Behavioral Activation (BA) for Medication-responsive Chronically Depressed Patients With Impaired Social Functioning

Not Applicable

Completed

Brief Summary: The investigators aimed to assess the ability of a modified version of Behavioral Activation for occupational and social improvement to produce change in: 1. social adjustment, 2. work functioning, 3. avoidance behavior and 4. behavioral activation.

Detailed Description: Psychosocial functioning was assessed before and after BA treatment in medication responsive depressed individuals who continued to have impaired social functioning. The primary goal was to demonstrate feasibility of recruitment and retention, and obtain an open pilot sense as to whether there are benefits from this brief psychotherapy approach in this population. The investigators also planned to refine measures and estimate the effect size of any treatment response to estimate power and sample size with the goal of completing a future controlled study.

Recruitment & Eligibility

Inclusion Criteria

adults aged 20-75 years
a primary diagnosis of Dysthymic Disorder, Chronic major depressive disorder or double depression
a >50% decrease in 17 item Hamilton Rating Scale for Depression (HRSD-17) score and a final HRSD-17 score ≤ 10 with an adequate antidepressant medication (ADM) trial (> 4 weeks on at least 50% Physician's Desk Reference maximum ADM dose)
a rating of 1 ("very much improved") or 2 ("much improved") on the Clinical Global Impressions-Improvement scale (CGI-I)
continued functional impairment, defined by scores >1.9 on the Social Adjustment Scale (SAS)
unemployment (jobless, looking for work) according to the Bureau of Labor Statistics: jobless and looking and available for work, or underemployed.

Exclusion Criteria

Structured Clinical Interview for Diagnostic and Statistical Manual, fourth edition (DSM-IV) Axis I disorders-diagnosed cognitive or psychotic disorders
bipolar disorder
active eating disorders
severe borderline personality disorder
alcohol or drug dependence (except nicotine) in the last 6 months
current suicide risk
unstable medical conditions
use of psychotropic medications other than antidepressants

Arm && Interventions

Group	Intervention	Description
Behavioral Activation for Return to Work	Behavioral Activation for return to work	BA is a manualized psychotherapy with comparable efficacy to cognitive behavioral treatment and antidepressant medication for acute treatment of depression. In this study, BA's focus was shifted to target work dysfunction by activating the patient into employment-related goals. BA-W consisted of 12 50-minute weekly sessions. Conceptualizing work dysfunction as a product of avoidance patterns and low levels of positive reinforcement, the treatment addressed maladaptive coping strategies such as avoidance as maintaining work dysfunction beyond remission of symptoms. Rather than broadly activating patients, activity scheduling focused on tasks such as sending out resumes, calling for job interviews, and networking to meet potential employers.

Primary Outcome Measures

Name	Time	Method
Paid Work Hours at Week 12	Week 12	Subject-reported paid work hours per week at week 12
Paid Work Hours at Week Baseline	Baseline	Subject-reported paid work hours per week at week baseline

Secondary Outcome Measures

Name	Time	Method
Social Functioning at Week Baseline on the Social Adjustment Scale	baseline	Social adjustment was measured using the Social Adjustment Scale (SAS). The SAS is a self-report scale that assesses depressive symptoms and functioning in nine social and work-related domains generating a total score that is indicative of a subject's overall level of social adjustment. Subjects rate their own social functioning over times on a 5-point scale on items covering work for pay, housework, extended family, parenting, marital status, social activity and leisure, family unit and student status (sub-scales). Mean values of all the sub-scales are used, with a range from 0-5. Higher score = worse outcome ... worse functioning
Social Functioning at Week 12 on the Social Adjustment Scale	Week 12	Social adjustment was measured using the Social Adjustment Scale (SAS). The SAS is a self-report scale that assesses depressive symptoms and functioning in nine social and work-related domains generating a total score that is indicative of a subject's overall level of social adjustment. Subjects rate their own social functioning over times on a 5-point scale on items covering work for pay, housework, extended family, parenting, marital status, social activity and leisure, family unit and student status (sub-scales). Mean values of all the sub-scales are used, with a range from 0-5. Higher score = worse outcome ... worse functioning