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Behavioral Activation Therapy: Getting out and doing things helps depression


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Yet another study shows lifestyle changes improve depression. So why is medication still the first-line treatment?


Behavioral Activation Therapy Helps Chronic Depression


By: DAMIAN McNAMARA, Clinical Psychiatry News Digital Network 08/09/11


BOCA RATON, FLA. – Work, relationships, and health status can remain impaired in people even after medication successfully treats their depressive symptoms. But there is hope.


Addition of behavioral activation therapy improves the social aspects of depression, according to a small pilot study. Twelve weeks of this therapy was enough to motivate and mobilize patients, an essential step in clinical improvement, Dr. David J. Hellerstein said at the annual meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.


Dr. Hellerstein and his colleagues at Columbia University and the New York State Psychiatric Institute treated 17 patients with dysthymic disorder or major depression using antidepressant medication combined with 12 weeks of behavioral activation therapy adapted to specifically improve social function. Behavioral activation is a brief approach to treating depression that seeks to alleviate the illness by promoting a person’s contact with sources of reward through increasing activation, improving problem solving, and decreasing avoidance and other barriers to activation (Curr. Psychiatry Rep. 2009;11:453-8).


All physician- and patient-rated depression scales improved with this combination approach. "Even in this small sample size, we showed improvement in the Hamilton Depression Rating Scale and the Beck Depression Inventory, and the Cornell Dysthymia Rating Scale," Dr. Hellerstein said in an interview.


"Medicine is the first step, [but they] must start to function again," said Dr. Hellerstein of the department of clinical psychiatry at Columbia University, New York. "About one-third to one-half of people with chronic depression respond to medication, but don’t get better psychosocially.


At baseline, participants responded to medication with a Hamilton Depression Rating Scale score of 10 or less. However, they still had persistent psychosocial dysfunction with a Social Adjustment Scale score of 1.9 or greater. They next enrolled in once-weekly behavioral activation therapy for 12 weeks while continuing their antidepressant regimen. Four participants had current major depressive disorder (MDD) and 14 had a history of a mean 2.71 MDD episodes.


....decreases in depressive symptoms were statistically significant on the patient-rated Beck Depression Inventory (t[9] = 3.025) and the clinician-rated Cornell Dysthymia Rating Scale (t[9] = 4.473) at 12 weeks.


Participants reported improved quality of life and greater environmental rewards posttreatment as well, Dr. Hellerstein said. For example, they had significant improvements on Quality of Life Enjoyment Satisfaction Questionnaire scores (t[9] = 2.445) and the Environmental Reward Observation Scale scores (t[9] = 2.440) from baseline to week 12.


Functional MRI studies have show behavioral activation therapy enhances the reward system in the brain, Dr. Hellerstein said. "This is consistent with what we are trying to do." He plans to continue his research with a larger study using fMRI to measure outcomes.


Participants also experienced significant improvements on the Behavioral Activation for Depression Scale (t[9] = 2.517). This indicates that had increased behavioral activation at the end of the dual treatment study.


"We’re helping patients to get mobilized," Dr. Hellerstein said. The combination approach also improved motivation. "If they get out there and do more things, [there is a greater] ... chance they can improve. They get the natural rewards of doing something they care about, for example, getting back to school or work."


Although behavioral activation therapy has not been looked at for improving social function, "I’m enthusiastic about it as a treatment approach," Dr. Hellerstein said. "It could be the active component of cognitive behavioral therapy."


Dr. Hellerstein described one patient who had been depressed for 17 years. She reported having muscle pain, having multiple function problems, and remaining apartment-bound. "We got her depression into remission. After this totally isolated patient started behavioral activation therapy, she [got a job] marketing for an online business and started a Facebook group with 1,500-2,000 members." She met a guy through Facebook, started dating again, and said ‘I am feeling back to the way I was 17 years ago,’ "Dr. Hellerstein said.


The study had no industry funding. Dr. Hellerstein said he had no relevant disclosures.




This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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