Also shown is a way to stimulate rodent brains with light using light sensitive proteins in rodents, called optogenetics. It makes a nice model for activity in the brain during depression. It’s an example of how new tools and research are shedding light on brain structures that may play an integral role in treating depression.
Depression is also accompanied by cognitive distortions negative self beliefs. This is effectively treated with cognitive behavioral therapy. In this video it’s explained how brain scans can illuminate effects of CBT on depression
Very informative video, nicely made and luckily made availble.
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
Online Cognitive Behavioral Psychotherapy for Depression:
Pretrial assessment screening by telephone for in and exclusion criteria
A face to face appointment with one of the researchers to complete a computerized assessment: SCID and Beck Depression Inventory
Online CBT with a therapist online in real time
Patients were allocated to one therapist
Patients made their own appointments online
Sessions were secured by individual passwords
Patienst and therapists typed free text into the computer, with messages sent instantaneously; no other media or means of communication were used
So this is how you do online real time cognitive behavioral therapy. But does it work?
43 (38%) patients recovered from depression (BDI score <10) in the intervention group versus 23 (24%) in the control group at 4 months, and 46 (42%) versus 26 (26%) at 8 months
Why is this important?
The use of conventional CBT for depression is declining, the use of antidepressants is increasing, many patients referred for psychotherapy never show up, and 505 of those who attending a first visit drop out by the fourth session. Face to face psychotherapy demands a large amount of time, motivation and is an expensive treatment.
New techniques such as telephone and Internet based therapies are more convenient for patients, better accessible and with lower costs. The level of live therapist contact is the strongest influence on costs. The Internet psychotherapy program mentioned above seems to be a good balance between high and non therapist contact. Between face-to-face contact and self help programs. Drop out is low and the treatment efficacious.
By increasing access and lowering costs, new com munication technologies could provoke some much-needed disruptive innovation in psychotherapy
What do you think?
Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial by David Kessler, Glyn Lewis, Surinder Kaur, Nicola Wiles, Michael King, Scott Weich, Debbie J Sharp, Ricardo Araya, Sandra Hollinghurst, Tim J Peters; The Lancet Vol 374 August 22, 2009. http://www.thelancet.com/
For depression several self help treatment options are available. In short mutual self help groups, cognitive behavioral therapy and problem solving therapy are the most important Mutual help groups provide limited but promising evidence that mutual help groups benefit people with three types of problems: chronic mental illness, depression/anxiety, and bereavement.
Cognitive behavioral therapy is very efficient as self help treatment, its structured format makes it very suitable for self-help purposes and it can be very efficacious for the treatment of depression. Problem solving therapy (PST) is another option for self help in depression. Recently, a new, generic, PST-based intervention for multiple mental health problems that could be applied through the Internet was developed.
What is Internet problem solving therapy?
The general idea of self-examination therapy is that subjects learn to regain control over their problems and lives by
determining what really matters to them
investing energy only in those problems that are related to what matters
thinking less negatively about the problems that are unrelated
accepting those situations that cannot be changed.
Self-examination therapy was exclusively designed to be a self-administered treatment and has been found to be effective in several studies in the United States [11-14]. In these studies, self-examination therapy was offered in book format, and it is not known whether it also works when given via the Internet.
How was this study done?
PST has a short duration of 5 weeks. CBT is an 8-week intervention, both can be administered on the Internet. These two forms of self help for depression were compared in a 3-arm randomized controlled trial to compare CBT, PST, and a waiting list group (WL). Patients had to have depressive symptoms (≥ 16 on the Center for Epidemiological Studies Depression scale). CBT and PST consisted of eight and five weekly lessons respectively. Participants were supported by email. Self-report measures of depression, anxiety, and quality of life were completed at pretest and after 5, 8, and 12 weeks.
Internet-based CBT and Internet-based PST are both effective in reducing depressive symptoms in comparison to a waiting list control group. These results were visible directly after treatment and 12 weeks after baseline. There is no indication that one is more effective than the other, although the effects are realized faster by PST than by CBT.
Mind you we’re talking about depressive symptoms not depressive disorder, this might also explain the high drop out rate.Overall the percentage of completers in this study was 38%. This is relatively low in comparison to other trials about Internet-based self-help for depression.
Of those participants assigned to CBT and PST, 8 (9.1%) versus 14 (15.9%) completed no lesson at all. Of those assigned to CBT, 63 (71.6%) participants completed at least four lessons and 34 (38.6%) completed all eight. Of those assigned to PST, 49 (55.7%) participants completed three or more sessions and 33 (37.5%) finished the whole course.
The advantage of this kind of therapies is the short duration until efficacy, low costs, prevents fear of stigmatization.
Lisanne Warmerdam, Annemieke van Straten, Jos Twisk, Heleen Riper, Pim Cuijpers (2008). Internet-Based Treatment for Adults with Depressive Symptoms: Randomized Controlled Trial Journal of Medical Internet Research, 10 (4) DOI: 10.2196/jmir.1094
On the Internet psycho education is as effective as cognitive behavior therapy in reducing symptoms of depression. The INTERNET is a useful tool in delivering interventions for depression. Cognitive behavior therapy was predicted to improve symptoms of depression and dysfunctional thoughts more than psycho education but depression literacy was found to be as effective as cognitive behavior therapy in reducing symptoms of depression.
Depression is a leading cause of disability worldwide and many individuals with depression do not receive adequate treatment. Large scale intervention programmes on the Internet can benefit these individuals and prevent the disabilities associated with this disease.
The researchers used participants recruited directly from the community to investigate this possibility by comparing the effects of a website for psycho education and a website offering cognitive behaviour therapy with a control intervention. One site provided depression literacy, offering evidence based information on depression and its treatment. The other site offered cognitive behaviour therapy for the prevention of depression. The control intervention used an “attention placebo,” which provided weekly contact with a lay interviewer to discuss lifestyle factors such as exercise, education, and health habits.
A questionnaire was send to 27 000 people aged 18-52 years in Canberra, Australia. They randomly selected participants from which 6122 people returned questionnaires.Of those participants 752 indicated a willingness to participate, had access to the internet, scored 22 or above on the Kessler psychological distress scale, and were not receiving clinical care from either a psychologist or psychiatrist. Of these, 525 (150 men, 375 women), aged 36.43 (SD = 9.4) years, completed the forms and were randomised to groups. These were not patients diagnosed with depression.
Lay interviewers contacted participants weekly by phone to direct their use of the websites. In the control group participants were phoned weekly by interviewers to discuss lifestyle and environmental factors that may have an influence on depression.
Effect sizes were some what smaller than brief cognitive therapy assisted by a therapist, self directed manualised computer therapy, and bibliotherapy, where pre-post effect sizes have ranged from about 0.70 to 1.20 standard deviation units for mixed or depressed samples. Computer assisted cognitive behavior therapy in general practice has produced even better pre-post effect sizes of approximately 1.20.
The cognitive behavioral group had a higher drop out rate. A follow-up study after 12 months will provide information about the sustainability of internet interventions.
Currently popular criteria for evaluating the quality of websites were not indicators of content quality. These Silberberg criteria are: accountability standards (disclosure of authorship, ownership, and currency of information). In this review the sites with higher quality information about depression and it’s treatment were sites with an editorial board and sites owned by organisations.
There is a need for better evidence based information about depression on the web, and a need to reconsider the role of accountability criteria as indicators of site quality and to develop simple valid indicators of quality.
Christensen, H. (2004). Delivering interventions for depression by using the internet: randomised controlled trial. BMJ, 328(7434), 265. DOI: 10.1136/bmj.37945.566632.EE