COGNITIVE BEHAVIORAL THREAPY FOR SEASONAL AFFECTIVE DISORDER

Cognitive Behavioral Therapy for

Seasonal Affective Disorder
Versus Light Therapy
Trisha L. Jones
Jackson College

COGNITIVE BEHAVIORAL THREAPY FOR SEASONAL AFFECTIVE DISORDER

1.For women aged 19 to 40 years old, living in the northern hemisphere who are diagnosed with
mild to moderate symptoms of seasonal affective disorder (SAD), what are the treatment
outcomes of cognitive behavioral therapy compared with individuals treated with light therapy
over a twelve-month period?
2.This is a therapy question/statement
3.The best evidence to answer a therapy PICOT question is evidence that uses RCT, controlled
trials and systematic reviews. The evidence should be up to date and credible.
4.I Used CINAHL database to for my first search. First terms: Seasonal Affective Disorder,
which resulted in 563 findings. My second advanced search was light therapy, which narrowed
my results to 197 articles. My last advanced search included Cognitive behavioral therapy, which
yielded zero results. I searched Medline and found two articles and an article from PSA. Overall,
there was not much current information.
5.I found 1 Systematic Review, 1 RCT (well designed)
6.Medium evidence found supporting CBT as an alternative treatment. Results showed the use of
CBT for SAD treatment was more effective over a longer period of time versus light therapy.
More research is needed as only one study has been completed to date.
7.See attached articles
8.SAD is acknowledged as a form of depression that reoccurs on an annual basis, with the
majority of the affected population experiencing depressive symptoms from reduced sunlight,
starting in the fall, with full remission in spring and summer (Farinde, 2014). This condition is

COGNITIVE BEHAVIORAL THREAPY FOR SEASONAL AFFECTIVE DISORDER

found to be more prevalent in females versus males (4:1), with a decline observed in older adults.
The defining characteristics of SAD are noted to be symptoms of hypersomnia, increased
appetite with weight gain and craving of carbohydrates (Farinde, 2014). In addition to the
defining characteristics, individuals with SAD also experience depressive symptoms such as
difficulty concentrating, a loss of interest or pleasure in activities, a marked change in sleep
pattern and exploring thoughts about death or suicide (Rohan, 2013).
There are several different theories regarding the etiology and pathophysiology of this cyclic
disorder, which makes it complex. The majority of the current treatment is based on the
hypothesis of circadian phase shifting and neurotransmitter dysfunction. With light therapy being
the first-line for short-term treatment, followed by antidepressant medication (Farinde, 2014).
Both of these treatments have proven to have a list of side effects with the patient experiencing a
relapse with discontinuation.
CBT is a form of psychotherapy. An individual attends structured sessions with a therapist to
help them become aware of inaccurate or negative thinking. The goal is for the individual to
view challenging situations in a different light and respond to them in a more effective way.
The results of my research indicated that CBT could be a viable alternative in the management of
SAD in acute episodes but more importantly used as long-term tool to reduce the episodes of
recurrence instead of suppressing the symptoms with just using light therapy alone. A study done
by SAD expert Dr. Kelly Rohan over a 2-year span of time, produced results that favor CBT for
long-term outcomes versus light therapy. Her research team randomly assigned 177 adults who
had major depression that was recurrent with a seasonal pattern to 6 weeks of CBT-SAD or light
therapy and followed them for 2 winters, according to the article (Davenport, 2015). The results
the first year showed no significant difference between the two therapies, at 12.3% for CBT and

COGNITIVE BEHAVIORAL THREAPY FOR SEASONAL AFFECTIVE DISORDER

21.1% for light therapy (Davenport, 2015). The results from the second winter proved that CBT
was responsible for a marked reduction in SAD recurrences versus light therapy, at 27.3% vs
45.6% and a reduction of severe symptoms (Davenport, 2015).
My PICOT question was partially answered by the current research. CBT therapy was proven to
be an effective form of treatment for SAD versus light therapy for long term use and
management. The study and results were not gender specific so the population of my question
did not match the results. Also the time frame in which the study was not congruent with my
question. There was not a lot of research surrounding CBT for SAD which indicates a further
need for research regarding this treatment.
9.The next steps I would take after having completed this research as a nurse would be to educate
my patients on this alternative treatment as either a sole form of therapy for mild symptoms or as
an option for an adjunct therapy for patients who either cannot tolerate light therapy or
antidepressants or who are not responding to their current treatment plan. I think it might be a
difficult task to get someone who is experiencing depressive symptoms to show up and complete
this form of treatment as it takes realization and work on the patients part in order for it to be
effective. I think in todays society we have expect a quick fix when it comes to medicine and
being treated for an illness and would rather take a pill to mask symptoms then to really explore
other forms of treatment.
My question was partially answered but the support of it was medium when critiquing results.
The study that was been completed yielded results in favor of my question and was reputable and
performed by a SAD expert, however, I feel like more research would be needed to solidify its
effectiveness for treating SAD. I think it would be beneficial to explore this treatment with
different age groups as well as focusing on this treatment used for prevention of SAD.

COGNITIVE BEHAVIORAL THREAPY FOR SEASONAL AFFECTIVE DISORDER

References
Davenport, L. (2015, November 17). CBT may trump Light Therapy for SAD in the long run.
Medscape. Retrieved fromhttp://www.medscape.com/viewarticle/854590
Farinde, A. (2014, October 24). Seasonal affective disorder: Established treatments and new therapies.
Pharmacy Times. Retrieved from http://www.apa.org/news/press/releases/2013/02/seasonaldisorder.aspx
Rohan, K. (2013, February 4). Seasonal affective disorder suffers have more than just winter blues.
American Psychological Association. Retrieved from
http://www.apa.org/news/press/releases/2013/02/seasonal-disorder.aspx