Researching why behavioural therapy for depression works better for some than others

The interplay of emotions and self-focused thoughts in daily life can trigger depressive episodes for those who suffer from depression. When self-focused thoughts arise without intention, awareness, or cognitive processing, there is a higher likelihood of distress intensifying, which can both trigger and sustain a depressive episode.

“The question arises whether psychological treatment, in this case, behavioural activation therapy, affects this relationship between emotions and daily thoughts, and if it might explain how well or poorly therapy works for people suffering from ongoing depression,” says Ragnar Pétur Ólafsson, professor and head of the Faculty of Psychology at the University of Iceland. He is currently leading a study on cognitive vulnerability factors for depression. This is a three-year research project funded by The Icelandic Centre for Research (Rannís) titled “Behavioural Therapy for Ongoing Depression: The Interaction of Vulnerability Factors and Treatment Outcomes.”

Childhood trauma has an impact

The study aims to examine whether cognitive vulnerability factors for depression are habitual and whether they can change through behavioural therapy or predict its success during an ongoing depressive episode. When asked about the inspiration for the study, Ragnar says that the project builds on a previous research project that concluded about two years ago and was also supported by The Icelandic Centre for Research. “In that project, we examined the relationship between daily emotional fluctuations and self-focused thoughts, including among people who had recovered from recurrent depressive episodes, and explored whether preventative therapy influenced this interaction,” Ragnar explains. That project revealed that a history of trauma before the age of 17 affected emotional fluctuations and self-focused thoughts, and other studies Ragnar has worked on suggest that cognitive control also plays a role. These factors are therefore also assessed and measured in the current research project Ragnar is leading.

Up to 130 people offered therapy

The study will involve offering behavioural therapy to individuals suffering from depression, with the research team aiming to provide treatment for up to 130 individuals. Measurements will be taken before, during, and after the therapy to examine its effects on well-being and cognitive factors. A variety of measurement methods will be used, including interviews, questionnaires, neuropsychological tests, and other tasks, along with daily self-reports through participants’ smartphones to gather data useful to the research. “This way, we can attempt to gather information on both more stable factors as well as fluctuations that occur day-to-day, or even from one moment to the next within the same day,” Ragnar explains. He anticipates that the therapy will benefit many participants: “It will be interesting to obtain information about how the therapy works and why it is more effective for some than others.”

A large and international research team

In addition to Ragnar, the study is co-led by Ívar Snorrason, psychologist and lecturer at Massachusetts General Hospital, Harvard Medical School in the U.S., and Igor Marchetti, associate professor at the University of Trieste in Italy, along with Sigurður Viðar, a PhD student at the Faculty of Psychology at the University of Iceland. Co-researchers include Dr. Kristján Helgi Hjartarson, psychologist at The Icelandic Centre for Treatment of Anxiety Disorders (KMS), and Josip Razum, a post-doctoral researcher at the Faculty of Psychology at the University of Iceland. The research team is also working with Christopher Martell, who leads psychological services at the University of Massachusetts in the U.S. and is one of the pioneers of this behavioural therapy globally. He oversees the supervision of clinical psychology master’s students who participate in the project as co-investigators and therapists. “Without them, the study wouldn’t be possible. The project has created an important opportunity for students to receive training in clinical psychology. Their research work also makes for good preparation for their future careers as psychologists, which are just around the corner after graduation,” Ragnar says about the large and international research team.

Findings could reveal why treatment is effective

The results of the study are not yet available, but as mentioned earlier, data collection has begun. Ragnar expects that the research will yield valuable information with both social and scientific significance. “First and foremost, we will offer up to 130 people suffering from depression free treatment through individual therapy sessions. Waiting lists for such services are long and psychological treatment in private clinics can often be costly. As a result of this project, many people who suffer from depression will have easier access to care and receive it sooner than they otherwise would have.”

It is well known that both behavioural therapy and cognitive-behavioural therapy can be highly beneficial for people suffering from depression, but much less is known about who benefits most from these treatments and why they are successful when they work well. “The research findings may provide important insights into this, helping to make the referral process for treatment options more targeted, which could improve therapy outcomes. Information about which processes change during effective therapy can also be used to modify treatments to further enhance success. The findings will also have scientific value when it comes to theories on vulnerability factors and maintaining mechanisms in severe depression,” Ragnar concludes.