Depressed patients are often driven to a vicious circle where everyday behavioural patterns exacerbate their symptoms
Text: Jaakko Kinnunen
Photo: Jonne Renvall
Some patients with depression can benefit from brief behavioural activation (BA) interventions. A new study found that the functional ability of patients who received evidence-based brief therapy interventions was better than that of a control group treated by conventional unstructured psychiatric methods.
Researcher Kaisa Luoto from the University of Tampere in Finland says that, during the two-year follow-up period, the depression symptoms of psychiatric patients, who also suffered from other disorders, significantly reduced.
“The result was statistically significant. This tells us that brief therapy interventions can be an effective treatment for depression in this group of patients whose overall situation is often quite complex and challenging,” Luoto says.
No difference in mortality, dropout rates or number of hospital stays was found between the intervention and the control group.
The patients who participated in the study had at least moderate depressive symptoms. Nearly everyone also suffered from other mental disorders. For example, about ten per cent suffered from both depression and panic disorder and about twenty per cent of alcohol abuse. Patients with problems related to alcohol were also treated by motivational interviews.
Patients suffering from psychotic disorders or brain diseases were excluded from the study.
The study included 242 patients, 148 of whom were women and 94 men. The control group consisted of 205 patients. Almost all of the participants took antidepressants during the study.
Brief therapy usually includes between five to twenty therapy sessions. In the treatment sessions, the patient’s current state is examined and the causes of depression are discussed. The patient and medical professionals cooperate to draft a treatment plan. Patients also receive regular homework in the form of therapeutic tasks, i.e. they are expected to be active as the treatment progresses.
For example, a patient may record everyday events that cause negative feelings. At the same time, he/she may reflect on alternative ways of action in order to avoid negative behaviours and feelings in the future. The patient needs experiences of success in order for the new behavioural models to become a habit.
Luoto emphasises that the goal is not only to shorten the patient queues by improving treatment, but to find the best treatment for each patient.
“The fact is that there are many patients and limited resources. The aim of our study is to find clear and effective means to develop the treatment of patients. There is currently a lot of variety in treatment practices, even within the same units. This structured treatment model may help develop new treatments,” Luoto says.
The fieldwork was carried out in the South Ostrobothnia hospital district in Finland as a part of the second phase of the wider Ostrobothnia Depression Study. Insufficient patient records were a problem in the case of the control group.
“We were unable to compare the alleviation of depression symptoms between the intervention and control groups because the medical records did not sufficiently describe the patients’ symptoms. It is nearly impossible to gather such data afterwards. On the other hand, we were able to compare the development of functional capacity, which is essential for smooth everyday life,” Luoto points out.
The study explored the impact of BA, which is a form of cognitive psychotherapy.
“At its simplest, BA means trying to activate the patient’s own behaviour regardless of the depression symptoms. This is the best way to break the vicious circle in the patient’s actions,” Luoto says.
Patients suffering from depression often remain imprisoned by negative feelings and patterns of behaviour. For example, people do not have the will or the energy to answer the telephone because they are afraid of bad news or other people’s negative reactions. However, failure to answer easily causes feelings of guilt and inadequacy, which aggravates the symptoms. Disrupting this vicious circle is the purpose of the BA model.
“The aim of the treatment is to get the patient realise how being active has a positive effect on feelings, even if they might occasionally think that they do not have the energy to do very much,” Luoto notes.
Depression is a common mental disorder that often lowers the patient’s functional ability. Depressed people frequently also suffer from other mental health problems. Symptoms often associated with depression include anxiety, self-destructiveness, reduced functional capacity, and problems with sleeping.
Kaisa E. Luoto, Lars H. Lindholm, Vesa Paavonen, Antti Koivukangas, Antero Lassila, Esa Leinonen, Olli Kampman: Behavioral activation versus treatment as usual in naturalistic sample of psychiatric patients with depressive symptoms: a benchmark controlled trial