Evaluating the necessity of booster sessions in relapse prevention for depression: a longitudinal study

IntroductionMajor depression is a highly prevalent and heterogenous mental disorder. Although therapeutic advances for major depressive disorder over the past quarter-century have been incremental rather than transformative, booster sessions have been proposed as a means of solidifying acute treatme...

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Main Authors: Jón Ingi Hlynsson, Tómas Kristjánsson, Gerhard Andersson, Per Carlbring, the ACTUA research group
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-06-01
Series:Frontiers in Psychology
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Online Access:https://www.frontiersin.org/articles/10.3389/fpsyg.2025.1568141/full
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author Jón Ingi Hlynsson
Jón Ingi Hlynsson
Tómas Kristjánsson
Gerhard Andersson
Gerhard Andersson
Gerhard Andersson
Per Carlbring
Per Carlbring
the ACTUA research group
author_facet Jón Ingi Hlynsson
Jón Ingi Hlynsson
Tómas Kristjánsson
Gerhard Andersson
Gerhard Andersson
Gerhard Andersson
Per Carlbring
Per Carlbring
the ACTUA research group
author_sort Jón Ingi Hlynsson
collection DOAJ
description IntroductionMajor depression is a highly prevalent and heterogenous mental disorder. Although therapeutic advances for major depressive disorder over the past quarter-century have been incremental rather than transformative, booster sessions have been proposed as a means of solidifying acute treatment gains and lowering relapse risk. However, evidence for the effectiveness of these treatment booster sessions remains inconclusive. This study therefore evaluated the long-term effectiveness of relapse prevention treatment booster sessions for major depression.MethodIn a two-arm, parallel-group, maintenance-phase randomized controlled trial (RCT) with repeated longitudinal measures, the sample consisted of participants in Sweden who had received acute treatment for depression (internet-based behavioral activation or physical activity) and were then randomly assigned to either an 8-week relapse prevention program (n = 119) or control group (n = 143). Participants were followed-up for 24-months with both monthly self-report questionnaires (Patient Health Questionnaire 9-item & Generalized Anxiety Disorder 7-item) and quarterly diagnostic interviews (Mini-International Neuropsychiatric Interview; MINI).ResultsBoth the relapse prevention group and control group exhibited similar depression-free trends over the course of the study period, with over 95% of participants in each group maintaining remission at the 24-month follow-up. Furthermore, all pre-hypothesized predictors of relapse were non-significant in differentiating the two groups at 24-month follow-up.DiscussionThese findings raise the question of whether treatment booster sessions are uniformly advisable for all mild–moderate cases of depression. For instance, preferentially recommending treatment boosters for psychotherapy-naïve individuals with depression may yield greater effects compared to individuals with difficult-to-treat depression. Our findings indicate that the efficacy of behavioral activation and physical activity may be even greater than previously reported, a testament to the lasting effects of internet-based psychotherapy.Clinical trail registrationClinicalTrials.gov, identifier NCT01619930.
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spelling doaj-art-48446df318a94ccaa7d3daea9c38b56c2025-08-20T03:32:07ZengFrontiers Media S.A.Frontiers in Psychology1664-10782025-06-011610.3389/fpsyg.2025.15681411568141Evaluating the necessity of booster sessions in relapse prevention for depression: a longitudinal studyJón Ingi Hlynsson0Jón Ingi Hlynsson1Tómas Kristjánsson2Gerhard Andersson3Gerhard Andersson4Gerhard Andersson5Per Carlbring6Per Carlbring7the ACTUA research groupDepartment of Psychology, University of Iceland, Reykjavík, IcelandDepartment of Psychology, Stockholm University, Stockholm, SwedenDepartment of Psychology, University of Iceland, Reykjavík, IcelandDepartment of Behavioural Sciences and Learning, Linköping University, Linköping, SwedenDepartment of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Clinical Neuroscience, Karolinska Institute, Stockholm, SwedenDepartment of Psychology, Stockholm University, Stockholm, SwedenSchool of Psychology, Korea University, Seoul, Republic of KoreaIntroductionMajor depression is a highly prevalent and heterogenous mental disorder. Although therapeutic advances for major depressive disorder over the past quarter-century have been incremental rather than transformative, booster sessions have been proposed as a means of solidifying acute treatment gains and lowering relapse risk. However, evidence for the effectiveness of these treatment booster sessions remains inconclusive. This study therefore evaluated the long-term effectiveness of relapse prevention treatment booster sessions for major depression.MethodIn a two-arm, parallel-group, maintenance-phase randomized controlled trial (RCT) with repeated longitudinal measures, the sample consisted of participants in Sweden who had received acute treatment for depression (internet-based behavioral activation or physical activity) and were then randomly assigned to either an 8-week relapse prevention program (n = 119) or control group (n = 143). Participants were followed-up for 24-months with both monthly self-report questionnaires (Patient Health Questionnaire 9-item & Generalized Anxiety Disorder 7-item) and quarterly diagnostic interviews (Mini-International Neuropsychiatric Interview; MINI).ResultsBoth the relapse prevention group and control group exhibited similar depression-free trends over the course of the study period, with over 95% of participants in each group maintaining remission at the 24-month follow-up. Furthermore, all pre-hypothesized predictors of relapse were non-significant in differentiating the two groups at 24-month follow-up.DiscussionThese findings raise the question of whether treatment booster sessions are uniformly advisable for all mild–moderate cases of depression. For instance, preferentially recommending treatment boosters for psychotherapy-naïve individuals with depression may yield greater effects compared to individuals with difficult-to-treat depression. Our findings indicate that the efficacy of behavioral activation and physical activity may be even greater than previously reported, a testament to the lasting effects of internet-based psychotherapy.Clinical trail registrationClinicalTrials.gov, identifier NCT01619930.https://www.frontiersin.org/articles/10.3389/fpsyg.2025.1568141/fullmajor depressionbehavioral activationphysical activityrelapse preventiontreatment boostersurvival analysis
spellingShingle Jón Ingi Hlynsson
Jón Ingi Hlynsson
Tómas Kristjánsson
Gerhard Andersson
Gerhard Andersson
Gerhard Andersson
Per Carlbring
Per Carlbring
the ACTUA research group
Evaluating the necessity of booster sessions in relapse prevention for depression: a longitudinal study
Frontiers in Psychology
major depression
behavioral activation
physical activity
relapse prevention
treatment booster
survival analysis
title Evaluating the necessity of booster sessions in relapse prevention for depression: a longitudinal study
title_full Evaluating the necessity of booster sessions in relapse prevention for depression: a longitudinal study
title_fullStr Evaluating the necessity of booster sessions in relapse prevention for depression: a longitudinal study
title_full_unstemmed Evaluating the necessity of booster sessions in relapse prevention for depression: a longitudinal study
title_short Evaluating the necessity of booster sessions in relapse prevention for depression: a longitudinal study
title_sort evaluating the necessity of booster sessions in relapse prevention for depression a longitudinal study
topic major depression
behavioral activation
physical activity
relapse prevention
treatment booster
survival analysis
url https://www.frontiersin.org/articles/10.3389/fpsyg.2025.1568141/full
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