphasized the development of a genuine, supportive and validating therapeutic relationship, in order to maximize exploration of emotional experiences; therapists in the T-EFT group were not permitted to use interventions for modifying cognitions, behaviors, or skills. Both groups were assessed at baseline and at 16 weeks post-treatment.

Results showed that MS patients with high levels of social support had greater reductions in depressive symptoms following T-CBT, compared to T-EFT. Among patients with low social support, similar reductions were noted for both treatments. For patients with high social support, CBT may, therefore, be a more beneficial treatment approach than EFT.

Beckner, V., Howard, I., Vella, L., & Mohr, D. C. (2010). Telephone-administered psychotherapy for depression in MS patients: moderating role of social support. Journal of Behavioral Medicine, 33, 1, 47-59.

Preventive Antenatal Group CBT for Chinese Women with Depression

According to the World Health Organization (WHO), major depression, including postnatal depression (PND), will be the second highest worldwide cause of disability and death by 2020. A recent study published in the International Journal of Nursing Practice, suggests that cognitive behavior therapy may be a promising treatment for women, worldwide, who suffer with PND.

Participants in the current study (n = 97) included pregnant Chinese women with mild to moderate depressive symptoms, recruited at the antenatal clinic in Hong Kong via convenience sampling. The trial program was conducted using quasi-experimental design.
Participants who received the intervention (n = 47) attended six, 2-hour, weekly group therapy sessions. Sessions focused on the core components of the cognitive behavior model, identifying patterns of irrational thoughts, strategies for managing unpleasant and stressful situations, identifying dysfunctional beliefs, relaxation exercises and engaging in pleasurable activities, and using CBT to handle future, stressful events.

Post-intervention evaluation showed highly positive feedback from participants. In fact, all of the participants agreed that content was easy to comprehend and reported that they found the intervention to be useful. This brief-antenatal CBT intervention was found to be both feasible for Hong Kong women and acceptable. This study provides helpful information for the future development and replication of the preventive, antenatal group CBT intervention.

Leung SSK, Lee AM, Chiang VCL, Lam SK, Yung C, Wong DFK. International Journal of Nursing Practice 2013; 19 (Suppl. 1): 28–37 Culturally sensitive, preventive antenatal group cognitive–behavioural therapy for Chinese women with depression, 19:1, 28–37.

CBT for People with Disabilities

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses how to use cognitive therapy with people who have disabilities. He discusses how an individual’s specific negative beliefs about his or her disability can lead to other disorders, including depression and suicidality. Dr. Beck then outlines three main objectives for therapists working with patients with disabilities.

To attend a workshop at the Beck Institute, visit our website.

CBT is Effective for Adherence and Depression in HIV-Infected Injection Drug Users

A recent study in the Journal of Consulting and Clinical Psychology suggests that cognitive behavioral therapy for adherence and depression (CBT-AD) can be an effective treatment for decreasing depression and increasing adherence to medication in HIV-infected injection drug users. The present study examined the effects of time-limited CBT-AD on participants with HIV and depression, and currently receiving treatment for their injection drug use.  Participants (n=89) ranged from age 18 to 65 and were randomly assigned to receive either CBT-AD (n=44) or enhanced treatment as usual (ETAU) (n=45). Participants in the intervention group received 9 treatment sessions over a period of 3 months, involving 11 informational, problem-solving, and cognitive behavioral steps. At each step, the participants and the therapist collaboratively defined the problem, generated alternative solutions, made decisions about the solutions, and developed a plan for implementing them.

At post-treatment, the intervention group showed significant improvements.  The Beck Depression Inventory showed a significant reduction in symptoms of depression in the CBT-AD group (M=5.1 points) compared to the ETAU group (M= <1 point). A 40% decrease in symptoms of depression was shown from baseline to post treatment with CBT-AD. These clinically significant improvements were maintained at the 12 month follow up. The Medication Event Monitoring System (MEMS) showed that during the CBT-AD intervention, adherence improved 11.8% from baseline and 11.3% more than the ETAU condition. However adherence gains were not maintained at follow-up. It is proposed that continued adherence counseling may be necessary to maintain adherence gains, even when depression symptoms improve.

Depression and substance abuse are the most comorbid disorders associated with HIV-infection, and it is suggested that even a small change in adherence can result in improved outcomes for HIV patients. The results of this study suggest that the integration of CBT-AD into substance abuse counseling may be useful for decreasing depression and improving adherence to medication (with continued sessions) in HIV-infected patients with a history of injection drug use.

Safren, S.A., O’Cleirigh, C.M., Bullis, J.R., Otto, M.W., Stein, M.D., & Pollack, M.H. (2012) Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in HIV-Infected Injection Drug Users: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 80(3), 404-415.