Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Kohlenberg, Robert 1. Functional analytic psychotherapy: creating intense and curative therapeutic relationships I Robert 1. Kohlenberg and Mavis Tsai. p. cm. Includes bibliographical references and index.

We dedicate this study and manuscript to the late Neil S. Jacobson, Ph.D. Dr. Jacobson was the originator of this study and shaped every aspect of its inception and implementation. His untimely death in 1999 left an irreplaceable gap, but his ideas about behavior therapy and his commitment to empirical inquiry have continued to serve as an inspiration and guide. Sandra Coffman and Christopher Martell provided onsite supervision and treatment for the cognitive therapy and behavioral activation conditions, respectively. Steve Sholl and David Kosins provided cognitive therapy. Ruth Herman-Dunn and Tom Linde provided behavioral activation therapy. Linda Cunning, Steven Dager, Kerri Halfant, Helen Hendrickson, and Alan Unis provided pharmacotherapy. Carolyn Bea and Chris Budech coordinated the pharmacotherapy conditions. Peggy Martin completed medical evaluations for the study. Lisa Roberts, and Elizabeth Shilling assisted in the coordination of the study, and David Markley assisted in the training and supervision of the clinical evaluators. Patty Bardina, Evelyn Mercier, Mandy Steiman, and Dan Yoshimoto were project evaluators. Melissa McElrea, Kim Nomensen, and Eric Gortner provided research support. Marina Smith, Jennifer Jones, Patricia Symons, Sonia Venkatraman, and Melissa Wisler conducted the adherence ratings. Virginia Rutter has been an unwavering supporter of this research, for which we are extremely grateful. NIH Public Access AbstractThis study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through one year of follow-up, compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the second year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to medication withdrawal at the level of a nonsignificant trend. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full two-year follow-up, and each was at least as efficacious as continuation medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy, and that both psychotherapies are less expensive and longerlasting alternatives to medication in the treatment of depression. KeywordsBehavioral Activation; Cognitive Therapy; Antidepressant Medication; Major Depression; Relapse; Recurrence Antidepressant medication (ADM) has been shown to prevent the return of symptoms associated with major depression for as long as it is continued or maintained (APA, 2000). However, there is little evidence that having taken ...

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