Abstract
Background
This study is a network intervention analysis comparing the symptomatic response of two first-line treatments for winter seasonal affective disorder (SAD): light therapy (LT) and group cognitive-behavioral therapy for SAD (CBT-SAD).
Methods
Scores on the Beck Depression Inventory-II at mid- and post-treatment on individual items and on four previously-identified symptom clusters were examined in SAD patients randomly assigned to receive LT (n = 85) or CBT-SAD (n = 74).
Results
No treatment differences in either individual symptoms or symptom cluster scores were observed. In both mid- and post-treatment networks, symptoms were primarily associated with each other within their respective, cognitive, vegetative, and affective domains (regardless of treatment). Results suggest that symptom network connections may weaken across treatment.
Conclusions
The lack of treatment differences indicates that these two mechanistically different treatments do not differ in effect on symptoms or symptom clusters. Future work should examine the association of treatment with symptom types over shorter time intervals.
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Notes
Negative Cognition: Pessimism, Past Failures, Guilty Feelings, Punishment Feelings, Self-Dislike, Self-Criticism, Suicidal Thoughts, Crying, Worthlessness, Sadness. Dysregulation: Irritability, Concentration, Agitation, Indecisiveness. Increased Appetite/Weight: Weight Gain, Increased Appetite. Loss of Vitality: Loss of Pleasure, Loss of Interest, Loss of Energy, Tiredness/Fatigue, Loss of Interest in Sex, Hypersomnia.
Several methods for measuring change exist. We also ran analyses using raw change scores and residualized change scores (e.g., Mullarkey et al., 2020). Results were virtually identical to those using raw scores at both mid- and post-treatment and so we report here the raw score results based on their simplicity and ease of interpretation.
Accuracy of the network edges was also examined through bootstrapping. These results are provided in supplementary materials.
References
Bagby, R. M., Ryder, A. G., Schuller, D. R., & Marshall, M. B. (2004). The Hamilton depression rating scale: Has the gold standard become a lead weight? The American Journal of Psychiatry, 161(12), 2163–2177. https://doi.org/10.1176/appi.ajp.161.12.2163
Beck, A. T., Rush, A. J., Shaw, B. F., et al. (1979). Cognitive therapy of depression. Guilford Press.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory (2nd ed.). The Psychological Corporation.
Blanken, T. F., Jansson-Fröjmark, M., Sunnhed, R., & Lancee, J. (2021). Symptom-specific effects of cognitive therapy and behavior therapy for insomnia: A network intervention analysis. Journal of Consulting and Clinical Psychology. https://doi.org/10.1037/ccp0000625
Blanken, T. F., Van Der Zweerde, T., Van Straten, A., Van Someren, E. J. W., Borsboom, D., & Lancee, J. (2019). Introducing network intervention analysis to investigate sequential, symptom-specific treatment effects: A demonstration in co-occurring insomnia and depression. Psychotherapy and Psychosomatics, 88(1), 52–54. https://doi.org/10.1159/000495045
Borkulo, C. V., Bork, R. V., Boschloo, L., Kossakowski, J., Tio, P., Schoevers, R., Borsboom, D., & Waldorp, L. (2017). Comparing network structures on three aspects: A permutation test. Doi: https://doi.org/10.13140/RG.2.2.29455.38569
Cramer, A. O. J., Waldorp, L. J., van der Maas, H. L. J., & Borsboom, D. (2010). Comorbidity: A network perspective. Behavioral and Brain Sciences, 33(2–3), 137–150. https://doi.org/10.1017/S0140525X09991567
David, S. J., Marshall, A. J., Evanovich, E. K., & Mumma, G. H. (2018). Intraindividual dynamic network analysis—implications for clinical assessment. Journal of Psychopathology and Behavioral Assessment, 40(2), 235–248. https://doi.org/10.1007/s10862-017-9632-8
Einhorn, H. J., & Hogarth, R. M. (1975). Unit weighting schemes for decision making. Organizational Behavior and Human Performance, 13(2), 171–192. https://doi.org/10.1016/0030-5073(75)90044-6
Epskamp, S., & Fried, E. I. (2018). A tutorial on regularized partial correlation networks. Psychological Methods, 23(4), 617–634. https://doi.org/10.1037/met0000167
First, M., Spitzer, R., Gibbon, M., & Williams, J. (1996). Structured clinical interview for DSM-IV axis I disorders (clinician version). American Psychiatric Press.
