Cognitive Behavior Therapy Shown Best for Seasonal Affective Disorder

Patient Expert

Seasonal affective disorder (SAD) is a form of severe recurrent depression that occurs annually in the fall and winter seasons, accounting for 10-20% of cases of recurrent depression. Bright light therapy has previously been shown to be the most effective treatment. In the management of SAD, the challenge is preventing the recurrent episodes in subsequent years.

University of Vermont psychologist Kelly Rohan has presented the first published research study of the long-term effects of different treatments for SAD. The first year Rohan randomized 69 people with SAD into one of four groups:

  • light therapy (LT) treatment: 10,000-lux SunRay© light box in two 45-minute daily dose, morning and evening (LT group)

  • group cognitive behavior therapy (CBT): 1.5-hour sessions, twice a week (CBT group)

  • a combination of the two (CBT+LT group)

  • wait-list control.

She then surveyed participants on how they were doing the next winter - one year later. (CBT is a form of psychotherapy based on the premise that our own distorted thoughts lead to negative moods and unhealthy behaviors. In CBT, those thoughts and the beliefs their underlying them are explored and dealt with.)

Study results:

  • Recurrence rate in the CBT group was 7%

  • Recurrence rate in the LT group was 36.7%

  • Recurrence rate in the CBT-LT group was 5.5 percent.

  • When the severity of the recurrent depression was analyzed, however, CBT was associated with less severe depression than those treated with either light therapy or a combination of both.

In a previous study that measured the acute affects of each treatment (immediately following six weeks of intervention), combination therapy was highly effective, with a nearly 80 percent remission rate compared to 50 percent for both CBT and light therapy alone and 20 percent on the wait-list.

Rohan hypothesizes that such dramatic results for the combination therapy are the result of being in a heavily monitored study with full participation. When people are left on their own to manage symptoms the subsequent winter, follow-through is much more difficult. This "watered-down" effect of a two-modality treatment, Rohan notes, has been reported for 20 years across psychology disorders of all sorts.

"People treated with only CBT - that's all they know," she says, "so I think they do it with gusto in the next year and reap the benefits."

Of the light therapy group, only four people used it on their own the following winter. Rohan considers this unsurprising given the commitment the treatment requires: 30 minutes sitting in front of a light box every day through the difficult season. Her data shows that long-term compliance is rare.

A $2 million, five-year grant from the National Institute of Mental Health will advance the next phase of Rohan's research. In the "Cadillac" version of the trial, as she calls it, Rohan will follow a much larger sample, 160 people, over two consecutive winters. That study, in progress now, will compare only CBT and light therapy.

"The combination therapy may blow your socks off across six weeks of the initial winter," says Rohan, "but if it doesn't have good long-term outcomes, what is the point? This is a recurrent depression. It's going to come back every year in some form and I want to develop treatments that are going to have lasting effects."

Summary and comments:

This small study seems to have clear outcomes and good news for anyone concerned about long-term treatment of seasonal affective disorder. Certainly, finding treatment that reduces both the rate of recurrence and the severity of the depression for patients do experience recurrence seems positive on both counts. If the results are replicated in the larger study, this could change the standard of care for SAD.


Resources:

Rohan, Kelly J.; Roecklein, Kathryn A.; Lacy, Timothy J.; Vacek, Pamela M. "Winter Depression Recurrence One Year After Cognitive-Behavioral Therapy, Light Therapy, or Combination Treatment." Behavior Therapy 40 (2009) 225-238.

Press Release. "For SAD Sufferers, Cognitive Behavior Better Than Light Therapy at Preventing Recurrence." University of Vermont. October 13, 2009.

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