COGNITIVE-BEHAVIORAL THERAPY VS LIGHT THERAPY FOR PREVENTING SAD RECURRENCE

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 季节性情感障碍(SAD)是一种经常发生的秋季/冬季抑郁症，在春季/夏季会有所改善，影响着超过1450万美国人。对于急性(当前)和长期(未来)的SAD治疗，现有的临床实践指南建议在每年秋季/冬季从首次症状出现到自然春季缓解期间每天使用光疗法，通常持续时间为一年中的3至6个月。光盒疗法是目前最好的SAD治疗方法，能有效治疗急性SAD。然而，这种治疗的长期依从性很差，因为它既繁重又耗时。需要替代的SAD治疗方法，以防止每个秋冬季节抑郁症的复发。光疗的理想替代疗法应该是有时间限制的(即在一个离散的时期内完成急性治疗，而每年秋天/冬天无限期地每天治疗)，有效地治疗急性SAD，并显示出持续到治疗结束后的效果，以防止这些使人丧失能力的症状每年再次出现。 认知行为谈话疗法(CBT)是一种对急性非季节性抑郁症有效的限时治疗，其益处似乎延伸到治疗结束后，以降低复发(治疗最初改善后抑郁症状的复发)和复发(全新抑郁发作的发作)的风险。首席调查员(PI)已经开发了一种新的认知行为谈话疗法来治疗SAD，并在之前的两项小规模研究中进行了测试。这些先前的研究表明，CBT对急性SAD的治疗可能与光疗一样有效，在一年后的下一个冬季，CBT可能优于光疗。 NIMH R01项目是一项规模更大、更具确定性的研究，有可能影响临床实践。这项随机临床试验将在最初的冬季和接下来的两个冬季进行的为期6周的试验中，将标准灯箱疗法与我们的CBT疗法进行比较。这项研究建议在项目头4年的秋冬季节招收160名合格的参与者。我们预计，我们可能需要同意并筛选多达3倍的潜在参与者才能达到我们的注册目标。参与者将从媒体广告以及在社区和当地诊所张贴的传单中招募。160名登记的参与者将被随机分配到两个为期6周的治疗中的一个：80人接受灯箱治疗(每天在标准灯箱前30分钟，服药时间和持续时间在第一周后单独调整)，80人接受认知-行为谈话治疗(1小时，每周两次小组治疗)。在为期6周的研究治疗期间，将通过半结构化访谈每周监测情绪，参与者将在治疗前、治疗中期(3周后)和治疗后完成一些问卷调查。参与者将在接下来的两个冬季的1月或2月(即治疗完成后的一年和两年)返回进行随访。第三次面对面的随访将在研究治疗完成后的8月份进行，以评估夏季情绪状态。在夏季随访和第一次冬季随访之间，将向参与者拨打两个简短的跟踪电话，以跟踪10月和12月第一次电话和第二次电话开始的任何复发和任何新的治疗方法。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Seasonal affective disorder (SAD), regularly occurring fall/winter depression that improves in spring/summer, affects over 14.5 million Americans. For acute (current) and long-term (future) SAD management, available clinical practice guidelines recommend daily use of light therapy from onset of first symptom through spontaneous springtime remission during every fall/winter season, generally spanning 3 to 6 months of the year. Light box therapy is the best available SAD treatment and effectively treats acute SAD. However, long-term compliance with the treatment is poor because it is burdensome and time-consuming. Alternative SAD treatments are needed to prevent the return of depression each fall/winter season. An ideal alternative treatment to light therapy would be time-limited (i.e., acute treatment completed in a discrete period vs. daily treatment every fall/winter indefinitely), effectively treat acute SAD, and show effects that endure beyond the end of treatment to prevent the annual return of these disabling symptoms. Cognitive-behavioral talk therapy (CBT) is a time-limited treatment that is effective for acute nonseasonal depression and appears to have benefits that extend beyond the end of treatment to reduce risk of relapse (the return of depression symptoms after an initial improvement with treatment) and recurrence (the onset of a brand new depressive episode). The Principal Investigator (PI) has developed a new cognitive-behavioral talk therapy for SAD and tested it in two prior small-scale studies. These prior studies suggest that CBT may be as effective as light therapy for acute SAD treatment and that CBT may be superior to light therapy during the next winter season 1-year later. This NIMH R01 project is a larger, more definitive study that has potential to impact clinical practice. The randomized clinical trial will compare standard light box treatment to our CBT treatment over a 6-week trial in the initial winter and at followup visits conducted in the next two winters. This study proposes to enroll 160 qualified participants during the fall/winter season of the first 4 project years. We anticipate that we may need to consent and screen up to 3X this number of potential participants to reach our enrollment goal. Participants will be recruited from media advertisements and from flyers posted in the community and in local clinics. The 160 enrolled participants will be randomly assigned to one of two 6-week treatments: 80 to light box therapy (30-min/day in front of a standard light box with administration time and duration individually-adjusted after the first week) and 80 to cognitive-behavioral talk therapy (1 ¿-hr twice-weekly group therapy). Mood will be monitored weekly during the 6-weeks of study treatment with a semi-structured interview, and participants will complete some questionnaire measures at pre-treatment, mid-treatment (after 3-weeks), and at post-treatment. Participants will return for followup during January or February of the next two winter seasons (i.e., 1- and 2-years after treatment completion). A third in-person followup will occur in the August following study treatment completion to assess summer mood status. Two brief tracking telephone calls will be made to participants in the time between summer followup and the first winter followup to track any recurrences and any new treatments initiated with the first call in October and the second in December.