Efficacy of Trial-Based Cognitive Therapy and Behavioral Activation in Treatment of Depression

Study Overview
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Brief Summary
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Major Depressive Disorder (MDD) is a mood disorder, highly prevalent in Brazil and in world. The treatments of choice are the psychotropic drugs of the class of antidepressants and Behavioral or Cognitive Behavior Therapy (CBT). The aim of this study is to compare the efficacy of Trial Based Cognitive Therapy with the Behavioral Activation and pharmacotherapy in the treatment of MDD in a randomized clinical trial witch 96 patients with MDD,

Detailed Description
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Major Depressive Disorder (MDD) is a mood disorder, highly prevalent in Brazil and in world. MDD is associated with an impaired quality of life and socio occupational functions. The treatments of choice are the psychotropic drugs of the class of antidepressants and Cognitive Behavior Therapy (CBT). Some of the patients with pharmacotherapy alone still symptomatic. This explains the association between psychotherapy and pharmacotherapy. The CBT seek to modify thoughts, emotions and behaviors and have shown efficacy in several mental disorders, including MDD. Among the CBT models, there is an emphasis on interventions that emphasize: 1) the modification or restructuring of thoughts and beliefs. In this point, the Trial based cognitive Therapy (TBCP) is an approach with a particular emphasis on the modification of core beliefs ; 2) the direct modification of behavior, such as the behavioral activation (BA) that analyzes contingencies and encourages the implementation of activities to improve mood. This project aims to compare the efficacy of TBCP with the BA in the treatment of MDD. For this, a randomized clinical trial will be conducted to treat 96 patients with MDD who are in drug treatment, which will be drawn to the interventions of TBCP most psychiatric drugs, BA more psychiatric drugs or pharmacotherapy alone, each group with 32 patients. Patients will be evaluated with scales and inventories to assess depression, quality of life and social functioning, and the data will be statistically compared between groups.

Official Title
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Efficacy of Trial-based Cognitive Therapy and Behavioral Activation in Treatment of Depression: a Randomized Clinical Trial

Conditions
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Major Depressive Disorder

Intervention / Treatment
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* Behavioral: Trial based cognitive therapy
* Behavioral: Behavioral Activation
* Drug: Antidepressants


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Major Depressive Disorder Both Genres Minimum of 20 in BDI Score Refractory depressive disorder Exclusion Criteria: Bipolar disorder High risk of suicide Borderline personality

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cognitive therapy<br>Major depressive disorder treated with cognitive therapy (Trial Based Cognitive Therapy plus Drug). | Behavioral: Trial based cognitive therapy<br>* Patients with MDD, in use of antidepressants plus Trial Based Cognitive Therapy<br>* Other names: TBCT;|
| Experimental: Behavioral Therapy<br>Major depressive disorder treated with behavioral therapy (Behavioral Activation plus drug). | Behavioral: Behavioral Activation<br>* Patients with MDD, in use of antidepressants plus Behavioral Activation<br>* Other names: BA;|
| Other: Antidepressants<br>Major depressive disorder treated only with antidepressants (Drug alone). | Drug: Antidepressants<br>* Patients with MDD, in use of antidepressants (fluoxetine, citalopram, escitalopram, bupropion, etc.) without psychotherapy.<br>* Other names: Pharmacotherapy, Control;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Severity of Depression | Change from baseline in severity of depression at twelve weeks. Scale used is Beck Depression Inventory (BDI). | Twelve weeks (three months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| WHOQoL | Change from baseline in quality of life at twelve weeks. The scale used is World Health Organization Quality-of-Life Scale (WHOQoL-brief) | Twelve weeks (three months). | 
| WHOQoL | Change from baseline in quality of life at one year (follow-up). The scale used is World WHOQoL-brief. | One year. | 
| Cognitive Distortions | Change from baseline in Cognitive Distortions at twelve weeks. The scale used is Cognitive Distortions Questionnaire (CD-Quest). | Twelve weeks (Three months). | 
| Cognitive Distortions | Change from baseline in Cognitive Distortions at one years (follow-up). The scale used is CD-Quest. | One year. | 
| Disability | Change from baseline in Disability at twelve weeks). The scale used is Sheehan Disability Scale. | twelve weeks. | 
| Disability | Change from baseline in Disability at one year (follow-up). The scale used is Sheehan Disability Scale.. | One year. | 
| Severity of Depression (BDI) | Change from baseline in Disability at one year (follow-up). Scale used is BDI. | One year. | 
| Severity of Depression | Change from baseline in severity of depression at one year (follow-up). Scale used is Hamilton Rating Scale for Depression (HRSD). | One year. | 
| Severity of Depression (HRSD) | Change from baseline in severity of depression at twelve weeks. Scale used is HRSD. | Twelve weeks. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Major depressive disorder, Cognitive behavioral therapy, Trial based cognitive therapy, Behavioral activation