Fried, E. I., & Cramer, A. O. J. (2017). Moving forward: Challenges and directions for psychopathological network theory and methodology. Perspectives on Psychological Science: A Journal of the Association for Psychological Science, 12(6), 999–1020. https://doi.org/10.1177/1745691617705892
Golden, R. N., Gaynes, B. N., Ekstrom, R. D., Hamer, R. M., Jacobsen, F. M., Suppes, T., Wisner, K. L., & Nemeroff, C. B. (2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. The American Journal of Psychiatry, 162(4), 656–662. https://doi.org/10.1176/appi.ajp.162.4.656
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62. https://doi.org/10.1136/jnnp.23.1.56
Haslbeck, J. M. B., & Waldorp, L. J. (2020). Estimating time-varying mixed graphical models in high-dimensional data. Journal of Statistical Software. https://doi.org/10.18637/jss.v093.i08
Hollon, S. D. (1984). Final report: System for rating psychotherapy audiorecordings. US Department of Health and Human Services.
Hollon, S. D., Evans, M., Elkin, E., & Lowery, H. A. (1984). System for rating therapies for depression. Los Angeles, CA: Annual Meeting of the American Psychiatric Association.
Lewis-Healey, E., Laukkonen, R., & van Elk, M. (2021). Future Directions for Clinical Psilocybin Research: The Relaxed Symptom Network [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/q3ymd
Lewy, A. J., Sack, R. L., Singer, C. M., White, D. M., & Hoban, T. M. (1988). Winter depression and the phase-shift hypothesis for bright light’s therapeutic effects: History, theory, and experimental evidence. Journal of Biological Rhythms, 3(2), 121–134. https://doi.org/10.1177/074873048800300203
McCarthy, E., Tarrier, N., & Gregg, L. (2002). The nature and timing of seasonal affective symptoms and the influence of self-esteem and social support: A longitudinal prospective study. Psychological Medicine, 32(8), 1425–1434. https://doi.org/10.1017/s0033291702006621
Meyerhoff, J., Young, M. A., & Rohan, K. J. (2018). Patterns of depressive symptom remission during the treatment of seasonal affective disorder with cognitive-behavioral therapy or light therapy. Depression and Anxiety, 35(5), 457–467. https://doi.org/10.1002/da.22739
Mullarkey, M. C., Marchetti, I., & Beevers, C. G. (2019). Using Network Analysis to Identify Central Symptoms of Adolescent Depression. Journal of Clinical Child & Adolescent Psychology, 48(4), 656–668. https://doi.org/10.1080/15374416.2018.1437735
Mullarkey, M. C., Stein, A. T., Pearson, R., & Beevers, C. G. (2020). Network analyses reveal which symptoms improve (or not) following an Internet intervention (Deprexis) for depression. Depression and Anxiety, 37(2), 115–124. https://doi.org/10.1002/da.22972
Nussbaumer, B., Kaminski-Hartenthaler, A., Forneris, C. A., Morgan, L. C., Sonis, J. H., Gaynes, B. N., Greenblatt, A., Wipplinger, J., Lux, L. J., Winkler, D., Van Noord, M. G., Hofmann, J., & Gartlehner, G. (2015). Light therapy for preventing seasonal affective disorder. The Cochrane Database of Systematic Reviews, 11, CD011269. https://doi.org/10.1002/14651858.CD011269.pub2
Pearl, J. (2009). Causality: Models, reasoning and inference (2nd ed.). Cambridge University Press.
Rohan, K. J. (2008). Coping with the seasons: A cognitive-behavioral approach to seasonal affective disorder: Therapist guide. Oxford University Press.
