Dr. Kelly Rohan: Benefits & Limitations of CBT for SAD

Cognitive-behavioral therapy (CBT) is emerging as an effective treatment for SAD. But all SAD therapies, including CBT and bright light therapies, have limitations. The first study to compare the long-term benefits of 10,000 lux light therapy vs. Cognitive Behavioral therapy for Seasonal Affective Disorder (SAD) was published in the journal Behavior Therapy, September 2009. People receiving Cognitive Behavioral Therapy – a short term, focused, talk-therapy – fared very well, making it a promising new treatment for seasonal depression. But not everyone benefits.

Photo by Cesstrelle, Morguefile.com

According to Dr. Rohan: There is no need to spend 5 out of every 12 months (40% of each year) struggling with symptoms of winter depression. Effective treatment options are available. Photo by Cesstrelle, Morguefile.com

Dr. Kelly Rohan, the study’s author, corresponded with this writer about the benefits and limitations of CBT for SAD.

LD: What is the percentage of people who do not get relief from CBT?

KR: “About half of SAD patients will NOT have a full remission across treatment—either with 10,000 lux light therapy (across studies) or with CBT (in our prior studies). Remission sets the bar high—it is feeling at the end of treatment almost as good as one feels when non-depressed, meaning in the summertime for SAD patients.”

Why SAD Treatment Doesn’t Always Work

LD: So even though half the people may not achieve full remission, they may still be getting some significant benefit from the CBT. Do you have any feeling as to why some people don’t achieve full remission of their depressive symptoms?

KR: “We do not have data on why some people do not remit with CBT for SAD. I can only hypothesize. It is my impression that participants who attend all 12 sessions and fully do their “homework” assignments between CBT sessions do the best. I also think they have to be open-minded enough to truly try the CBT for SAD treatment instead of reasoning, “This will not be helpful because I have no control over my SAD symptoms. This is a biological problem, and I just need more light to fix it.”

Lack of Light is Not the Only Cause of Seasonal Depression Symptoms

LD: So all of the successes with CBT, including your study, seem to show that even if the depression is a biological problem, people can override it by changing the way they think and act, an important thing to know.

KR: “CBT for SAD is the only evidence-based psychotherapy treatment for SAD to date.”

LD: Is there any other information in particular that you would like people to know?

Around half of people with SAD can achieve full remission from this treatment. Others may get relief from their symptoms, even if they are not fully cured.

KR: “The average SAD-related depressive episode persists for 5 consecutive months before spontaneous springtime remission. In my clinical experience, most individuals with SAD that I see have waited several years before seeking treatment for the first time. There is no need to spend 5 out of every 12 months (40% of each year) struggling with these symptoms. Effective treatment options are available.

“Because depression, including SAD, is a potentially serious mental health problem and can be challenging to diagnose accurately, I strongly discourage self-diagnosis and self-treatment. If you think you might have SAD, talk to your doctor about having your symptoms evaluated by a qualified professional. And if you think you have a seasonal pattern to your symptoms, do not wait until you are in the depths of a clinical depression to do so.”

CBT for SAD is the only proven talk therapy treatment for Seasonal Depression. Around half of people with SAD can achieve full remission from this treatment. Others may get relief from their symptoms, even if they are not fully cured. Even people with a biologically-caused depression can improve or eliminate their symptoms with talk therapy that helps people change their thoughts and behavior.

Click to read Part One and Part Two of this interview with Dr. Rohan

Click here to read about 10,000 lux light therapy for SAD

©Lisa C. DeLuca, all rights reserved.  It is a violation of copyright law to reproduce this work on the web or for business use without permission from the author. This article was originally published on the web on Jan 14, 2010. Please contact the author with your reprint request.

This article is for general information only and is not a substitute for personal medical or mental health advice. If you are experiencing troubling symptoms please seek the advice of a medical or mental health professional in person. 

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