Samad FEREIDOONI, Ali SAHRAEIA, Seyed Mohammad Davood HOSEINI, Banafsheh GHARAEI, Behrooz BIRASHK

Efficacy of Group Behavioral Activation Treatment as Supplemental Treatment to Pharmacotherapy in Inpatients with Depressive Disorders

Amaç: Depresyon ile baş etme yöntemlerinin tarihini gözönüne almak önemlidir ki davranış aktivasyonu (DA) [buyazının odaklandığı] davranışçı yaklaşımlardan gelişmiştir.Fakat güncel DA hem danışanın ihtiyaç ve hedeflerini açıklayan hem de depresif davranış ve mizacı destekleyençevresel tesadüfleri belirleyen idiyografik, işlevsel bir yaklaşım sağlar. Bu çalışmanın amacı depresif bozukluk nedeniyle yatan hastalarda farmakoterapi tedavisine ek olarakGrup Davranış Aktivasyon Tedavisi (GDAT)nin etkinliğinideğerlendirmektir. Yöntem: Bu çalışma bir klinik araştırma çalışmasıdır. SCID- Ie göre depresif bozukluk tanısı alan, çalışmaya katılmayıkabul eden, Shiraz Psikiyatri Hastanesinde 2010 yaz ayındayatarak tedavi gören 24 olgu çalışmaya dahil edildi. Olgularrastgele müdahale, kontrol ve plasebo olmak üzere 3 grubaayrıldı. Birinci gruba GDAT uygulandı. Terapistin dikkatininetkinliğini kontrol etmek için üçüncü grup ayrıca videolarıizledi. Tüm olgular Beck depresyon ölçeği-II (BDÖ-II) veDepresyon için DA ölçeği doldurdu.Bulgular: Tekrar eden ölçümlerin değişken analiz sonuçlarına göre; her üç grupta da BDÖ-II sonuçlarına göre ilk ve 2.aylık takibinde aynı şekilde anlamlı azalma gözlendi, fakatgruplar arasında istatistiki olarak anlamlı farklılık gözlenmedi. Ancak BDÖ-II analiz sonuçlarına göre Davranış aktivasyon terapisi hastaların depresyonunu azaltmada etkilibulunmuştur (F=11.27, p=0.001). GDAT analiz sonuçlarınagöre hastaların depresyonu anlamlı olarak azalmıştır(F=105.97, p=0.001). Sonuç: Bizim sonuçlarımız GDATnin yatarak tedavi görendepresyon hastalarında destekleyici olarak ilaç tedavisininetkinliğini arttırdığını göstermiştir. Küçük örneklem büyüklüğü ve mevcut bulguların genelleştirilmesindeki sınırlılıklar nedeniyle bu sonuçlar için dikkatli olunmalıdır.

Yatarak tedavi gören depresif bozukluk olgularında farmakoterapi tedavisine ek olarak grup davranış aktivasyon tedavisinin etkinliği

Objective: It is important to consider history of dealingwith depression as it evolved from pure behavioralapproaches that predate behavioral activation. Currentbehavioral activation adds an idiographic and functionalapproaches, which explores client s needs, goals andenvironmental contingencies that support depressivebehaviors and moods. The aim of this study is to evaluateefficacy of Group Behavioral Activation Treatment (GBAT)as a supplemental treatment to pharmacotherapy ininpatients suffering from depressive disorders. Methods: This is a clinical trial. We included 24 patients withdepressive disorders (according to SCID-I), who were admittedto Shiraz Psychiatric Hospital in summer 2010. They wererandomly divided into three groups: intervention, control, andplacebo. All three groups prescribed their usual pharmacologicaltreatment. Additionally, first group was treated with GBAT. Inorder to control the efficacy of therapist s attention, thirdgroup watched video-movie as well. All participantscompleted Beck Depression Inventory-II (BDI-II) andBehavioral Activation for Depression Scale (BADS). Results: According to the results of the analysis of variancefor repeated measures: all 3 groups showed same decreasein post and 2 mounts follow-up in BDI-II, however there wasno significant difference among groups. Nevertheless, basedon the results of analysis for BDI-II, it is indicated thatbehavioral activation therapy has been effective in decreasingdepression of patients (F=11.27; p=0.001). Results indicatedthat based on the analysis of BADS, patients depression hassignificantly decreased (F=105.97; p=0.001). Conclusions: Our research findings indicate that using theGBAT as a supplemental treatment for depressed inpatientscan increase the effectiveness of medication therapy. Smallsample size and cautions in the generalization of thepresent findings to be noted.

