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Winter Blues: Let's Talk

Talk therapy may be an effective alternative for seasonal affective disorder.

Sally, a Los Angeles native who recently had moved to the East Coast, was not amused when she received a chirpy text message from a friend in California claiming that she had just fit into a pair of size four jeans. Instead, Sally's usually upbeat persona took a turn for the worst: her first experience with a real winter season was accompanied by fatigue, excessive sleep, feelings of depression, and, of course, weight gain—she couldn't help herself from eating that second portion of pasta at dinnertime.

Sally may have seasonal affective disorder (SAD), known to us as the winter blues. Symptoms include sleepiness, social withdrawal, and cravings for sugary and starchy foods. SAD more often affects women than men, and tends to occur in geographically northern regions. Researchers have found that college students who move from the southern states to northern New England are more likely to experience winter depression. They believe it's caused by the season's shorter daylight hours, which can throw off the body's clock.

A common treatment for SAD is light therapy, which involves sitting in front of a specially designed light box for at least half an hour per day. But psychologist Kelly Rohan, at the University of Vermont, is pioneering a specially tailored method of treating SAD that uses cognitive-behavioral therapy. Also known as talk therapy, CBT is used to treat everything from relationship issues to clinical depression.

Rohan's method involves twelve 90-minute therapy sessions, which she describes as "identifying, challenging, and changing negative thoughts" associated with depressed mood. Participants write down their negative thoughts, and explore the evidence for and against these thoughts by assessing their accuracy with a therapist. Finally, patients reframe these depressive thoughts in a more positive and realistic light. For example, the phrase "I hate winter" might be replaced by a less negative "I prefer summer to winter."

The second part of Rohan's method involves the engagement of personally enjoyable activities, from photography to woodworking, anything to keep up a happier mood.

"For example, we treated a painter who had abandoned her artwork. She now uses winter as a time to get back into her painting, and has come to find it as a very productive time," Rohan said. In fact participating in wintertime activities like skiing or ice-skating, she adds, can help SAD sufferers form positive associations with this time of year.

Preliminary results show that, in the long term, Rohan's approach to treating SAD may be more effective than light therapy. The reason: People may be more likely to continue the activities they enjoy throughout the winter season, while they may not devote a half hour in front of a light box every day. They also learn to identify and anticipate negative thoughts before the winter season arrives.

"We think the patients learn the skills to fortify themselves against a future recurrence of their depression. They learn how to behave more proactively, and become engaged and interested in activities at a time when they would generally be feeling depressed," Rohan says.

Rohan's method is still under study. But if proven effective, it will follow the heels of FDA-approval of the antidepressant Wellbutrin for SAD. Rohan does not dismiss the antidepressant's possible efficacy. Teodor Postolache, at the University of Maryland School of Medicine, agrees. It's really up to the patients to decide what works best for them. "Some people find it easy to take one pill a day and difficult to go to therapy," he says, "while other people find therapy interesting, and gain a lot from it."