Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-25T19:01:11.211Z Has data issue: false hasContentIssue false
  • English
  • Français

Efficacy of trial-based cognitive therapy, behavioral activation and treatment as usual in the treatment of major depressive disorder: preliminary findings from a randomized clinical trial

Published online by Cambridge University Press:  26 November 2019

Curt Hemanny Open the ORCID record for Curt Hemanny [Opens in a new window] ,
Clara Carvalho ,
Nina Maia ,
Daniela Reis ,
Ana Cristina Botelho ,
Dagoberto Bonavides ,
Camila Seixas  and
Irismar Reis de Oliveira
Curt Hemanny*
Affiliation:
Postgraduate Program of Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Brazil
Clara Carvalho
Affiliation:
Postgraduate Program of Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Brazil
Nina Maia
Affiliation:
Postgraduate Program of Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Brazil
Daniela Reis
Affiliation:
Postgraduate Program of Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Brazil
Ana Cristina Botelho
Affiliation:
Postgraduate Program of Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Brazil
Dagoberto Bonavides
Affiliation:
Postgraduate Program of Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Brazil
Camila Seixas
Affiliation:
Postgraduate Program of Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Brazil
Irismar Reis de Oliveira*
Affiliation:
Postgraduate Program of Interactive Processes of Organs and Systems, Health Sciences Institute, Federal University of Bahia, Brazil Department of Neurosciences and Mental Health, Postgraduate Program in Medicine and Health, Federal University of Bahia, Brazil.
*
*Curt Hemanny, Email: hemanny@gmail.com
†Curt Hemanny and Irismar Reis de Oliveira contributed equally to this work.
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction.

Major depressive disorder (MDD) is a prevalent, debilitating and disabling disorder, and its prevalence is increasing. Antidepressants (AD), cognitive-behavioral therapy (CBT) and behavioral activation (BA) are the main treatments for MDD. Trial-based cognitive therapy (TBCT) addresses and restructures dysfunctional negative core beliefs (CBs) and is a novel and promising approach.

Objective.

The aim of this study was to compare the efficacy of TBCT, BA and treatment as usual (TAU) in the treatment of MDD.

Methods.

A total of 76 patients with MDD were randomized into 1 of 3 groups and evaluated at baseline, after 6 weeks and at week 12 (final evaluation). The primary outcome was changing in HAM-D scores, and the secondary outcomes included scores on the BDI, CD-Quest, Sheehan Disability Scale (SDS) and WHOQOL.

Results.

Both TBCT and BA (which also included AD) were different from TAU (which included antidepressants alone) in reducing the HAM-D and BDI scores and other measures. TBCT and BA were different from TAU in the reduction of disability in SDS and WHOQOL physical domain scores. Besides limited by a small sample size, the dropout rate in the TAU arm was higher, and only 10 patients completed the 3 evaluations.

Conclusion.

This trial provides evidence that TBCT and BA combined with antidepressants were more efficacious than the TAU (drug alone) in reducing the severity of depressive symptoms and disability, showing that this combination can be useful for clinical practice.

Keywords

Behavioral activationtrial-based cognitive therapymajor depressive disorderclinical trialtreatment as usual.
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 4 , August 2020 , pp. 535 - 544
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, (DSM-5). Philadelphia, PA; 2013.CrossRefGoogle Scholar
World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017.Google Scholar
Kessler, RC, Bromet, EJThe epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119-138. doi:10.1146/annurev-publhealth-031912-114409.CrossRefGoogle ScholarPubMed
Wiles, N, Thomas, L, Abel, A, et al.Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. 2013;381(9864):375–384. doi:10.1016/S0140-6736(12)61552-9.CrossRefGoogle ScholarPubMed
Beck, AT. Thinking and depression. I. Idiosyncratic content and cognitive distortions. Arch Gen Psychiatry. 1963;9:324–333.CrossRefGoogle ScholarPubMed
Beck, ATThinking and depression. II. Theory and therapy. Arch Gen Psychiatry. 1964;10:561–571.CrossRefGoogle ScholarPubMed
Kanter, JW, Busch, AM, Weeks, CE, et al. The nature of clinical depression: symptoms, syndromes, and behavior analysis. Behav Anal. 2008;31(1):1– 21.CrossRefGoogle ScholarPubMed
Dohrenwend, BS, Dohrenwend, BP. Some issues in research on stressful life events. J Nerv Ment Dis. 1978;166(1):7–15.CrossRefGoogle ScholarPubMed
Paykel, ES. Which depressions are related to life stress? Acta Neuropsychiatr. 2002;14(4):167-172. doi:10.1034/j.1601-5215.2002.140402.x.CrossRefGoogle ScholarPubMed
Belmaker, RH, Agam, G.Major depressive disorder. N Engl J Med. 2008;358(1):55–68. doi:10.1056/NEJMra073096.CrossRefGoogle ScholarPubMed
Tao, M, Li, Y, Xie, D, et al.Examining the relationship between lifetime stressful life events and the onset of major depression in Chinese women. J Affect Disord. 2011;135(1-3):95–99. doi:10.1016/j.jad.2011.06.054.CrossRefGoogle ScholarPubMed
McFeeters, D, Boyda, D, O’Neill, S. Patterns of stressful life events: distinguishing suicide ideators from suicide attempters. J Affect Disord. 2015;175:192–198. doi:10.1016/j.jad.2014.12.034.CrossRefGoogle ScholarPubMed
Liu, Y, Zhang, J.the impact of negative life events on attempted suicide in rural China. J Nerv Ment Dis. 2018;206(3):187–194. doi:10.1097/NMD.0000000000000727.CrossRefGoogle ScholarPubMed
Alford, BA, Beck, AT, Jones, JV Jr. The integrative power of cognitive therapy. 1997.CrossRefGoogle Scholar
Osmo, F, Duran, V, Wenzel, A, et al.The Negative Core Beliefs Inventory: development and psychometric properties. J Cogn Psychother. 2018;32(1):67–84.CrossRefGoogle ScholarPubMed
Lewinsohn, PM. A behavioral approach to depression. Essent Pap Depress. 1974:150–172.Google Scholar
Ferster, CB. A functional analysis of depression. Am Psychol. 1973;28(10):857.CrossRefGoogle Scholar
Martell, CR, Addis, ME, Jacobson, NS. Depression in Context: Strategies for Guided Action . New York, NY: W W Norton & Co; 2001.Google Scholar
National Institute for Health and Care Excellence. Depression in adults: recognition and management; 2018.Google Scholar
American Psychiatric Association. Treating Major Depressive Disorder: A Quick Reference Guide. Washington, DC: American Psychiatric Association; 2010:1–28.Google Scholar
Parikh, SV, Quilty, LC, Ravitz, P, et al.Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 2. Psychological treatments. Can J Psychiatry. 2016;61(9):524–539. doi:10.1177/0706743716659418.CrossRefGoogle ScholarPubMed
Hollon, SD, DeRubeis, RJ, Fawcett, J, et al.Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial. JAMA Psychiatry. 2014;71(10):1157–1164. doi:10.1001/jamapsychiatry.2014.1054.CrossRefGoogle ScholarPubMed