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1. Akiskal Hagop S. Mood Disorders: Clinical Features. In: Sadock Benjamin J, Sadock Virginia A, Ruiz Pedro. Kaplan & Sadocks Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. P.1693-1734.
2. Ferster CB. A functional analysis of depression. American Psychologist. 1973;28:857-870.
3. Lewinsohn, P. M. A behavioral approach to depression. In R. J. Friedman, & M. M. Katz (Eds.), The psychology of depression: Contemporary theory and research. New York: John Wiley & Sons; 1974.
4. Martell CR, Addis ME, Jacobson NS. Depression in context: Strategies for guided action. 1st ed. New York: Norton; 2001.
5. Carvalho John P, Hopko Derek R. Behavioral theory of depression: Reinforcement as a mediating variable between avoidance and depression. Journal of Behavior Therapy and Experimental Psychiatry. 2011;42:154-62.
6. Skinner BF. Science and human behavior. New York: The Free Press; 1953.
7. Lewinsohn PM, Antonuccio DO, Breckenridge JS, Teri L. The Coping with Depression course. Eugene, OR: Castalia; 1984.
8. Hopko Derek R, Armento Maria EA, Cantu Melissa S, Chambers Laura L, Lejuez CW. The use of daily diaries to assess the relations among mood state, overt behavior, and reward value of activities. Behaviour Research and Therapy. 2003;41:1137-48.
9. Lewinsohn PM, Graf M. Pleasant activities and depression. Journal of Consulting and Clinical Psychology. 1973;41:261-8.
10. Lewinsohn P, Libet J. Pleasant events, activity schedules, and depression. Journal of Abnormal Psychology. 1972;79:291-295.
11. MacPhillamy DJ, Lewinsohn PM. Depression as a function of levels of desired and obtained pleasure. Journal of Abnormal Psychology.1974;83:651-7.
12. Pim Cuijpers, Annemieke van Straten, Lisanne Warmerdam. Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review. 2007;27:318-26.
13. Hopkoa DR, Lejuez CW, Ruggiero Kenneth J, Eifert Georg H. Contemporary behavioral activation treatments for depression: Procedures, principles, and progress. Clinical Psychology Review. 2003;23:699-717.
14. Hopko DR, Lejuez CW, McNeil DW, Hopko SD. A brief behavioral activation treatment for depression: An adjunct to pharmacotherapy. Poster presented at the 3rd International Conference on Bipolar Disorder, Pittsburgh, PA. Bipolar Disorders. 1999;1:36.
15. Hopko DR, LePage J, Hopko SD, Lejuez CW, McNeil DW, Roberts H. A brief behavioral activation treatment for depression: Implementation and efficacy within an inpatient setting. Poster presented at the 33rd annual meeting of the Association for the advancement of Behavior Therapy, Toronto, Canada; 1999.
16. Lejuez CW, Hopko DR, LePage JP, Hopko SD, McNeil DW. A brief behavioral activation treatment for depression. Cognitive and Behavioral Practice. 2001;8:164-75.
17. Lejuez CW, Hopko Derek R, Hopko Sandra D. A Brief Behavioral Activation Treatment for Depression: Treatment Manual. Behaviour Modification. 2001;25:255-86.
18. Goodarzi Nasser, Besharat Mohammad Ali, Rostami Reza, Bahrami Ehsan Hadi, Lavasani Masoud Golamali. The effectivness of group contracting and behavioral activation therapy on opioid substance use disorders. Contemporary Psychology. 2008,3,3-14. (In Persian)
19. Amiri Mehdi, Yekeyazdan Dost Rokhsareh, Tabatabaei Seyed Mahmood. The effectiveness of group behavioral activation therapy in reducing the severity of depression symptoms and enhance general health and quality of life In clients at therapeutic community center. circuit treatment community center maddjoyan. Research on addiction. 2009;9:101-114. (In Persian)
20. Veale David. Behavioural activation for depression. Advances in Psychiatric Treatment. 2008;14: 29-36.
21. Gollan Jackie, Atlis Mera, Coner O, Megan Marlow. Behavioral Activation: Group Treatment for Depression. (unpublished manuscript). 2003.
22. Kanter JW, Mulick PS, Busch AM, Berlin KS, Martell CR. The Behavioral Activation for Depression Scale (BADS): Psychometric properties and factor structure. Journal of Psychopathology and Behavioral Assessment. 2006;29:191-202.
23. Kanter Jonathan W, Rusch Laura C, Busch Andrew M, Sedivy Sonya K. Validation of the Behavioral Activation for Depression Scale (BADS) in a Community Sample with Elevated Depressive Symptoms. Psychopathology and Behavioral Assessment. 2009;31:36-42.
24. Kanter JW, Mulick P. Basic science foundations and new applications of behavioral activation. Symposium accepted for the annual meeting of the Association of Behavioral and Cognitive Therapies. 2007.
25. Mohammadi Abolfazl, Amiri Mehdi. Behavioral Activation for Depression Scale: Psychometric Properties and Confirmatory factor analysis for Persian version. Iranian Journal of Psychiatry and Clinical Psychology (IJPCP). 2010;16:65-73. (In Persian)
26. Beck AT, Steer RA, Brown GK. Manual for the BDI-II. San Antonio, TX: The Psychological Corporation. 1996.
27. Nezu AM, Ronan GF, Meadows EA, McClure KS. Practitioners guide to empirically based measures of depression. New York: Kluwer; 2000.
28. Beck AT, Steer RA. Manual for the Beck Depression Inventory. San Antonio, TX. 1993.
29. Biggs JT, Wylie LT, Ziegler VE. Validity of the Zung Self-rating Depression Scale. Br J Psychiatry. 1978;132:381-5.
30. Beck AT, Steer RA, Carbin M. Psychometric properties of the Beck depression inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77-100.
31. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588-97.
32. Richter P, Werner J, Heerlein A, Kraus A, Sauer H. On the validity of the Beck depression Inventory: A review. Psychopathology. 1998;31:160-8.
33. Zung WWK. Zung Self-rating Depression Scale (Zung SDS). in Handbook of psychiatric measures. Washington, DC, APA, 2000: 534-537.
34. National Institute for Clinical Excellence (NICE). Depression: Management of depression in primary and secondary care. UK: National Clinical Practice Guideline Number 23; 2004. 358 p.
35. Hopko DR, Lejuez CW, Lepage JP, Hopko SD, McNeil DW. A brief behavioral activation treatment for depression; a randomized pilot trial within an inpatient psychiatric hospital. Behavior Modification. 2003;27:458-69.