CBT May Be More Durable Treatment for SAD Than Light Therapy

Six weeks of cognitive-behavioral therapy sessions tailored for seasonal affective disorder (CBT-SAD) may lead to longer-lasting effects than those seen with light therapy, according to a recent study in AJP in Advance.

Light therapy is a proven approach to treat acute SAD, but previous studies show that most patients fail to reinitiate light therapy in subsequent winters—leaving them vulnerable to the recurrence of depression. A recent analysis found CBT-SAD to be as effective as light therapy in alleviating depression associated with SAD, but it was unknown how long lasting these effects might be.

In the current study, researchers examined outcomes for 177 participants with SAD who were randomly assigned to receive CBT-SAD (two 90-minute sessions a week) or light therapy (30 minutes each morning) for six weeks. The participants were then assessed one and two winters later. The primary outcome was winter depression recurrence status on the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version.

In the first follow-up winter, recurrence of SAD was the same in the two groups (28.9% for CBT and 24.9% for light therapy). At the second winter, CBT-SAD had a 27.3% recurrence rate compared with 45.6% for light therapy. Participants treated with CBT-SAD also reported less severe symptoms and showed a higher rate of remission, as measured by the Beck Depression Inventory-Second Edition scores.

“Light therapy remains an important treatment for SAD, but this study shows the value of educating people about their illness and behaviors that can help manage it,” said Norman Rosenthal, M.D., a clinical professor of psychiatry at Georgetown University School of Medicine. Rosenthal, an expert on SAD, was not involved in the study.

For more on the effectiveness of CBT and light therapy for SAD, see the Psychiatric News article “CBT, Light Therapy Found Comparable for Seasonal Affective Disorder.”

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Benefits of Supported Employment Persist After Five Years, Study Finds

The benefits of supported employment for individuals with severe mental illness persist up to five years after program enrollment, according to the report "Long-Term Effectiveness of Supported Employment: 5-Year Follow-Up of a Randomized Controlled Trial" published in AJP in Advance.

The study confirms and extends the significant benefits—more hours of competitive work, higher pay, and diminished likelihood of hospitalization—of supported employment for people with schizophrenia and other severe mental illnesses that had been found at two and three years. Additionally, the study found that over time, the supports associated with the intervention could be removed without diminishing the benefits; recipients became less dependent on the program to retain employment.

In the study, 100 unemployed individuals with severe mental illness were randomly assigned to either the supported employment program or traditional vocational rehabilitation. The supported employment program, known as the Job Coach Project, was modeled after the individual placement and support model of supported employment. Once employed, participants receive on-the-job training and follow-along support to help them keep their jobs.

The researchers found that participants in supported employment were more likely to obtain competitive work than those in traditional vocational rehabilitation (65% vs. 33%), worked more hours and weeks, earned more wages, and had longer job tenures. Reliance on supported employment services for retaining competitive work decreased from the two-year to the five-year follow-up, and participants were also significantly less likely to be hospitalized, had fewer psychiatric hospital admissions, and spent fewer days in the hospital.

Robert Drake, M.D., Ph.D., of Dartmouth University, one of the founders of supported employment, said the findings are consistent with 21 other studies in the literature. “The new findings here are that employment supports can be reduced without eroding benefits, and cost savings are great when you follow people for five years rather than 18 months as in most U.S. trials,” he told Psychiatric News.

For more information on this topic, see the Psychiatric News article "Study Finds Evidence Supported Employment Works." Also see the report "Supported Employment: Assessing the Evidence" in Psychiatric Services.

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