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Treating depression with activation
Umeå University, Faculty of Social Sciences, Department of Psychology.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Aktivering som behandling vid depression (Swedish)
Abstract [en]

The aim of this thesis was to evaluate and compare four therapist-supported Internet-administered treatments for depression. Three studies were conducted. The first was a systematic review to determine the most effective mode and dose of physical activity (PA) for treating major depressive disorders (MDDs), and to suggest guidelines and recommendations for clinicians. These recommendations included that the PA needs to be individually customized, performed for at least 30 minutes, preferably under supervision, and with a frequency of at least three times per week to be effective for treating MDDs. Recommendations, however, must be viewed in light of the relatively few studies that match the inclusion criteria. The second study aimed to empirically evaluate and compare the effect of four therapist-supported Internet-administered treatments for mild to moderate depression. Two of the treatments were based on PA and two on behavioural activation (BA). One PA group was provided with a rationale; whereas, the other was not. The treatment in one BA group was based on Lewinsohn’s model and the other on Martell’s model. Results showed that all groups (including the control group) significantly reduced their depressive symptoms. Group comparisons revealed that three of the four treatment groups (all except the PA group that did not receive a rationale) had a significantly greater symptom reduction than the control group. This suggests that some sort of rationale is important for symptom reduction. The third study aimed to examine if a relapse prevention program would affect symptom change during a 24-month follow-up. We also examined if symptom change during the acute phase (AP) treatment period predicted symptom change during the follow-up period. A third and final aim was to examine if the number of symptoms post-AP treatment predicted symptom change during the follow-up period. The initial analysis indicated that the introduction of a relapse prevention program did not affect symptom change during follow-up. The symptom change during AP treatment did predict symptom change during follow-up for three of the four treatment groups (all except one of the BA groups). The number of symptoms post-AP treatment, however, did not predict symptom change during follow-up for any of the treatment groups. The main conclusion from this thesis is that PA seems to be effective for treating and preventing depressive symptoms. PA with a rationale is more effective than without one, and an understanding of the person’s situation is important for a treatment outcome. If a symptom change can be achieved during the acute phase, the likelihood for symptom change during the follow-up increases.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2018. , p. 90
Keywords [en]
depression treatment, physical activity, behavioural activation, 24-month follow-up, relapse prevention
National Category
Applied Psychology
Research subject
Clinical Psychology; Psychology
Identifiers
URN: urn:nbn:se:umu:diva-145292ISBN: 978-91-7601-857-6 (print)OAI: oai:DiVA.org:umu-145292DiVA, id: diva2:1186000
Public defence
2018-03-23, Hörsal H, Humanisthuset, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2018-03-02 Created: 2018-02-27 Last updated: 2018-06-09Bibliographically approved
List of papers
1. Treating Major Depression with Physical Activity: a Systematic Overview with Recommendations
Open this publication in new window or tab >>Treating Major Depression with Physical Activity: a Systematic Overview with Recommendations
2015 (Swedish)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 4, p. 341-352Article in journal (Refereed) Published
Abstract [en]

The purpose of this systematic overview was to determine the most effective mode and doseof physical activity (PA) for treating major depressive disorder (MDD), and to suggest guidelines and recommendations for clinicians. The selection process consisted of a comprehensive search that was conducted up until April 2014 in the following databases: sycINFO, Medline, PubMed and Scopus. The inclusion criteria were: (1) a randomized controlled trial (RCT) design, (2) complete description of intensity, duration and frequency of the PA, (3) the participants had to be diagnosed with MDD according to Diagnostic Statistical Manual 4 th edition (DSM-IV) or International Classification of Disease tenth Revision (ICD-10) criteria (4) if the controls received any treatment, it had to be specified, (5) published after 1990, (6) consist of aerobic or anaerobic treatment PA, and (7) not be a pilotor preliminary study. A quality assessment of each study was conducted independently by two reviewers; this stringent selection process resulted in 12 reviewed studies. Conclusion: individually customized PA, for at least 30 minutes, preferably performed under supervision and with a frequency of at least three times per week is recommended when treating MDD. hese recommendations must be viewed in light of the relatively few studies matching the inclusion criteria.

Place, publisher, year, edition, pages
Taylor & Francis, 2015
Keywords
RCT, treatment, physical activity, depression, major depression
National Category
Applied Psychology
Identifiers
urn:nbn:se:umu:diva-104393 (URN)10.1080/16506073.2015.1015440 (DOI)000355812000010 ()
Available from: 2015-06-10 Created: 2015-06-10 Last updated: 2018-06-07Bibliographically approved
2. Behavioral activation versus physical activity via the internet: A randomized controlled trial
Open this publication in new window or tab >>Behavioral activation versus physical activity via the internet: A randomized controlled trial
Show others...
2017 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 215, p. 85-93Article in journal (Refereed) Published
Abstract [en]

Background: A major problem today is that only about fifty percent of those affected by depression seeks help. One way to reach more sufferers would be by offering easily accessible internet based treatments. The purpose of this study was to compare/evaluate four therapist supported internet administered treatments.

Method/results: Two hundred eighty six participants were included. The treatment period lasted twelve weeks, consisting of the following treatments: 1) physical activity without treatment rational, 2) physical activity with treatment rational, 3) behavioral activation without treatment rational and 4) behavioral activation with treatment rational. All groups (including a control-group) showed a significant decrease in depressive symptoms. When the treatment groups were pooled and compared to the control group, there were significant differences from pretest to posttest (Hedges gav treatment =1.01, control group =0.47). This held true also when each of the four treatment groups was compared to the control group, with one exception: Physical activity without treatment rationale.

Limitations: The differences between how many modules the participants completed could indicate that there are other factors than the treatments that caused the symptom reduction, however, the dose-response analysis did not detect any significant differences on account of modules completed.

Conclusions: The results support the positive effects of internet administered treatments for depression, and highlights the importance of psychoeducation, which tends to affect both the treatment outcome and the probability of remaining in treatment. These aspects need to be considered when developing and conducting new treatments for depression, since they would increase the likelihood of positive treatment outcomes.

Keywords
Depression, Physical activity, Behavioral activation, Treatment, RCT, Growth curve modeling
National Category
Applied Psychology
Identifiers
urn:nbn:se:umu:diva-136322 (URN)10.1016/j.jad.2017.03.018 (DOI)000401213300012 ()28319696 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, FORTE 2011-0477
Available from: 2017-06-26 Created: 2017-06-26 Last updated: 2018-06-09Bibliographically approved
3. Factors affecting relapse risk: a 24-months follow-up of an Internet administered treatment for depression
Open this publication in new window or tab >>Factors affecting relapse risk: a 24-months follow-up of an Internet administered treatment for depression
(English)Manuscript (preprint) (Other academic)
Keywords
follow-up depression treatment, relapse prevention
National Category
Psychology
Research subject
Clinical Psychology
Identifiers
urn:nbn:se:umu:diva-145291 (URN)
Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2018-06-09

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