Abstract
Major depressive disorder (MDD) is among the leading causes of chronic disease and a major contributor to the global burden of mental illness. Although effective antidepressant medications are available, treatment resistance is a significant issue for patients. Cognitive behavioral therapy (CBT) is an evidence-based adjunctive or stand-alone psychological therapy for treatment-resistant depression (TRD). In addition to CBT, which has high demands on cognitive functioning, simpler approaches like behavioral activation (BA) are proven to be effective for depression. To overcome the scarcity of resources in routine care and the associated treatment gaps, the Internet is suggested for the provision of standardized programs to a broader range of patients. It could reduce barriers to seek help and improve the access to treatment. This chapter aims to provide an overview about the effectiveness and applications of CBT and BA.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psychiatr Sci. 2009;18:23–33.
World Health Organization. Depression and other common mental disorders: Global health estimates. Geneva; 2017.
American Psychiatric Association: diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.
Hetrick SE, Cox GR, Merry SN. Treatment-resistant depression in adolescents: is the addition of cognitive behavioral therapy of benefit? Psychol Res Behav Manag. 2011;4:97.
Al-Harbi KS. Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient Prefer Adherence. 2012;6:369.
Fava M. Diagnosis and definition of treatment-resistant depression. Biol Psychiatry. 2003;53:649–59.
Lépine J-P, Briley M. The increasing burden of depression. Neuropsychiatr Dis Treat. 2011;7:3.
Barth J, Munder T, Gerger H, Nüesch E, Trelle S, Znoj H, et al. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med. 2013;10:e1001454.
Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev. 2007;27:318–26.
Cuijpers P, Dekker JJ, Hollon SD, Andersson G. Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: a meta-analysis. J Clin Psychiatry. 2009;70:1219–29.
Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJH. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry. 2016;15:245–58.
Patel V, Maj M, Flisher AJ, Silva MJ, Koschorke M, Prince M, et al. Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry. 2010;9:169–76.
Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry. 2014;13:288–95.
Huguet A, Rao S, McGrath PJ, Wozney L, Wheaton M, Conrod J, et al. A systematic review of cognitive behavioral therapy and behavioral activation apps for depression. PLoS One. 2016;11:e0154248.
Donker T, Petrie K, Proudfoot J, Clarke J, Birch M-R, Christensen H. Smartphones for smarter delivery of mental health programs: a systematic review. J Med Internet Res. 2013;15:e247.
McMain S, Newman MG, Segal ZV, DeRubeis RJ. Cognitive behavioral therapy: current status and future research directions. Psychother Res. 2015;25:321–9.
Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res. 2012;36:427–40.
Beck AT. Thinking and depression: I. Idiosyncratic content and cognitive distortions. Arch Gen Psychiatry. 1963;9:324–33.
Beck AT. Cognitive therapy and the emotional disorders. New York, NY, USA, Penguin; 1979.
Beck AT. Thinking and depression: II. Theory and therapy. Arch Gen Psychiatry. 1964;10:561–71.
Beck AT. Cognitive therapy: nature and relation to behavior therapy. Behav Ther. 1970;1:184–200.
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. Chichester: Wiley; 1980.
Beck AT, Rush AJ, Shaw BF, Emery G. Kognitive Therapie der Depression. 5th ed. Weinheim: Beltz; 2017.
Rupke SJ, Blecke D, Renfrow M. Cognitive therapy for depression. Am Fam Physician. 2006;73:83–6.
Jacobson NS, Dobson KS, Truax PA, Addis ME, Koerner K, Gollan JK, et al. A component analysis of cognitive-behavioral treatment for depression. J Consult Clin Psychol. 1996;64:295–304.
Gortner ET, Gollan JK, Dobson KS, Jacobson NS. Cognitive-behavioral treatment for depression: relapse prevention. J Consult Clin Psychol. 1998;66:377.
Jacobson NS, Martell CR, Dimidjian S. Behavioral activation treatment for depression: returning to contextual roots. Clin Psychol. 2001;8:255–70.
Ekers DM, Dawson MS, Bailey E. Dissemination of behavioural activation for depression to mental health nurses: training evaluation and benchmarked clinical outcomes. J Psychiatr Ment Health Nurs. 2013;20:186–92.
Ferster CB. A functional analysis of depression. Am Psychol. 1973;28:857–70.
Lewinsohn PM, Graf M. Pleasant activities and depression. J Consult Clin Psychol. 1973;41:261.
Lejuez CW, Hopko DR, Acierno R, Daughters SB, Pagoto SL. Ten year revision of the brief behavioral activation treatment for depression: revised treatment manual. BMO. 2011;35:111–61.
Kanter JW, Manos RC, Bowe WM, Baruch DE, Busch AM, Rusch LC. What is behavioral activation?: a review of the empirical literature. Clin Psychol Rev. 2010;30:608–20.
Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26:17–31.
Cuijpers P, van Straten A, Schuurmans J, van Oppen P, Hollon SD, Andersson G. Psychotherapy for chronic major depression and dysthymia: a meta-analysis. Clin Psychol Rev. 2010;30:51–62.
Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13:56–67.
Hamilton KE, Dobson KS. Cognitive therapy of depression: pretreatment patient predictors of outcome. Clin Psychol Rev. 2002;22:875–93.
Hamill-Skoch S, Hicks P, Prieto-Hicks X. The use of cognitive behavioral therapy in the treatment of resistant depression in adolescents. Adolesc Health Med Ther. 2012;3:95.
Mazzucchelli T, Kane R, Rees C. Behavioral activation treatments for depression in adults: a meta-analysis and review. Clin Psychol. 2009;16:383–411.
Ekers D, Webster L, van Straten A, Cuijpers P, Richards D, Gilbody S. Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PLoS One. 2014;9:e100100.
Andrade LH, Alonso J, Mneimneh Z, Wells JE, Al-Hamzawi A, Borges G, et al. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med. 2014;44:1303–17.
Schröder J, Berger T, Westermann S, Klein JP, Moritz S. Internet interventions for depression: new developments. Dialogues Clin Neurosci. 2016;18:203.
Kvillemo P, Brandberg Y, Bränström R. Feasibility and outcomes of an internet-based mindfulness training program: a pilot randomized controlled trial. JMIR Ment Health. 2016;3:e33.
Spijkerman MP, Pots WT, Bohlmeijer ET. Effectiveness of online mindfulness-based interventions in improving mental health: a review and meta-analysis of randomised controlled trials. Clin Psychol Rev. 2016;45:102–14.
Donker T, Blankers M, Hedman E, Ljótsson B, Petrie K, Christensen H. Economic evaluations of internet interventions for mental health: a systematic review. Psychol Med. 2015;45:3357–76.
Schröder J, Sautier L, Kriston L, Berger T, Meyer B, Späth C, et al. Development of a questionnaire measuring attitudes towards psychological online interventions-the APOI. J Affect Disord. 2015;187:136–41.
Backhaus A, Agha Z, Maglione ML, Repp A, Ross B, Zuest D, et al. Videoconferencing psychotherapy: a systematic review. Psychol Serv. 2012;9:111.
Littlewood E, Duarte A, Hewitt C, Knowles S, Palmer S, Walker S, et al. A randomised controlled trial of computerised cognitive behaviour therapy for the treatment of depression in primary care: the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial. Health Technol Assess. 2015;19:1.
Meyer B, Berger T, Caspar F, Beevers GC, Andersson G, Weiss M. Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial. J Med Internet Res. 2009;11:e15.
Krieger T, Meyer B, Sude K, Urech A, Maercker A, Berger T. Evaluating an e-mental health program (“deprexis”) as adjunctive treatment tool in psychotherapy for depression: design of a pragmatic randomized controlled trial. BMC Psychiatry. 2014;14:285.
Shen N, Levitan M-J, Johnson A, Bender JL, Hamilton-Page M, Jadad AAR, et al. Finding a depression app: a review and content analysis of the depression app marketplace. JMIR Mhealth Uhealth. 2015;3:e16.
Dahne J, Lejuez CW, Kustanowitz J, Felton JW, Diaz VA, Player MS, et al. Moodivate: a self-help behavioral activation mobile app for utilization in primary care—development and clinical considerations. Int J Psychiatry Med. 2017;52:160–75.
Hedman E, Ljótsson B, Kaldo V, Hesser H, El Alaoui S, Kraepelien M, et al. Effectiveness of internet-based cognitive behaviour therapy for depression in routine psychiatric care. J Affect Disord. 2014;155:49–58.
Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32:329–42.
Arnberg FK, Linton SJ, Hultcrantz M, Heintz E, Jonsson U. Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PLoS One. 2014;9:e98118.
Karyotaki E, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, et al. Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: a meta-analysis of individual participant data. JAMA Psychiatry. 2017;74:351–9.
Foroushani PS, Schneider J, Assareh N. Meta-review of the effectiveness of computerised CBT in treating depression. BMC Psychiatry. 2011;11:131.
Twomey C, O’Reilly G. Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: meta-analysis. Aust N Z J Psychiatry. 2017;51:260–9.
Johansson R, Andersson G. Internet-based psychological treatments for depression. Expert Rev Neurother. 2012;12:861–970.
El Alaoui S, Ljótsson B, Hedman E, Svanborg C, Kaldo V, Lindefors N. Predicting outcome in internet-based cognitive behaviour therapy for major depression: a large cohort study of adult patients in routine psychiatric care. PLoS One. 2016;11:e0161191.
