Well-Being Therapy. G.A. Fava

20], and therefore may result in more effective cognitive restructuring. These results also lend support to our hypothesis that WBT provides something that CBT alone does not possess.

      Addressing Cyclothymic Disorder

      Until then we had conceptualized WBT essentially as a tool for increasing psychological well-being in people who had impaired levels. But in my clinical practice I had observed patients in whom these psychological dimensions were exaggerated or unrealistic, whose environmental mastery, for instance, led them to take too many challenges and to be under very stressful situations. Was the role of WBT simply that of a well-being enhancer or could it also serve a stabilizing function?

We thus decided to apply WBT to treatment of cyclothymic disorder, which involves mild or moderate fluctuations of mood, thought, and behavior without meeting formal diagnostic criteria for either major depressive disorder or mania [21]. It is a common and disabling condition that does not attract much research attention since no drugs have been patented for its treatment. Sixty-two patients with cyclothymic disorder were randomly assigned to the sequential combination of CBT and WBT or clinical management. An independent blind evaluator assessed the patients before treatment, after therapy, and at 1 - and 2-year followups. The CID [2] and the Mania Scale developed by Per Bech and his collaborators [22] were used to evaluate symptoms. After treatment, a significant difference was found in outcome measures, with greater improvements in the CBT/WBT group compared to clinical management. Therapeutic gains were maintained at the 1- and 2-year follow-ups [21]. The results thus indicate that WBT may address both polarities of mood swings and comorbid anxiety, and may yield significant and lasting benefits in cyclothymic disorder.

      What Is the Role of Well-Being Therapy?

The studies that are summarized in this chapter and other investigations that are going to be discussed later in this book indicate that WBT's potential role was broader than originally assumed (improving the risk of relapse in the residual phase of mood and anxiety disorders). Developing the protocols for these studies and using WBT in clinical practice paved the way for a refinement of the original formulation of WBT [5]. With the contribution of Elena Tomba, a first modification was offered in 2009 [23]. Further input came when a leading figure of American CBT, Jesse H. Wright, started using WBT [24]. In Part II of this book, I will describe how WBT can actually be implemented in clinical practice. After a chapter on clinical evaluation, the 8-session program will be described. Such a format, when needed, can be extended to 12 or more sessions or abridged to 4 sessions if preceded by CBT.

      References

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12 Frank JD, Frank B: Persuasion and Healing. Baltimore, Johns Hopkins University Press, 1991.

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15 Stangier U, Hilling C, Heidenreich T, Risch AK, Barocka A, Schlösser R, Kronfeld K, Ruckes C, Berger H, Röschke J, Weck F, Volk S, Hambrecht M, Serfling R, Erkwoh R, Stirn A, Sobanski T, Hautzinger M: Maintenance cognitive-behavioral therapy and manualized psychoeducation in the treatment of recurrent depression: a multicenter prospective randomized controlled trial. Am J Psychiatry 2013;170:624-632.

16 Kennard BD, Emslie GJ, Mayes TL, Nakonezny PA, Jones JM, Foxwell AA, King J: Sequential treatment with fluoxetine and relapse-prevention CBT to improve outcomes in pediatric depression. Am J Psychiatry 2014;171:1083-1090.

17 Offidani E, Fava GA, Sonino N: Iatrogenic comorbidity in childhood and adolescence: new insights from the use of antidepressant drugs. CNS Drugs 2014;28:769-774.

18 Moeenizadeh M, Salagame KKK: The impact of well-being therapy on symptoms of depression. Int J Psychol Stud 2010;2:223-230.

19 Fava GA, Ruini C, Rafanelli C, Finos L, Salmaso L, Mangelli L, Sirigatti S: Well-being therapy of generalized anxiety disorder. Psychother Psychosom 2005;74:26-30.

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