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Cognitive predictors and moderators of winter depression treatment outcomes in cognitive-behavioral therapy vs. light therapy.

Behaviour research and therapy
December 1, 2013
Lilya Sitnikov et al. (5 authors)
Comparative StudyJournal ArticleRandomized Controlled TrialResearch Support, N.I.H., ExtramuralResearch Support, U.S. Gov't, Non-P.H.S.Human StudyClinical
Study Details

Study Goal

The researchers aimed to determine whether baseline cognitive vulnerability constructs could predict or moderate treatment outcomes for SAD patients receiving light therapy (LT), cognitive-behavioral therapy (CBT), or their combination.

Results Summary

Cognitive constructs did not predict acute treatment outcomes, but higher baseline dysfunctional attitudes and negative automatic thoughts were associated with worse next-winter depression outcomes for LT alone compared to CBT. Patients with rigid cognitions fared better with CBT than LT.

Population

Seasonal affective disorder (SAD) patients

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (8)
InterventionDirectionEndpointPopulationDosageImpactClaim #
light therapy (LT)
no change
acute treatment outcomes
SAD patients
null
did not predict or moderate
#1
cognitive-behavioral therapy (CBT)
no change
acute treatment outcomes
SAD patients
null
did not predict or moderate
#2
combination (CBT + LT)
no change
acute treatment outcomes
SAD patients
null
did not predict or moderate
#3
cognitive-behavioral therapy (CBT)
decrease
next winter depression outcomes
SAD patients with higher baseline levels of dysfunctional attitudes and negative automatic thoughts
null
had less severe depression
#4
light therapy (LT)
increase
next winter depression outcomes
SAD patients with baseline dysfunctional attitudes and negative automatic thoughts at or above the sample mean
null
had more severe depressive symptoms
#5
cognitive-behavioral therapy (CBT)
no change
next winter depression outcomes
SAD patients with baseline dysfunctional attitudes and negative automatic thoughts
null
did not predict treatment outcomes
#6
combination (CBT + LT)
no change
next winter depression outcomes
SAD patients with baseline dysfunctional attitudes and negative automatic thoughts
null
did not predict treatment outcomes
#7
light therapy (LT)
increase
subsequent winter depression
SAD patients with extremely rigid cognitions
null
did not fare as well
#8
Abstract

There is no empirical basis for determining which seasonal affective disorder (SAD) patients are best suited for what type of treatment. Using data from a parent clinical trial comparing light therapy (LT), cognitive-behavioral therapy (CBT), and their combination (CBT + LT) for SAD, we constructed hierarchical linear regression models to explore baseline cognitive vulnerability constructs (i.e., dysfunctional attitudes, negative automatic thoughts, response styles) as prognostic and prescriptive factors of acute and next winter depression outcomes. Cognitive constructs did not predict or moderate acute treatment outcomes. Baseline dysfunctional attitudes and negative automatic thoughts were prescriptive of next winter treatment outcomes. Participants with higher baseline levels of dysfunctional attitudes and negative automatic thoughts had less severe depression the next winter if treated with CBT than if treated with LT. In addition, participants randomized to solo LT who scored at or above the sample mean on these cognitive measures at baseline had more severe depressive symptoms the next winter relative to those who scored below the mean. Baseline dysfunctional attitudes and negative automatic thoughts did not predict treatment outcomes in participants assigned to solo CBT or CBT + LT. Therefore, SAD patients with extremely rigid cognitions did not fare as well in the subsequent winter if treated initially with solo LT. Such patients may be better suited for initial treatment with CBT, which directly targets cognitive vulnerability processes.

Medical Subject Headings (MeSH)
Attitude to HealthCognitionCognitive Behavioral TherapyCombined Modality TherapyFemaleHumansMaleMiddle AgedPhototherapyPsychiatric Status Rating ScalesSeasonal Affective DisorderTreatment Outcome
Study Links
Quality Scores
SafetyNot Assessed
Efficacy65/10
Quality85/10
Citation Metrics
Total Citations7
Citations/Year0.6
Relative Citation Ratio0.33
NIH Percentile17.8%
Research Impact Scores
APT Score0.25
Weight Score1.47
Normalized Score0.63
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