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dc.contributor.authorRohan, Kelly J
dc.contributor.authorFranzen, Peter L
dc.contributor.authorRoeckelin, Kathryn A
dc.contributor.authorSiegle, Greg J
dc.contributor.authorKolko, David J
dc.contributor.authorPostolache, Teodor T
dc.contributor.authorVacek, Pamela M
dc.date.accessioned2022-05-17T13:21:11Z
dc.date.available2022-05-17T13:21:11Z
dc.date.issued2022-05-12
dc.identifier.urihttp://hdl.handle.net/10713/18875
dc.description.abstractBackground: This study is a confirmatory efficacy trial of two treatments for winter seasonal affective disorder (SAD): SAD-tailored group cognitive-behavioral therapy (CBT-SAD) and light therapy (LT). In our previous efficacy trial, post-treatment outcomes for CBT-SAD and LT were very similar, but CBT-SAD was associated with fewer depression recurrences two winters later than LT (27.3% in CBT-SAD vs. 45.6% in LT). CBT-SAD engaged and altered a specific mechanism of action, seasonal beliefs, which mediated CBT-SAD's acute antidepressant effects and CBT-SAD's enduring benefit over LT. Seasonal beliefs are theoretically distinct from LT's assumed target and mechanism: correction of circadian phase. This study applies the experimental therapeutics approach to determine how each treatment works when it is effective and to identify the best candidates for each. Biomarkers of LT's target and effect include circadian phase angle difference and the post-illumination pupil response. Biomarkers of CBT-SAD's target and effect include decreased pupillary and sustained frontal gamma-band EEG responses to seasonal words, which are hypothesized as biomarkers of seasonal beliefs, reflecting less engagement with seasonal stimuli following CBT-SAD. In addition to determining change mechanisms, this study tests the efficacy of a "switch" decision rule upon recurrence to inform clinical decision-making in practice. Methods: Adults with SAD (target N = 160) will be randomzied to 6-weeks of CBT-SAD or LT in winter 1; followed in winter 2; and, if a depression recurrence occurs, offered cross-over into the alternate treatment (i.e., switch from LT➔CBT-SAD or CBT-SAD➔LT). All subjects will be followed in winter 3. Biomarker assessments occur at pre-, mid-, and post-treatment in winter 1, at winter 2 follow-up (and again at mid-/post-treatment for those crossed-over), and at winter 3 follow-up. Primary efficacy analyses will test superiority of CBT-SAD over LT on depression recurrence status (the primary outcome). Mediation analyses will use parallel process latent growth curve modeling. Discussion: Consistent with the National Institute of Mental Health's priorities for demonstrating target engagement at the level of Research Domain Criteria-relevant biomarkers, this work aims to confirm the targets and mechanisms of LT and CBT-SAD to maximize the impact of future dissemination efforts. Trial registration: ClinicalTrials.gov identifier: NCT03691792 . Registered on October 2, 2018.en_US
dc.description.urihttps://doi.org/10.1186/s13063-022-06330-9en_US
dc.language.isoenen_US
dc.publisherSpringer Natureen_US
dc.relation.ispartofTrialsen_US
dc.rights© 2022. The Author(s).en_US
dc.subjectBiomarkersen_US
dc.subjectCognitive-behavioral therapyen_US
dc.subjectDepression recurrenceen_US
dc.subjectExperimental therapeuticsen_US
dc.subjectLight therapyen_US
dc.subjectMediationen_US
dc.subjectRandomized clinical trialen_US
dc.subjectSeasonal affective disorderen_US
dc.titleElucidating treatment targets and mediators within a confirmatory efficacy trial: study protocol for a randomized controlled trial of cognitive-behavioral therapy vs. light therapy for winter depression.en_US
dc.typeArticleen_US
dc.identifier.doi10.1186/s13063-022-06330-9
dc.identifier.pmid35550645
dc.source.journaltitleTrials
dc.source.volume23
dc.source.issue1
dc.source.beginpage383
dc.source.endpage
dc.source.countryUnited States
dc.source.countryEngland


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