Symposium Summary:
Recent investigations suggested that the promotion of positivity should be included as a main focus in the treatment of depression, since patients tend to systematically avoid positivity. In this symposium we present different clinical implementations which explicitly target positivity in depressed populations, using controlled designs.
The first presenter (Barney Dunn) will discuss the results of a pilot randomised controlled trial comparing Augmented Depression Treatment (ADepT) to traditional Cognitive Behavior Therapy (CBT) in individuals with severe recurrent depression.
The second presentation (Fredrike Bannink and Nicole Geschwind) will illustrate the comparison between traditional CBT and Positive CBT in depressed adults to verify if positive CBT was associated with higher rates of improvement, compared to traditional CBT.
The third and fourth presentation (Carmelo Vazquez and Chiara Ruini) will illustrate the implementation of 2 positive interventions delivered in group settings. The first positive group intervention was addressed to women suffering from depression and dysthymia. A comparison with standard group therapy for depression was performed, The second group intervention aimed at promoting wellbeing in depressed older adults and it was delivered in a community setting.
Following the four presentations, we will discuss differences and similarities between these interventions. The clinical implications of the findings presented in this symposium suggest that a stronger focus on positive emotions and positive mental health may improve treatment of depression, using both individual and group interventions.
Symposium Presentation 1 Proposal:
Title: Augmented Depression Treatment (ADepT) compared to traditional Cognitive Behavior Therapy (CBT) in the treatment of depression
Presenter: Barney Dunn
Proposal:
Background: While existing psychological treatments for depression are effective for many, a significant proportion of depressed individuals do not respond to current approaches and few remain well over the long-term. Augmented Depression Therapy (ADepT) has been co-designed with service-users to target wellbeing and positive recovery, in addition to symptomatic relief.
Aims:To compare ADepT to cognitive behavior therapy (CBT) in the treatment of depression.
Methods: 82 clinically depressed participants were recruited, predominantly from high intensity therapy waiting lists from Improving Access to Psychological Therapy Services in the UK. Participants were randomized 1:1 to receive ADepT (15 weekly acute and 5 booster sessions in following year) or CBT (20 weekly acute sessions). Clinical and health economic assessments were conducted at intake and six-, twelve- and eighteen- month follow-up.
Results:The pilot trial met its feasibility aims, suggesting a definitive trial could be run. There were large effect size improvements in depression and wellbeing pre- to post- acute treatment in the ADepT arm. While pilot trials of this nature are not a priori powered to demonstrate statistical superiority of one treatment over another, there were indications that ADepT has potential to be superior to CBT in terms of clinical- and cost- effectiveness.
Conclusions: These findings suggest ADepT has potential to be an effective treatment for depression and now requires definitive trial evaluation.
Symposium Presentation 2 Proposal:
Title: Positive CBT in the treatment of major depressive disorder
Presenter: Nicole Geschwind
Proposal:
Background and objectives: Previous research suggests that a stronger focus on positive emotions may improve the efficacy of Cognitive Behavioral Therapy (CBT). Positive CBT targets positive emotions by integrating CBT with (i) solution-focused brief therapy and (ii) positive psychology exercises, thereby structurally and persistently reinforcing attention to positive features . Objectives were to compare differential improvement of depressive symptoms (primary outcome), positive affect, and positive mental health indices during positive CBT versus traditional, problem-focused CBT for major depressive disorder.
Method: Forty-nine patients with major depressive disorder received positive and traditional CBT in two treatment blocks of eight sessions each (cross-over design, order randomized). Intent-to-treat mixed regression modelling was used. We also conducted in-depth interviews with the first twelve individuals.
Results: Intention-To-Treat mixed regression modelling indicated that depressive symptoms improved similarly during the first phase, but significantly more in positive CBT during the second treatment phase. Rate of improvement of the less-frequently measured secondary outcomes was not significantly different. Across phases, positive CBT was associated with significantly higher rates of clinically significant or reliable change for depression, negative affect, and happiness. Analysis of the interviews indicated that most clients preferred positive to traditional CBT for depression.
Conclusion: Overall, findings suggest that clients with moderate to severe and largely treatment-resistant depression preferred positive CBT to traditional CBT, and that positive CBT had superior effects on depressive symptoms when given in the second phase of treatment. Future between-subject research is needed, as well as investigation of follow-up and relapse-prevention effects.
Symposium Presentation 3 Proposal:
Title: CBT and positive psychology interventions for clinical depressed women.
Presenter: Carmelo Vazquez
Proposal:
Background: This presentation shows data from a 2-year longitudinal study comparing the efficacy of a manualized protocol of empirically-validated positive psychology interventions (PPI) with a cognitive-behavioral therapy (CBT) protocol.
Methods: This controlled clinical trial initially included 128 adult women with a DSM-IV diagnosis of major depression or dysthymia. Participants were blindly allocated to a 10-session PPI (n = 62) or CBT (n = 66) group therapy condition. Patients were assessed at 6 months and at 2 years after finishing their respective treatments.
Results: both interventions were similarly effective in reducing clinical symptoms and increasing wellbeing. At the end of the treatment and at follows up there were no significant differences between groups in either main outcomes (i.e., severity of depressive symptoms and clinical diagnosis) or secondary outcomes (e.g., positive and negative affect, and satisfaction with life). 53%-59% of patients were not improvements in symptoms and general wellbeing were maintained over time.
Conclusions: this study shows that positive interventions can have sustainable effects in clinical depression and seem to be at least as efficacious as gold-standard protocols as the CBT. The implications of these promising results for the clinical field will be discussed.
Symposium Presentation 4 Proposal:
Title: A Positive group intervention for treating depression in older adults
Presenter: Chiara Ruini
Proposal:
Background and aims : positive interventions are often delivered in group settings, but few interventions were addressed to clinically depressed individuals. Long-term follow-up evaluations of those interventions are scarcely available in the literature. The aim of this presentation is to illustrate the implementation of a positive intervention delivered in group-community setting, addressed to depressed older adults.
Method: 169 older adults (older than 60 years) were recruited in aging communities centers. They received a positive intervention consisting of 6 weekly group sessions (120 mins each) where hedonic and eudaimonic dimensions of wellbeing were discussed and promoted. Eudaimonia, life satisfaction, and depression, were assessed before and after the program and at 6-month follow up.
Results: older adults assigned to the group intervention reported significantly increased self-acceptance and personal growth and lower levels of depression, which were maintained 6 months later. Participants with lower levels of life satisfaction and poorer sleep at baseline benefited the most.
Conclusions: this positive intervention delivered in a group format can have sustainable beneficial effects in depressed older adults and the results are maintained in the long-term follow-up.