We thought, given the terrible situation in Haiti, it might be useful to post the results of this classic study of survivors of the great Turkish earthquake of 1999, which points to what makes survivors more vulnerable to PTSD.  Subsequent surveys from China, Japan, Italy, El Salvador and Iceland support these findings. , Additional factors appear to be dislocation, subsequent financial difficulties, disruption of social networks, injury, the intensity of fear and/or presence of dissociation at the time of the trauma. Loss of family and friends appear to be more associated with depression rather than posttraumatic stress.  Difficulties appear to be fairly longstanding, according to most of these surveys.

Researchers from King's College at the University of London in the UK examined the incidence of posttraumatic stress disorder (PTSD) and depression in 586 earthquake survivors living in prefabricated housing, an average of 20 months after the 1999 Marmara earthquake in Turkey. 

Investigators from the Coimbra Nursing School in Coimbra, Portugal and the University of Akron’s College of Nursing reported on the efficacy of a guided imagery intervention for decreasing depression, anxiety, and stress and increasing comfort in psychiatric inpatients with depressive disorders.

A quasi-experimental design sampled 60 short-term hospitalized patients suffering from depression, selected consecutively. The experimental group listened to a guided imagery compact disk once a day for 10 days.

Australia, with its vast distances between urban centers and medical help, has always been a world leader in developing mental health services over the internet, and do a tremendous amount of research in this area.  

So it’s no surprise to see that most recently, investigators from St Vincent's Hospital in Sydney, New South Wales, Australia, ran a study with 45 depressed subjects, randomly assigning them to either an internet-based, clinician-assisted, computerized, cognitive behavioral treatment (CaCCBT) program for depression (called the Sadness Programme) or to a waitlist control group.

In the Sadness Programme, participants completed six online lessons, weekly homework assignments, receive weekly email contact from a clinical psychologist, and contribute to a moderated online discussion forum with other participants.

Researchers from the Department of Psychology at the University of Vermont in Burlington looked at the recurrence of SAD (seasonal affective disorder or depression) in the fall/winter, one year after receiving cognitive behavioral treatment.

The investigators had previously developed a group cognitive-behavioral therapy approach (CBT) specifically targeted for SAD and tested its efficacy in 2 pilot studies that compared outcomes with light therapy.

This study examines impact during the subsequent winter season (approximately 1 year after acute treatment), following participants randomized to CBT, light therapy, and a combination of both treatments.  (N=69).

Researchers from the Department of Psychobiology at the Universidade Federal de São Paulo in Brazil looked at the efficacy of Siddha Samadhi Yoga, a program of meditation and pranayama (breathing exercises).  Twenty-two volunteers with anxiety complaints (Median age = 42.8 yr., Standard deviation = 10.3) were assigned to two groups: 14 attended the yoga group, and 8 attended a waiting-list or control group.

Subjects were evaluated before the intervention and 1 month after it on the State-Trait Anxiety Inventory, the Beck Depression Inventory, Tension Feelings Self-evaluation Scales, and the Well-being Self-evaluation Scales. 

Cochrane analysts examined five randomized, controlled trials of the efficacy of exercise therapy for Chronic Fatigue Syndrome (CFS) and found that after 12 weeks, those receiving exercise therapy were less fatigued than the control participants (SMD -0.77, 95% CIs -1.26 to -0.28).  Additionally, physical functioning was significantly improved with exercise therapy (SMD -0.64, CIs -0.96 to -0.33) but there were more dropouts with exercise therapy (RR 1.73, CIs 0.92 to 3.24). 

Romanian researchers from Babes-Bolyai University in Cluj, Romania, undertook a randomized clinical trial to investigate the relative efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy in the treatment of 170 outpatients with nonpsychotic, major depressive disorder.

The patients were randomly assigned to one of the following: 14 weeks of REBT, 14 weeks of CT, or 14 weeks of pharmacotherapy (fluoxetine or prozac). The outcome measures used were the Hamilton Rating Scale for Depression and the Beck Depression Inventory.

British researchers from the University of York in Road, Durham, UK, performed a meta-analysis of studies testing the efficacy of various behavioral therapies for depression. [Ed. Note: Generally speaking, behavioral therapies use changes in reactivity and behavior as opposed to changes in insight, thoughts and feelings to catalyze improvements.]

The study identified randomized trials of behavioral treatments for depression and compared them to controls or other psychotherapies.  Seventeen randomized controlled trials, encompassing a total of 1109 subjects, were included in this meta-analysis.

A random-effects meta-analysis of symptom-levels, post-treatment, showed that behavioral therapies were superior to controls*, brief psychotherapy, supportive therapy and equal to cognitive behavioral therapy (CBT).

The results in this study indicate behavioral therapy is an effective treatment for depression, with outcomes equal to Cognitive Behavioral Therapy, the current recommended psychological intervention and preferable to brief psychotherapy and supportive therapy.  Future research is needed to clarify and better sort out these findings.
 
Citation:  Ekers D, Richards D, Gilbody S. A meta-analysis of randomized trials of behavioural treatment of depression. Psychological Medicine. 2008 May;38 (5): pages 611-23. Epub 2007 Oct 1, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it