SAD and CBTSay Goodbye to SAD with CBT.

 Light therapy might be the long-standing and go-to treatment for Seasonal Affective Disorder (SAD), but the latest research puts promising new light on CBT (Cognitive Behavioral Therapy) as an effective treatment method.

While light therapy does prove effective for some patients suffering acute SAD, there are downsides: nearly 50 percent of patients find it ineffective, some are too sensitive to the bright, fluorescent light’s intensity; and even for those who encounter positive outcomes, many do not repeat light therapy in the future, anyway—leaving them susceptible to deep depression during future winters.

Standard CBT addresses psychiatric disorders through modifying the relationship between our thoughts, feelings, and behaviors.  More specifically, CBT offers strategies to restructure negative automatic thoughts and core beliefs and encourages behavior change. Within the context of SAD, a patient might track negative thoughts in a diary (e.g. how heavy, oppressive, and dull winter mornings are, or the sense of feeling “lost” or “drowned” in so much snow, hating the cold or darkness).  Having concretely identified the negative thoughts and beliefs, the therapist helps the patient challenge and change them to more helpful and accurate thoughts.

Sometimes, fresh perspective can be gained by challenging the position itself, vis-á-vis the language and specific words the patient uses. For example, do you really despise the dark mornings and short days of winter, or would it be more accurate to say they’re not your favorite, or there are other seasons you like more?

In addition, a therapist might suggest modifying behavior to include enjoyable winter hobbies, activities, and encourage regular exercise, or deter the patient from sleeping too much.

A recent study and subsequent analysis found 6-week sessions of CBT to be just as effective as light therapy, with potentially longer-lasting effects when it comes to diminishing depression.

However, the full extent and lasting power of this CBT-SAD treatment is still undetermined.

The study was published in AJP in Advance. There were 177 participants, patients with SAD, who received either two sessions (90 minutes each) of the CBT-SAD treatment, or 30 minutes every morning of light therapy.

Researchers followed up with participants one and two weeks after the study’s completion, and, using two distinct methods, measured the severity of their depression.

According to one method of measurement, after six weeks approximately 47 percent of either patient group (CBT-SAD or Light therapy) experienced depression remission; according to the second method, patients experienced a 60 percent remission rate.

The following winter, both patient treatment groups had similar SAD reoccurrence rate (28.9 percent for CBT and 24.9 percent for light therapy). However, the winter after that—two years later—there were reoccurrence rates of 27.3 percent and 45.6 percent, respectively.

Those who received CBT-SAD also reported less severe depressive symptoms.

In other studies investigating SAD and light therapy versus CBT treatments, patients have shown some preference for light therapy prior to the start of the study.

The results here are highly encouraging—enough that health professionals may need to pay more attention to CBT in the future: if it becomes a more practical, viable treatment method for SAD than light therapy, or—also possible—if a conjunction of the two treatments provides some with optimal, more durable outcomes.

Eric Baron

References

http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2015.5b10

http://psychnews.psychiatryonline.org/doi/full/10.1176/pn.44.24.psychnews_44_24_024

http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2015.14101293?journalCode=ajp

For more information…

Using a Therapy Light

Bright Light for Non-Seasonal Depression

Treatment and Medication (more on CBT)