Seasonal Affective Disorder (SAD) or Winter Depression can be succesfully treated with bright light therapy. Across studies, 53% of cases of SAD remit with bright light therapy. This involves sitting in front of full-spectrum lights that mimic sunlight on a regular basis — typically for about 30 minutes to 60 minutes each morning. Sometimes one or two weeks is sufficient but some patients will need this for the whole season. This hampers compliance with this therapy, only 41% of patients continued regular light therapy, 59% discontinued light therapy due to ineffectiviness and inconvenience. More important is the prevention of the recurrence of this kind of depressive episodes over subsequent winter seasons.
Cognitive behavioral Therapy could represent a more effective, practical, and palatable approach to long-term SAD management than light therapy
This conclusion was based on a 1 year follow-up study of two pilot studies. The first was an uncontrolled feasability study comparing a novel group CBT, light therapy and the combination of both. The second was the first controlled study comparing CBT, light therapy and the combination of both in 61 patients with SAD compared to a control group of waiting list patients.
The researchers pooled all available data from the naturalistic follow up during the subsequent winter season of participants who had not dropped out of the study.
Both CBT and CBT with light therapy did significantly better at follow up compared to light therapy alone. CBT treated participants &% had another depressive episode in the subsequent winter season, fo CBT and light therapy 5,5%, and for light therapy alone 37%.
Among completers who provided 1-year data, all statistically significant differences between the CBT and light therapy groups persisted after adjustment for ongoing treatment with light therapy, antidepressants, and psychotherapy
Limitations of this study
It was a naturalistic follow up study, the treatment duing this follow up period varied very much. The participants in the waiting list group from the second trial were not assessed.
A randomized controlled trial with follow up is still needed to confirm these promising results.
Rohan, K., Roecklein, K., Lacy, T., & Vacek, P. (2009). Winter Depression Recurrence One Year After Cognitive-Behavioral Therapy, Light Therapy, or Combination Treatment Behavior Therapy, 40 (3), 225-238 DOI: 10.1016/j.beth.2008.06.004
Hands-on Help is a narrative review of the mushrooming field of computer-aided psychotherapy for mental health problems as a whole, from the time it began in the 1960’s through to the present day. The many types of computer-aided psychotherapy and how each might be accessed are detailed together with the pros and cons of such help and the functions it can serve. The authors review prevention as well as treatment.
Beating the Blues® is a computerised cognitive behavioural therapy (CCBT) program for depression and anxiety that is available via CD-ROM and the Internet. It has been shown to be a cost effective and time efficient way of helping people suffering from these conditions to get better and stay better. In Feb 2006 the National Institute of Health and Clinical Excellence (NICE) recommended Beating the Blues® as a treatment option for all people seen with mild or moderate depression.
Cognitive-behavioral psychotherapy is a form of psychotherapy that lends it self well for a computer based program. Computer based forms of Psychoanalytic Psychotherapy are far more complicated to my opinion. We recently discussed using a blog during psychodynamic psychotherapy, blogtherapy. Based on this review you can conclude that at least some patients may benefit from this kind of therapy. Nevertheless despite a lot of research questions about computer based psychotherapy remain.
As with other new developments healthcare companies are reluctant to pay for this kind of therapy. What should be the price and who do you have to pay. The developer of the program, the therapist working with patient and computer?
How much human contact with the therapist is best? No human contact at all in these programs are associated with large drop out rates.When should human contact be necessary, with intake or followup or during the program for monitoring progress?
How should human contact take place, by telephone, email, face to face?
What should be the background of the therapists? Psychologists trained in cognitive behavioral therapy, trained nurses, general practitioners, trained volunteers?
Most trials with CBT were with care as usual and waiting lists conditions. These trials suffer from a large placebo effect and high expectancy of the participants of the new treatment. Trials with comparison to other therapies are necessary. Knowledge of what works in this kind of psychotherapy is still fragmentary.
Some patients prefer live to computer-guided help. Not all depressions can be treated by computer psychotherapy. Mostly mild to moderate depression can benefit, more severe forms of depression will still need other forms of therapy of which medication is one.
Overall computer aided psychotherapy as an early option in the treatment of depression is opening up new possibilities. It can be a cost-effective treatment that can reduce chronicity and perhaps even prevalence of depression. Will computer-aided psychotherapy integrate smoothly into the palette of therapeutic options? A lot of research and time will tell.
What is Computer aided cognitive-behavioral therapy?
Computer-aided cognitive–behavioural therapy (CCBT) is any computing system that aids cognitive–behavioural therapy by using patient input to make at least some computations and treatment decisions. This definition excludes video conferencing and ordinary telephone and electronic mail consultations, chat rooms and support groups, which expedite communication and overcome the tyranny of distance but do not delegate any treatment tasks to a computer or other electronic device. It excludes, too, the electronic delivery of educational materials and electronic recording of clinical state or behaviour where those allow no more interaction than do paper leaflets and workbooks.
Computer-aided therapy may be delivered on a range of computing devices, such as stand-alone personal computers, internet-linked computers, palmtops and personal digital assistants, telephone interactive voice response systems, gaming machines, CD–ROMs, DVDs, cellphones and virtual reality devices.
This post was inspired by a recent editorial in the British Journal of Psychiatry.
Marks, I.M., Cavanagh, K., Gega, L. (2007). Computer-aided psychotherapy: revolution or bubble?. The British Journal of Psychiatry, 191(6), 471-473. DOI: 10.1192/bjp.bp.107.041152
This is one of the hardest questions to answer especially if your working on a inpatient unit with depressed patients. They are mostly severely ill for a long time and demoralised when they get admitted. To get a clear picture of what is wrong we usually get rid of all psychopharmacological drugs for diagnostic purposes. That’s why i find this article of major importance, clearly written by experienced clinicians. The table offers clinical features that may help differentiate chronic depression from personality disorder. Guidelines: 1. avoid unsupported conclusions based on nonresponse 2. bear in mind that depression is likely to make personality traits look more like full-fledged PDs by exaggerating a range of personality traits such as avoidance, dependence, and interpersonal sensitivity. Always consider what evidence exists that these were more than traits at any point when a patient was less markedly depressed 3. use multiple informants (family members, close friends, primary care doctors, psychotherapists) as well as other collateral information (eg, performance evaluations from work) to gauge the highest and usual levels of occupational and psychosocial functioning when less depressed. For example, even if the patient is in the middle of multiple struggles with his treatment team, a history from family and coworkers of the patient’s typically satisfying stable work and personal relationships before a first episode of MDD in his mid-20s should lead a diagnostician to question the hypothesis of borderline PD. 4. systematically assess personality pathology with specific questions about onset, quality of relationships, mood fluctuations, and patterns of coping. In this respect, clinician-rated, semistructured interviews that inquire about specific symptoms and behaviors and associated impairment may be helpful as a supplement to global clinical impressions. This may be even more reliable than patient-rated questionnaires, which may be more sensitive but less specific.