Rohan, K. J., Mahon, J. N., Evans, M., Ho, S.-Y., Meyerhoff, J., Postolache, T. T., & Vacek, P. M. (2015). Randomized trial of cognitive-behavioral therapy versus light therapy for seasonal affective disorder: Acute outcomes. The American Journal of Psychiatry, 172(9), 862–869. https://doi.org/10.1176/appi.ajp.2015.14101293
Rohan, K. J., Meyerhoff, J., Ho, S.-Y., Evans, M., Postolache, T. T., & Vacek, P. M. (2016). Outcomes one and two winters following cognitive-behavioral therapy or light therapy for seasonal affective disorder. The American Journal of Psychiatry, 173(3), 244–251. https://doi.org/10.1176/appi.ajp.2015.15060773
Rohrer, J. M. (2018). Thinking clearly about correlations and causation: graphical causal models for observational data. Advances in Methods and Practices in Psychological Science, 1(1), 27–42. https://doi.org/10.1177/2515245917745629
Rosen, L. N., Targum, S. D., Terman, M., Bryant, M. J., Hoffman, H., Kasper, S. F., Hamovit, J. R., Docherty, J. P., Welch, B., & Rosenthal, N. E. (1990). Prevalence of seasonal affective disorder at four latitudes. Psychiatry Research, 31(2), 131–144. https://doi.org/10.1016/0165-1781(90)90116-m
Rosenthal, N. E., Sack, D. A., Gillin, J. C., Lewy, A. J., Goodwin, F. K., Davenport, Y., Mueller, P. S., Newsome, D. A., & Wehr, T. A. (1984). Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. Archives of General Psychiatry, 41(1), 72–80. https://doi.org/10.1001/archpsyc.1984.01790120076010
Smetter, J. B., Antler, C. A., Young, M. A., & Rohan, K. J. (2021). The symptom structure of seasonal affective disorder: Integrating results from factor and network analyses in the context of the dual vulnerability model. Journal of Psychopathology and Behavioral Assessment, 43, 95–107. https://doi.org/10.1007/s10862-020-09861-0
Stassen, H. H., Delini-Stula, A., & Angst, J. (1993). Time course of improvement under antidepressant treatment: A survival-analytical approach. European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology, 3(2), 127–135. https://doi.org/10.1016/0924-977x(93)90264-m
Terman, M., Terman, J. S., Quitkin, F. M., McGrath, P. J., Stewart, J. W., & Rafferty, B. (1989). Light therapy for seasonal affective disorder. A review of efficacy. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 2(1), 1–22. https://doi.org/10.1016/0893-133x(89)90002-x
Terman, M., Terman, J. S., & Rafferty, B. (1990). Experimental design and measures of success in the treatment of winter depression by bright light. Psychopharmacology Bulletin, 26(4), 505–510.
Whitcomb-Smith, S., Sigmon, S. T., Martinson, A., Young, M., Craner, J., & Boulard, N. (2014). The temporal development of mood, cognitive, and vegetative symptoms in recurrent SAD episodes: A test of the dual vulnerability hypothesis. Cognitive Therapy and Research, 38(1), 43–54. https://doi.org/10.1007/s10608-013-9577-5
Wichers, M., Groot, P. C., Psychosystems, ESM Group, EWS Group. (2016). Critical slowing down as a personalized early warning signal for depression. Psychotherapy and Psychosomatics, 85(2), 114–116. https://doi.org/10.1159/000441458
Williams, J., Link, M., Rosenthal, N., Amira, L., & Terman, M. (1992). Structured interview guide for the hamilton depression rating scale-seasonal affective disorder version. New York State Psychiatric Institute.
Young, M. A., Watel, L. G., Lahmeyer, H. W., & Eastman, C. I. (1991). The temporal onset of individual symptoms in winter depression: Differentiating underlying mechanisms. Journal of Affective Disorders, 22(4), 191–197. https://doi.org/10.1016/0165-0327(91)90065-z
Funding
This work was partially supported by grant R01MH078982 from the National Institute of Mental Health to Dr. Kelly J. Rohan. Clinical Trial Registration Number: NCT01714050.
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Dr. Kelly Rohan receives book royalties from Oxford University Press for the treatment manual for the cognitive-behavioral therapy intervention for seasonal affective disorder. Richard J. Norton and Michael A. Young declare no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The parent study was approved by the Institutional Review Board at the University of Vermont.
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Norton, R.J., Young, M.A. & Rohan, K.J. Lack of Differential Symptom Change with Cognitive-Behavioral versus Light Therapy for Winter Depression: A Network Intervention Analysis. Cogn Ther Res 46, 992–1005 (2022). https://doi.org/10.1007/s10608-022-10315-y
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DOI: https://doi.org/10.1007/s10608-022-10315-y