COGNITIVE-BEHAVIORAL THERAPY VS LIGHT THERAPY FOR PREVENTING SAD RECURRENCE

这个子项目是许多利用 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 季节性情感障碍（SAD），经常发生的秋季/冬季抑郁症，在春季/夏季改善，影响超过1450万美国人。 对于急性（当前）和长期（未来）SAD管理，现有的临床实践指南建议从首次症状发作到每年秋冬季节的自发春季缓解期间每天使用光疗，通常持续3至6个月。 灯箱疗法是最好的SAD治疗方法，可有效治疗急性SAD。 然而，长期的治疗依从性差，因为它是负担和耗时。 需要替代性SAD治疗来防止每个秋季/冬季抑郁症的复发。 光疗法的理想替代治疗将是有时间限制的（即，在不连续的时期内完成急性治疗与每年秋季/冬季无限期地每日治疗），有效治疗急性SAD，并显示出持续超过治疗结束的效果，以防止这些致残症状的年度复发。 认知行为谈话疗法（CBT）是一种有时间限制的治疗方法，对急性非季节性抑郁症有效，并且似乎具有超出治疗结束的益处，以降低复发（治疗初步改善后抑郁症状的恢复）和复发（全新抑郁发作的发作）的风险。 首席研究员（PI）开发了一种新的认知行为谈话疗法，用于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，对于急性SAD治疗，CBT可能与光疗法一样有效，并且在1年后的下一个冬季，CBT可能上级光疗法。 NIMH R 01项目是一项更大、更确定的研究，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周的随访中比较标准灯箱治疗和我们的CBT治疗。 本研究拟在前4个项目年的秋冬季节招募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，以达到我们的入组目标。 参与者将从媒体广告和张贴在社区和当地诊所的传单中招募。 160名入组受试者将被随机分配至两种为期6周的治疗之一：80名接受灯箱治疗（在标准灯箱前30分钟/天，第一周后单独调整给药时间和持续时间），80名接受认知行为谈话治疗（每周两次，每次1小时）。 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一次情绪，受试者将在治疗前、治疗中（3周后）和治疗后完成一些问卷测量。 参与者将在接下来的两个冬季的1月或2月返回进行随访（即，1-治疗结束后2年）。 第三次面对面随访将在研究治疗完成后的8月进行，以评估夏季情绪状态。 在夏季随访和第一次冬季随访之间的时间内，将向参与者进行两次简短的跟踪电话，以跟踪任何复发和任何新的治疗，第一次电话在10月，第二次在12月。

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.