Journal Article

Behavioral activation therapy for return to work in medication-responsive chronic depression with persistent psychosocial dysfunction

Hellerstein, David J., McGrath, Patrick J., Reynolds, Sarah K., O’Shea, Donna, Erickson, Greg, Chen, Ying, Hunnicutt-Ferguson, Kallio, Stewart, Jonathan W., Wang, Yuanjia, Withers, Amy

2015

Overview

Chronic depression is associated with significant impairment in work functioning, relationships, and health. Such impairment often persists following medication-induced remission of depressive symptoms. We adapted and tested Behavioral Activation therapy with a goal of return to work (BA-W) in subjects with chronic depression who had responded to medication treatment but remained unemployed. Sixteen adults aged 18–65 with DSM-IV diagnosed Dysthymic Disorder or chronic Major Depression were recruited from clinical trials taking place at the New York State Psychiatric Institute between 4/2009 and 12/2012 and enrolled in 12 weeks of individual manual-driven BA-W. Functioning was measured at intake, post-treatment and at 24 week follow-up. Eighty-seven percent (n=14) of subjects completed the full 12 weeks of BA-W. Hours of work related activity (p<.005, d=0.83), hours of paid work (p<.0003, d=0.54), and work productivity (p<.0004, d=−0.48) increased significantly over the study period. Earned income increased post-treatment (p=.068) with significant changes by 24 week follow-up (p=.011). Secondary outcomes including behavioral avoidance (p<.004, d=−0.56), and global functioning (p<.0003, d=1.42) were also significantly improved post-treatment. Effect sizes, including for outcomes with non-significant changes, were generally in the range of 0.5–0.8. This pilot study provides preliminary evidence of the efficacy of a work-targeted psychotherapy to remediate vocational impairment in subjects with chronic depression. Data suggests that further testing of BA-W using a randomized controlled trial is warranted and may represent a significant advance in treatment for the residual disability present after successful pharmacotherapy.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adolescent / Adult / Aged / Antidepressive Agents - therapeutic use / Behavior / Behavior Therapy - methods / Chronic Disease / Depressive Disorder, Major - drug therapy / Depressive Disorder, Major - psychology / Diagnostic and Statistical Manual of Mental Disorders / Efficiency / Female / Humans / Income / Inventory / Male / Mental depression / Middle Aged / Neuropsychological Tests / Occupational Therapy - methods / Patients / Pilot Projects / Psychiatric Status Rating Scales / Psychiatry / Psychotherapy / Quality of life / Return to Work - psychology / Social Behavior Disorders - drug therapy / Social Behavior Disorders - psychology / Studies / Teenagers / Treatment Outcome / Unemployment / Young Adult