Quote:
Originally Posted by James Pretzer
A post-hoc analysis by Coffman et al (2007) examines some of the questions I raised in my initial post about Behavioral Activation. It is clear that the apparent superiority of BA is due to a sub-group of severely depressed and chronically depressed individuals. For these individuals CT had virtually no benefit while BA had some benefit (but they were still clinically depressed).
I recommend taking a look at Coffman et al's study for a discussion of the characteristics of this sub-group, they go into quite a bit of detail. I'll think it over as i have time and hopefully post more about it in the near future.
Coffman, S. R., Martell, C. R., Dimidjian, S., Gallop, R. & Hollon, S. D. (2007). Extreme nonresponse in cognitive therapy: Can behavioral activation succeed where cognitive therapy fails? Journal of Consulting and Clinical Psychology, 75, 531-541. |
I think that BA may be more effective with the most severely depressed because it is simple, concrete, nonjudgmental and therefore it is a good approach to getting the most depressed to a point where they can think functionally and benefit from CT.
DBT (Dialectical Behavior Therapy-Linehan) is well-known for its benefits for those with Borderline PD, and made up of skills in 4 separate categories, including Distress Tolerance. I thought of DT when reading your phrase about ruminating and using activities and mental redirection as a way of combatting that. When I lead a DBT group, I prefer to start with Distress Tolerance. As with Borderline PD, depression can lead a person to be overly sensitive to perceived criticism, and I find the Distress Tolerance the most User Friendly in this regard.
It makes absolute sense to use a multi-stage approach, and also perhaps there is no one approach that works for everyone. Some clients ruminate because of past trauma, and simply having the chance to tell their story helps many to unload some of that emotional memory and become more aware of trauma triggers (and ultimately able to sidestep them).
What about research that suggests that a combination of medication and therapy is the most effective?