Dimidjian, S, Hollon, SD, Dobson, KS, et al.Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006;74(4):658–670. doi:10.1037/0022-006X.74.4.658.CrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Warmerdam, L.Behavioral activation treatments of depression: a meta-analysis . Clin Psychol Rev. 2007;27(3):318–326. doi:10.1016/j.cpr.2006.11.001.CrossRefGoogle ScholarPubMed
Gelenberg, AJ, Freeman, MP, Markowitz, JC, et al.Practice guideline for the treatment of patients with major depressive disorder third edition. Am J Psychiatry. 2010;167(10):1.Google Scholar
Cuijpers, P, Huibers, M, Ebert, DD, et al.How much psychotherapy is needed to treat depression? A metaregression analysis. J Affect Disord. 2013;149(1-3):1–13. doi:10.1016/j.jad.2013.02.030.CrossRefGoogle ScholarPubMed
Cuijpers, P, Karyotaki, E, Weitz, E, Andersson, G, Hollon, SD, van Straten, A.The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis . J Affect Disord. 2014;159:118– 126. doi:10.1016/j.jad.2014.02.026.CrossRefGoogle ScholarPubMed
Rosen, GM, Davison, GC. Psychology should list empirically supported principles of change (ESPs) and not credential trademarked therapies or other treatment packages. Behav Modif. 2003;27(3):300–312. doi:10.1177/0145445503027003003.CrossRefGoogle ScholarPubMed
Gaudiano, BA, Miller, IW. The evidence-based practice of psychotherapy: facing the challenges that lie ahead. Clin Psychol Rev. 2013;33(7):813–824. doi:10.1016/j.cpr.2013.04.004.CrossRefGoogle ScholarPubMed
Busch, AM, Rusch, LC, Kanter, JW. Behavioral Activation: Distinctive Features. London, UK: Routledge; 2009.Google Scholar
Lejuez, CW, Hopko, DR, Acierno, R, et al.Ten year revision of the brief behavioral activation treatment for depression: revised treatment manual. Behav Modif. 2011;35(2):111–161. doi:10.1177/0145445510390929.CrossRefGoogle ScholarPubMed
Takagaki, K, Okamoto, Y, Jinnin, R, et al.Enduring effects of a 5-week behavioral activation program for subthreshold depression among late adolescents: an exploratory randomized controlled trial. Neuropsychiatr Dis Treat. 2018;14:2633–2641. doi:10.2147/NDT.S172385.CrossRefGoogle ScholarPubMed
Abreu, PR, Abreu, JHSS. Ativação comportamental: Apresentando um protocolo integrador no tratamento da depressão. Rev Bras Ter Comport e Cogn. 2017;19(3):238–259.Google Scholar
Jacobson, NS, Dobson, KS, Truax, PA, et al.A component analysis of cognitive-behavioral treatment for depression. J Consult Clin Psychol. 1996;64(2):295–304.CrossRefGoogle ScholarPubMed
Ruggiero, GM, Spada, MM, Caselli, G, et al.A Historical and Theoretical Review of Cognitive Behavioral Therapies: From Structural Self-Knowledge to Functional Processes. J Ration Cogn Ther. 2018;36(4):378–403. doi:10.1007/s10942-018-0292-8.CrossRefGoogle ScholarPubMed
de Oliveira, IR. Trial-Based Cognitive Therapy: Distinctive Features. London, UK: Routledge; 2016.CrossRefGoogle Scholar
Thoma, N, Pilecki, B, McKay, D.Contemporary cognitive behavior therapy: A review of theory, history, and evidence. Psychodyn Psychiatry. 2015;43(3):423–461. doi:10.1521/pdps.2015.43.3.423.CrossRefGoogle ScholarPubMed
Hayes, SC, Levin, ME, Plumb-Vilardaga , J, et al.Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013;44(2):180–198. doi:10.1016/j.beth.2009.08.002.CrossRefGoogle ScholarPubMed
de Oliveira, IR. Terapia Cognitiva Processual: Manual para Clínicos. Artmed Editora; 2015.Google Scholar
de Oliveira, IR. Kafka’s trial dilemma: proposal of a practical solution to Joseph K.’s unknown accusation. Med Hypotheses. 2011;77(1):5–6. doi:10.1016/j.mehy.2011.03.010.CrossRefGoogle ScholarPubMed
de Oliveira, IR, Hemmany, C, Powell, VB, et al.Trial-based psychotherapy and the efficacy of trial-based thought record in changing unhelpful core beliefs and reducing self-criticism . CNS Spectr. 2012;17(1):16–23. doi:10.1017/S1092852912000399.CrossRefGoogle ScholarPubMed
