Accept Yourself! A Pilot Randomized Controlled Trial of a Self-Acceptance-Based Treatment for Large-Bodied Women With Depression.

A pilot parallel randomized controlled trial compared a self-acceptance, non-weight-loss intervention, Accept Yourself! (AY), to a weight loss program, Weight Watchers (WW), in order to provide preliminary safety, feasibility, and efficacy data in preparation for a definitive RCT of AY as an intervention to enhance the mental and physical health of larger-bodied women with Major Depressive Disorder (MDD). Adult women with MDD and a Body Mass Index ≥30 were eligible. Nineteen women were randomized by random number table into AY (n = 9) or WW (n = 10). Intake, pretreatment, posttreatment, 3-, 6-, 9-, and 12-month follow-up assessments occurred at a rural academic medical center. Primary outcomes included depression severity and cardiovascular fitness. Chi-square and t-tests assessed attrition and participant preferences for treatment; other analyses used intention-to-treat, linear mixed-effects models for repeated measures, including all participants' available data. Both groups improved in self-reported, F(5, 43.81) = 7.45, p < .001, partial η2 = .38, and blinded-clinician-rated depression, F(6, 62.03) = 10.41, p < .001, partial η2 = .5. AY was superior to WW in self-reported depression, F(5, 43.81) = 2.72, p = .03, partial η2 = .11. Neither group improved in fitness. Eating disorder symptoms and weight gain worsened in WW. AY appeared safe, feasible, and offered initial evidence of efficacy for depression; it should be investigated in a definitive RCT, with modifications to increase potency. WW may not be suitable as a comparator intervention for AY because of risk to participants.

Uncontrolled pilot study of an Acceptance and Commitment Therapy and Health at Every Size intervention for obese, depressed women: Accept Yourself!

Depression and obesity frequently co-occur, but providing adequate treatment to depressed obese women is challenging because existing treatments for each problem in isolation are suboptimal, and treatments to address one problem may exacerbate the other. This study used an uncontrolled, pretreatment-to-posttreatment design, with 3-month follow-up, to evaluate the feasibility and outcome of a novel, self-acceptance-based treatment for obese women with depression, "Accept Yourself!" Accept Yourself! is an 11-week manualized, group-based intervention that integrates Health At Every Size (an evidence-based paradigm to enhance physical health) and Acceptance and Commitment Therapy (an evidence-based psychotherapy often used to treat depression and eating-related concerns) to improve the physical and mental health of obese, depressed women without encouraging weight loss. Twenty-one obese women with Major Depressive Disorder received the intervention; 18 completed at least seven sessions, a minimal dose of the intervention. Depressive symptoms, depression diagnosis, physical health outcomes (including physical activity and blood pressure), and obesity-related quality of life were assessed at baseline, posttreatment, and 3-month follow-up. Weight was also monitored. Depression, blood pressure, and obesity-related quality of life significantly improved from pretreatment to posttreatment, and improvements were sustained over a 3-month follow-up. Participants did not gain significant weight during the intervention or at follow-up. These data, although preliminary and nonexperimental, suggest that Accept Yourself! could be a promising treatment for obese, depressed women, and support the value of larger randomized controlled trials. (PsycINFO Database Record

Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes.

(Reprinted with permission from PLoS Med 2013; 10(3): e1001403).

Feasibility study of an interactive multimedia electronic problem solving treatment program for depression: a preliminary uncontrolled trial.

Computer-based depression interventions lacking live therapist support have difficulty engaging users. This study evaluated the usability, acceptability, credibility, therapeutic alliance and efficacy of a stand-alone multimedia, interactive, computer-based Problem Solving Treatment program (ePST™) for depression. The program simulated live treatment from an expert PST therapist, and delivered 6 ePST™ sessions over 9weeks. Twenty-nine participants with moderate-severe symptoms received the intervention; 23 completed a minimally adequate dose of ePST™ (at least 4 sessions). Program usability, acceptability, credibility, and therapeutic alliance were assessed at treatment midpoint and endpoint. Depressive symptoms and health-related functioning were assessed at baseline, treatment midpoint (4weeks), and study endpoint (10weeks). Depression outcomes and therapeutic alliance ratings were also compared to previously published research on live PST and computer-based depression therapy. Participants rated the program as highly usable, acceptable, and credible, and reported a therapeutic alliance with the program comparable to that observed in live therapy. Depressive symptoms improved significantly over time. These findings also provide preliminary evidence that ePST™ may be effective as a depression treatment. Larger clinical trials with diverse samples are indicated.

Predicting depression outcome in mental health treatment: a recursive partitioning analysis.

OBJECTIVE: Recursive partitioning was applied to a longitudinal dataset of outpatient mental health clinic patients to identify empirically factors and interactions among factors that best predicted clinical improvement and deterioration in symptoms of depression across treatment. METHOD: Sixty-two variables drawn from an initial patient survey and from chart review were included as covariates in the analysis, representing nearly all of the demographic, treatment, symptom, diagnostic, and social history information obtained from patients at their initial evaluations. Trees estimated the probability of participants' having depression at their last assessment, improving to a clinically significant degree during treatment, or developing a new onset of significant depressive symptoms during treatment. RESULTS: Initial pain, the presence of anxiety, and a history of multiple types of abuse were risk factors for poorer outcome, even among patients who did not initially have significant depressive symptoms. CONCLUSIONS: By examining multiple-related outcomes, we were able to create a series of overlapping models that revealed important predictors across trees. Limitations of the study included the lack of cross-validation of the trees and the exploratory nature of the analysis.

Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes.

BACKGROUND: Atypical antipsychotic medications are widely prescribed for the adjunctive treatment of depression, yet their total risk-benefit profile is not well understood. We thus conducted a systematic review of the efficacy and safety profiles of atypical antipsychotic medications used for the adjunctive treatment of depression. METHODS AND FINDINGS: We included randomized trials comparing adjunctive antipsychotic medication to placebo for treatment-resistant depression in adults. Our literature search (conducted in December 2011 and updated on December 14, 2012) identified 14 short-term trials of aripiprazole, olanzapine/fluoxetine combination (OFC), quetiapine, and risperidone. When possible, we supplemented published literature with data from manufacturers' clinical trial registries and US Food and Drug Administration New Drug Applications. Study duration ranged from 4 to 12 wk. All four drugs had statistically significant effects on remission, as follows: aripiprazole (odds ratio [OR], 2.01; 95% CI, 1.48-2.73), OFC (OR, 1.42; 95% CI, 1.01-2.0), quetiapine (OR, 1.79; 95% CI, 1.33-2.42), and risperidone (OR, 2.37; 95% CI, 1.31-4.30). The number needed to treat (NNT) was 19 for OFC and nine for each other drug. All drugs with the exception of OFC also had statistically significant effects on response rates, as follows: aripiprazole (OR, 2.07; 95% CI, 1.58-2.72; NNT, 7), OFC (OR, 1.30, 95% CI, 0.87-1.93), quetiapine (OR, 1.53, 95% CI, 1.17-2.0; NNT, 10), and risperidone (OR, 1.83, 95% CI, 1.16-2.88; NNT, 8). All four drugs showed statistically significant effects on clinician-rated depression severity measures (Hedges' g ranged from 0.26 to 0.48; mean difference of 2.69 points on the Montgomery-Asberg Depression Rating Scale across drugs). On measures of functioning and quality of life, these medications produced either no benefit or a very small benefit, except for risperidone, which had a small-to-moderate effect on quality of life (g = 0.49). Treatment was linked to several adverse events, including akathisia (aripiprazole), sedation (quetiapine, OFC, and aripiprazole), abnormal metabolic laboratory results (quetiapine and OFC), and weight gain (all four drugs, especially OFC). Shortcomings in study design and data reporting, as well as use of post hoc analyses, may have inflated the apparent benefits of treatment and reduced the apparent incidence of adverse events. CONCLUSIONS: Atypical antipsychotic medications for the adjunctive treatment of depression are efficacious in reducing observer-rated depressive symptoms, but clinicians should interpret these findings cautiously in light of (1) the small-to-moderate-sized benefits, (2) the lack of benefit with regards to quality of life or functional impairment, and (3) the abundant evidence of potential treatment-related harm. Please see later in the article for the Editors' Summary.

Psychotherapy versus second-generation antidepressants in the treatment of depression: a meta-analysis.

Most meta-analyses have concluded that psychotherapy and pharmacotherapy yield roughly similar efficacy in the short-term treatment of depression, with psychotherapy showing some advantage at long-term follow-up. However, a recent meta-analysis found that selective serotonin reuptake inhibitors medications were superior to psychotherapy in the short-term treatment of depression. To incorporate results of several recent trials into the meta-analytic literature, we conducted a meta-analysis of trials which directly compared psychotherapy to second-generation antidepressants (SGAs). Variables potentially moderating the quality of psychotherapy or medication delivery were also examined, to allow the highest quality comparison of both types of intervention. Bona fide psychotherapies showed equivalent efficacy in the short-term and slightly better efficacy on depression rating scales at follow-up relative to SGA. Non-bona fide therapies had significantly worse short-term outcomes than medication (d = 0.58). No significant differences emerged between treatments in terms of response or remission rates, but non-bona fide therapies had significantly lower rates of study completion than medication (odds ratio = 0.55). Bona fide psychotherapy appears as effective as SGAs in the short-term treatment of depression, and likely somewhat more effective than SGAs in the longer-term management of depressive symptoms.

Relationship power and betrayal experience as predictors of reactions to infidelity.

Explanations for sexual infidelity have been dominated by an evolutionary psychological theory of jealousy that finds its strongest support in research that employs a forced-choice hypothetical infidelity paradigm wherein participants imagine experiencing infidelity and choose whether sexual or emotional infidelity would be more distressing. Robust gender differences that support evolutionary psychological perspectives are consistently found using this paradigm, but recent work suggests that gender differences may be attenuated among actual infidelity victims. However, no research has used the forced-choice paradigm to compare real and hypothetical infidelity. This study uses this paradigm to compare reactions to imagined dating infidelity to those of infidelity victims. No gender differences are observed in response to the forced-choice question among victims of infidelity. Gender differences among participants who imagined infidelity are partially mediated by level of relationship power. Difficulties with the hypothetical forced-choice paradigm and implications for the evolutionary psychological theory of jealousy are discussed.