Showing papers by "Neal Doran published in 2006"

Behavioral Activation Treatment for Major Depressive Disorder: A Pilot Investigation

Abstract: Behavioral activation (BA) has emerged as an effective intervention for major depressive disorder. Previous research has indicated that it is as effective as the full cognitive behavioral treatment package (CBT). Conceptualized to consume fewer participant sessions, BA may be more efficient and cost-effective than CBT. With depression among the most common diagnoses in practice settings, NIMH's recent vision statement calls for continued research devoted to cost- and time-effective targeted treatment alternatives, including "behavioral activation as a more simply behavioral form of CBT" (NIMH, 2005, p. 92). The present investigation piloted a 10-week individual intervention model of BA with medicated and unmedicated participants in a clinical research setting. This follows our earlier report (Porter, Spates, & Smitham, 2004) of an efficacious group-administered BA intervention. In comparison to the group intervention, end state functioning of participants in the present investigation revealed more robust symptom reductions to within the fully recovered range of functioning. Keywords: depression, behavioral activation, behavior therapy, cognitive behavioral therapy. ********** Major depressive disorder (MDD) is the most prevalent psychological disorder (Kimerling, Ouimette, Cronkite, & Moos, 1999) and is now the 4th leading cause of disability across the lifespan and the 2nd leading cause of disability among people aged 15-44 (World Health Organization, 2005). According to a National Comorbidity Survey Replication (NCS-R) the lifetime prevalence rate of MDD is 16% (Kessler et al., 2003). The prevalence of MDD is expected to rise such that by the year 2020, MDD will be second only to heart disease in terms of global burden of disease (World Health Organization, 2005). Although high, prevalence rates may be underestimated given that only about 70% of individuals with depression seek treatment (Angst, 1998). The effective treatment and prevention of MDD are of paramount importance and rank high among both mental health research and clinical objectives. A number of psychological interventions have been identified as holding at least partial efficacy towards this end. Among them are cognitive behavior therapy (CBT), cognitive therapy (CT), behavior therapy (BT), and interpersonal therapy (IT). Both behavioral and cognitive theories of depression are supported with substantial clinical and empirical evidence (Beck, Rush, Shaw, & Emery, 1979; Dobson, 1989; McLean, Ogston, & Grauer, 1973; Steinbrueck, Maxwell, & Howard, 1983), and distinct treatment modalities have emerged from each perspective. A behavioral conceptualization of depression first emerged in the 1970s, and suggested that depression is a result of a reduction in positively reinforcing behavior either via reduced availability of reinforcing alternatives, lack of skill to obtain reinforcing alternatives, or increased punishment (Lewinsohn, 1974). The treatment emanating from behavior theory is referred to as behavioral activation (BA). In BA, restoring an adequate schedule of reinforcement by having the patient increase activity levels is instrumental in decreasing depressive symptoms (Lewinsohn, Biglan, & Zeiss, 1976). BA has been reconceptualized since its original introduction. According to Martell and colleagues (Martell, Addis, & Jacobson, 2001), BA no longer aims to replenish a broad class of positive reinforcing activities but rather to replenish positive reinforcing activities that specifically move the patient toward personal goals while blocking avoidance patterns that prevent the patient from reaching those goals. The approach is both functional analytic and idiographic, in which contingencies that maintain behavior for each patient are identified via self-monitoring. Avoidance patterns are changed by integrating new behaviors into a daily routine, observing the outcome, and assessing whether the behavior serves to approach or avoid personal goals. …

Effect of nicotine on negative affect among more impulsive smokers.

Abstract: In the present study, the authors tested the hypothesis that nicotine would provide greater relief from negative affect for more impulsive smokers than for less impulsive smokers. Euthymic adult smokers (N 70) participated in 2 laboratory sessions, during which they underwent a negative mood induction (music autobiographical memory), then smoked either a nicotinized or de-nicotinized cigarette. Mixed-effects regression yielded a significant Impulsivity Condition (nicotinized vs. de-nicotinized) Time interaction. Simple effects analyses showed that heightened impulsivity predicted greater negative affect relief after smoking a nicotinized cigarette but not after smoking a de-nicotinized cigarette. These data suggest that nicotine may be a disproportionately powerful negative reinforcer for highly impulsive smokers, promoting higher levels of nicotine dependence and inhibiting smoking cessation.

Elevated positive mood: a mixed blessing for abstinence.

Abstract: The present study, a secondary analysis of published data (B. Hitsman et al., 1999), assessed (a) the influence of initial positive mood (PM) on smoking cessation and (b) whether smokers low in PM benefited from fluoxetine versus placebo for cessation. Euthymic adult smokers (N = 103) received 10 weeks of cessation treatment. Analyses showed a Time X PM interaction, indicating that higher baseline PM predicted decreased abstinence during treatment but increased abstinence afterward, mediated by time to dropout. Dichotomous initial PM interacted with drug, suggesting a benefit of fluoxetine for low-PM smokers. Results indicate that lower pretreatment PM may inhibit long-term cessation. Smokers with lower baseline PM may benefit from treatment that increases PM.