De Oliveira, IR. Trial-Based Cognitive Therapy: A Manual for Clinicians. London, UK: Routledge; 2014.CrossRefGoogle Scholar
de Oliveira, IR, Powell, VB, Wenzel, A, et al.Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia. J Clin Pharm Ther. 2012;37(3):328–334. doi:10.1111/j.1365-2710.2011.01299.x.CrossRefGoogle ScholarPubMed
Caetano, KAS, Depreeuw, B, Papenfuss, I, et al. Trial-based cognitive therapy: Efficacy of a new CBT approach for treating social anxiety disorder with comorbid depression. 2018; Int J Cogn Ther. 11(3):325–342. doi:10.1007/s41811-018-0028-7.CrossRefGoogle Scholar
Powell, VB, Oliveira, OH de, Seixas, C, et al.Changing core beliefs with trial-based cognitive therapy may improve quality of life in social phobia: a randomized study. Rev Bras Psiquiatr. 2013;35(3):243–247. doi:10.1590/1516-4446-2012-0863.CrossRefGoogle ScholarPubMed
Delavechia, TR, Velasquez, ML, Duran, ÉP, et al.Changing negative core beliefs with trial-based thought record. Arch Clin Psychiatry. 2016;43(2):31–33.Google Scholar
APA Presidential Task Force on Evidence-Based Practice. Evidence-based practice in psychology. Am Psychol. 2006;61(4):271–285. doi:10.1037/0003-066X.61.4.271.CrossRefGoogle Scholar
Leonardi, JL, Meyer, SB. Prática baseada em evidências em psicologia e a história da busca pelas provas empíricas da eficácia das psicoterapias. Psicol Ciência e Profissão. 2015;35(4):1139–1156.CrossRefGoogle Scholar
Amorim, P.Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Rev Bras Psiquiatr. 2000;22(3):106–115.CrossRefGoogle Scholar
Lecrubier, Y, Sheehan, D V, Weiller, E, et al.The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur psychiatry. 1997;12(5):224–231.CrossRefGoogle Scholar
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.CrossRefGoogle ScholarPubMed
Beck, AT, Ward, CH, Mendelson, M, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–571.CrossRefGoogle ScholarPubMed
Cunha , JA. Manual da versão em português das Escalas Beck. São Paulo: casa do psicólogo. 2001.Google Scholar
Henrique-Araújo, R, Osório, FL, Ribeiro, MG, et al. Transcultural adaptation of GRID Hamilton Rating Scale for Depression (GRID-HAMD) to Brazilian Portuguese and evaluation of the impact of training upon inter-rater reliability. Innov Clin Neurosci. 2014;11(7–8):10–18.CrossRefGoogle Scholar
Neto, JG, Júnior, MSC, von Krakauer Hübner, C.Escala de Depressão de Hamilton (HAM-D): revisão dos 40 anos de sua utilização. Rev da Fac Ciências Médicas Sorocaba. 2001;3(1):10–14.Google Scholar
Furukawa, TA. Assessment of mood: guides for clinicians. J Psychosom Res. 2010;68(6):581–589. doi:10.1016/j.jpsychores.2009.05.003.CrossRefGoogle ScholarPubMed
Beck, AT, Epstein, N, Brown, G, et al.An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–897.CrossRefGoogle ScholarPubMed
Sheehan, DV. The anxiety disease: New hope for the millions who suffer from anxiety. New York, Scribner. 1983.Google Scholar
Kaplan, SC, Morrison, AS, Goldin, PR, et al.The Cognitive Distortions Questionnaire (CD-Quest): Validation in a Sample of Adults with Social Anxiety Disorder. Cognit Ther Res. 2017;41(4):576–587. doi:10.1007/s10608-017-9838-9.CrossRefGoogle Scholar
de Oliveira, IR, Seixas, C, Osorio, FL, et al.Evaluation of the Psychometric Properties of the Cognitive Distortions Questionnaire (CD-Quest) in a Sample of Undergraduate Students. Innov Clin Neurosci. 2015;12(7-8):20– 27.Google Scholar
World Health Organization. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28(3):551–558.Google Scholar
Fleck, MP, Louzada, S, Xavier, M, et al.Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref . Rev Saude Publica. 2000;34(2):178–183.CrossRefGoogle ScholarPubMed