Burns MN, Begale M, Duffecy J, Gergle D, Karr CJ, Giangrande E, et al. Harnessing context sensing to develop a mobile intervention for depression. J Med Internet Res. 2011;13:e55.
Watts S, Mackenzie A, Thomas C, Griskaitis A, Mewton L, Williams A, et al. CBT for depression: a pilot RCT comparing mobile phone vs. computer. BMC Psychiatry. 2013;13:49.
Kauer SD, Reid SC, Crooke AHD, Khor A, Hearps SJC, Jorm AF, et al. Self-monitoring using mobile phones in the early stages of adolescent depression: Randomized controlled trial. J Med Internet Res. 2012;14:e67.
Reid SC, Kauer SD, Hearps SJC, Crooke AHD, Khor AS, Sanci LA, et al. A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial. BMC Fam Pract. 2011;12:131.
Bakker D, Kazantzis N, Rickwood D, Rickard N. Mental health smartphone apps: Review and evidence-based recommendations for future developments. JMIR Ment Health. 2016;3:e7.
Ly KH, Janni E, Wrede R, Sedem M, Donker T, Carlbring P, et al. Experiences of a guided smartphone-based behavioral activation therapy for depression: a qualitative study. Internet Interv. 2015;2:60–8.
Ly KH, Topooco N, Cederlund H, Wallin A, Bergström J, Molander O, et al. Smartphone-supported versus full behavioural activation for depression: a randomised controlled trial. PLoS One. 2015;10:e0126559.
Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010;5:e13196.
van Ballegooijen W, Cuijpers P, van Straten A, Karyotaki E, Andersson G, Smit JH, et al. Adherence to internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PLoS One. 2014;9:e100674.
Rost T, Stein J, Löbner M, Kersting A, Luck-Sikorski C, Riedel-Heller SG. User acceptance of computerized cognitive behavioral therapy for depression: systematic review. J Med Internet Res. 2017;19:e309.
Apolinário-Hagen J, Kemper J, Stürmer C. Public acceptability of E-mental health treatment services for psychological problems: a scoping review. JMIR Ment Health. 2017;4:e10.
Musiat P, Goldstone P, Tarrier N. Understanding the acceptability of e-mental health-attitudes and expectations towards computerised self-help treatments for mental health problems. BMC Psychiatry. 2014;14:109.
Hennemann S, Beutel ME, Zwerenz R. Drivers and barriers to acceptance of web-based aftercare of patients in inpatient routine care: a cross-sectional survey. J Med Internet Res. 2016;18:e337.
Ebert DD, Berking M, Cuijpers P, Lehr D, Pörtner M, Baumeister H. Increasing the acceptance of internet-based mental health interventions in primary care patients with depressive symptoms. A randomized controlled trial. J Affect Disord. 2015;176:9–17.
Lal S, Adair CE. E-mental health: a rapid review of the literature. Psychiatr Serv. 2014;65:24–32.
Topooco N, Riper H, Araya R, Berking M, Brunn M, Chevreul K, et al. Attitudes towards digital treatment for depression: a European stakeholder survey. Internet Interv. 2017;8:1–9. https://doi.org/10.1016/j.invent.2017.01.001.
Berger T. The therapeutic alliance in internet interventions: a narrative review and suggestions for future research. Psychother Res. 2017;27:511–24.
Sucala M, Schnur JB, Constantino MJ, Miller SJ, Brackman EH, Montgomery GH. The therapeutic relationship in e-therapy for mental health: a systematic review. J Med Internet Res. 2012;14:e110.
Apolinario-Hagen JA, Tasseit S. Access to psychotherapy in the era of web 2.0-new media, old inequalities?/Zugang zur Psychotherapie in der Ära des Web 2.0-Neue Medien, Alte Ungleichheiten? Int J Health Prof. 2015;2:119–29.
Arean PA, Hallgren KA, Jordan JT, Gazzaley A, Atkins DC, Heagerty PJ, et al. The use and effectiveness of mobile apps for depression: results from a fully remote clinical trial. J Med Internet Res. 2016;18:e330.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Apolinário-Hagen, J., Fritsche, L., Albers, L., Salewski, C. (2019). Cognitive Behavioral Therapy and Behavioral Activation Therapy for Treatment-Resistant Depression: Traditional and Digital Therapy Perspectives. In: Kim, YK. (eds) Treatment Resistance in Psychiatry. Springer, Singapore. https://doi.org/10.1007/978-981-10-4358-1_21
Download citation
DOI: https://doi.org/10.1007/978-981-10-4358-1_21
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-4357-4
Online ISBN: 978-981-10-4358-1
eBook Packages: MedicineMedicine (R0)