Cognitive-Behavioral Approaches to Seasonal Depression

描述（由申请人提供）：季节性情感障碍（SAD）是一种反复出现的秋冬抑郁症，在春季和夏季有缓解期，是一种非常普遍的心理健康问题，特别是在北纬地区。尽管不同研究的缓解率各不相同，但据估计，有相当一部分人（即多达40-50%的SAD患者）对光疗（SAD治疗的“黄金标准”）难以治愈。需要替代和/或补充治疗。认知行为疗法（CBT）对非季节性重度抑郁症是有效的，但在SAD的治疗中尚未得到充分的探讨。我们的初步研究表明，SAD患者表现出消极的认知风格、行为退缩和反刍，需要进一步研究SAD的认知行为模型。我们的试点工作进一步表明，在减轻急性SAD症状方面，CBT单独使用或与光照联合使用可能与单独使用光照一样有效，并且在随后的冬季可能比光照疗法具有更持久的效果（Rohan等人，2001;2002）。在一个明显的协同效应中，CBT和光疗联合治疗在治疗后和一年随访中产生了优于单独治疗的缓解率。两项研究旨在探讨SAD的认知行为模型和治疗方法。研究1通过增加样本量、增加对照组和采用长期随访来扩展我们的试点研究。在为期六周的试验中，该研究比较了光疗法、CBT及其联合的“协同”效果，以及最小接触/延迟治疗控制在治疗当前SAD发作中的作用。光疗将按照标准方案进行。手动CBT将以小组形式进行，每周举行两次会议。整个冬季和夏季将检查症状严重程度、缓解和复发率指标。为了检查这些治疗的预防价值，我们正在进行的试点研究的参与者将在冬季（即治疗完成后一年）评估症状严重程度和重度抑郁发作的存在。研究2比较了SAD患者、非季节性抑郁症患者和非抑郁症患者的各种认知行为因素，包括自动思维、功能失调态度、图式、反刍、活动频率和享受，以及对光相关刺激的反应。提出的研究将有助于发展CBT治疗SAD的方法，并有助于理解SAD症状学中生物和心理因素之间的相互作用。

DESCRIPTION (provided by applicant): Seasonal affective disorder (SAD), a recurrent fall-winter depression with periods of remission in spring and summer, is a highly prevalent mental health problem, especially at Northern latitudes. Although remission rates vary across studies, it is estimated that a significant minority (i.e., as many as 40-50% of SAD sufferers) is refractory to treatment with light therapy--the "gold standard" for SAD treatment. Alternative and/or supplementary treatments are needed. Cognitive-behavioral therapy (CBT) is effective for non-seasonal Major Depressive Disorder, but has not been adequately explored in the case of SAD. Our preliminary work suggests that individuals with SAD demonstrate a negative cognitive style, behavioral withdrawal, and rumination, and further research on cognitive-behavioral models for SAD is needed. Our pilot work further suggests that CBT, alone or combined with light, may be as effective as light alone in reducing acute SAD symptoms and may have more durable effects than light therapy into the subsequent winter season (Rohan et al., 2001; 2002). In an apparent synergistic effect, the combination of CBT and light therapy together produced superior remission rates to either treatment alone at post-treatment and at one-year follow-up. Two studies are proposed to explore cognitive-behavioral models and treatments for SAD. STUDY 1 expands our pilot study by increasing sample size, adding a control group, and employing a longer-term follow-up. It involves a comparison of light therapy, CBT, their combined "synergistic" effects, and a minimal contact/delayed treatment control in treating a current SAD episode over a six-week trial. Light therapy will be administered according to standard protocol. Manualized CBT will be conducted in groups, meeting twice a week. Indices of symptom severity and remission and relapse rates will be examined throughout the winter and during the summer. To examine the prophylactic value of these treatments, participants from our ongoing pilot study will be assessed for symptom severity and presence of a Major Depressive Episode during the winter (i.e., one year following treatment completion). STUDY 2 compares individuals with SAD, those with non-seasonal depression, and never-depressed controls on various cognitive-behavioral factors including automatic thoughts, dysfunctional attitudes, schemata, rumination, activity frequency and enjoyment, and reactivity to light-related stimuli. The proposed studies will contribute to the development of CBT approaches to SAD and to understanding interactions between biological and psychological factors in SAD symptomatology.