IBM Corp. Released 2017. IBM SPSS Statistics for, Version 25.0. Armonk, NY: IBM Corp.Google Scholar
Gupta, SK. Intention-to-treat concept: A review. Perspect Clin Res. 2011;2(3):109–112. doi:10.4103/2229-3485.83221.CrossRefGoogle ScholarPubMed
Rubin, DB. Multiple Imputation for Nonresponse in Surveys. New York: John Wiley & Sons; 2004.Google Scholar
Cohen, J.A power primer. Psychol Bull. 1992;112(1):155.CrossRefGoogle ScholarPubMed
Monroe, SM, Harkness, KL. Recurrence in major depression: a conceptual analysis. Psychol Rev. 2011;118(4):655–674. doi:10.1037/a0025190.CrossRefGoogle ScholarPubMed
Yang, H, Chuzi, S, Sinicropi-Yao , L, et al.Type of residual symptom and risk of relapse during the continuation/maintenance phase treatment of major depressive disorder with the selective serotonin reuptake inhibitor fluoxetine. Eur Arch Psychiatry Clin Neurosci. 2010;260(2):145–150. doi:10.1007/s00406-009-0031-3.CrossRefGoogle ScholarPubMed
Berwian, IM, Walter, H, Seifritz, E, et al.Predicting relapse after antidepressant withdrawal – a systematic review. Psychol Med. 2017;47(3):426–437. doi:10.1017/S0033291716002580.CrossRefGoogle ScholarPubMed
Zu, S, Xiang, Y-T , Liu, J, et al.A comparison of cognitive-behavioral therapy, antidepressants, their combination and standard treatment for Chinese patients with moderate-severe major depressive disorders. J Affect Disord. 2014;152-154:262–267. doi:10.1016/j.jad.2013.09.022.CrossRefGoogle ScholarPubMed
Cartwright, C, Gibson, K, Read, J, et al.Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Prefer Adherence. 2016;10:1401–1407. doi:10.2147/PPA.S110632.CrossRefGoogle ScholarPubMed
Lopez, MA, Basco, MA. Effectiveness of cognitive behavioral therapy in public mental health: comparison to treatment as usual for treatment-resistant depression. Adm Policy Ment Health. 2015;42(1):87–98. doi:10.1007/s10488-014-0546-4.CrossRefGoogle ScholarPubMed
Beck, AT. Cognitive Therapy of Depression. Guilford press; 1979.Google Scholar
Jacobson, NS, Martell, CR, Dimidjian, S.Behavioral activation treatment for depression: Returning to contextual roots. Clin Psychol Sci Pract. 2001;8(3):255–270.CrossRefGoogle Scholar
Richards, DA, Ekers, D, McMillan, D, et al.Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet. 2016;388(10047):871–880. doi:10.1016/S0140-6736(16)31140-0.CrossRefGoogle ScholarPubMed
Kohlenberg, RJ, Tsai, M.Functional analytic psychotherapy: a guide for creating intense and curative therapeutic relationships. New York: Plenum Press; 1991.CrossRefGoogle Scholar
Busch, AM, Manos, RC, Rusch, LC, Bowe, WM, Kanter, JW. FAP and behavioral activation. In: The Practice of Functional Analytic Psychotherapy. Springer; 2010:65–81.CrossRefGoogle Scholar
Kanter, JW, Manos, TC, Busch, AM, et al.Making behavioral activation more behavioral. Behav Modif. 2008;32(6):780–803.CrossRefGoogle ScholarPubMed
Manos, RC, Kanter, JW, Rusch, LC, et al. Integrating functional analytic psychotherapy and behavioral activation for the treatment of relationship distress. Clin Case Stud. 2009;8(2):122– 138.CrossRefGoogle Scholar
Kern, D, Busch, A, Schneider, KL, et al.Psychosocial factors associated with treatment outcomes in women with obesity and major depressive disorder who received behavioral activation for depression. J Behav Med. 2018:1–12. doi:10.1007/s10865-018-9993-9.CrossRefGoogle Scholar
Nagy, GA, Cernasov, P, Pisoni, A, et al.Reward network modulation as a mechanism of change in behavioral activation. Behav Modif. 2018 (Oct). [Epub ahead of print]. doi:10.1177/0145445518805682.Google Scholar
Brueton, VC, Tierney, JF, Stenning, S, et al.Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis . BMJ Open. 2014;4(2):e003821. doi:10.1136/bmjopen-2013-003821.CrossRefGoogle ScholarPubMed