title: Behavioral activation therapy for return to work in medication-responsive chronic depression with persistent psychosocial dysfunction.
abstract: OBJECTIVE
  Chronic depression is associated with significant impairment in work functioning, relationships, and health. Such impairment often persists following medication-induced remission of depressive symptoms. We adapted and tested Behavioral Activation therapy with a goal of return to work (BA-W) in subjects with chronic depression who had responded to medication treatment but remained unemployed.
  
  
  METHODS
  Sixteen adults aged 18-65 with DSM-IV diagnosed Dysthymic Disorder or chronic Major Depression were recruited from clinical trials taking place at the New York State Psychiatric Institute between 4/2009 and 12/2012 and enrolled in 12 weeks of individual manual-driven BA-W. Functioning was measured at intake, post-treatment and at 24 week follow-up.
  
  
  RESULTS
  Eighty-seven percent (n=14) of subjects completed the full 12 weeks of BA-W. Hours of work related activity (p<.005, d=0.83), hours of paid work (p<.0003, d=0.54), and work productivity (p<.0004, d=-0.48) increased significantly over the study period. Earned income increased post-treatment (p=.068) with significant changes by 24 week follow-up (p=.011). Secondary outcomes including behavioral avoidance (p<.004, d=-0.56), and global functioning (p<.0003, d=1.42) were also significantly improved post-treatment. Effect sizes, including for outcomes with non-significant changes, were generally in the range of 0.5-0.8.
  
  
  CONCLUSIONS
  This pilot study provides preliminary evidence of the efficacy of a work-targeted psychotherapy to remediate vocational impairment in subjects with chronic depression. Data suggests that further testing of BA-W using a randomized controlled trial is warranted and may represent a significant advance in treatment for the residual disability present after successful pharmacotherapy.
authors.affiliation: New York State Psychiatric Institute, New York, NY; Columbia University College of Physicians and Surgeons, New York, NY. Electronic address: hellers@nyspi.columbia.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hellerstein
authors.affiliation: New York State Psychiatric Institute, New York, NY; University of Chicago, School of Social Services Administration, Chicago, IL.
authors.forename: Greg
authors.initials: G
authors.lastname: Erickson
authors.affiliation: New York State Psychiatric Institute, New York, NY; Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Stewart
authors.affiliation: New York State Psychiatric Institute, New York, NY; Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McGrath
authors.affiliation: Northwestern University Department of Psychiatry and Behavioral Sciences, Chicago, IL.
authors.forename: Kallio
authors.initials: K
authors.lastname: Hunnicutt-Ferguson
authors.affiliation: Behavioral Consultants of Westchester, White Plains, NY.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Reynolds
authors.affiliation: New York State Psychiatric Institute, New York, NY; Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Donna
authors.initials: D
authors.lastname: O'Shea
authors.affiliation: New York State Psychiatric Institute, New York, NY; Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
authors.affiliation: New York State Psychiatric Institute, New York, NY.
authors.forename: Amy
authors.initials: A
authors.lastname: Withers
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Yuanjia
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods*; D002908:Chronic Disease; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004526:Efficiency; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009788:Occupational Therapy / Q000379:methods*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D062707:Return to Work / Q000523:psychology*; D012920:Social Behavior Disorders / Q000188:drug therapy* / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents