Depression
Beevers, C. G., Scott, W. D., McGeary, C., & McGeary, J. E. (2008). Negative cognitive response to a sad mood induction: Associations with polymorphisms of the serotonin transporter (5-HTTLPR) gene.. Cognition and Emotion , 1-13.
Correspondence Address:
Christopher G. Beevers, Ph.D., Department of Psychology, University of Texas at Austin, 1 University Station, A8000, Austin, TX 78712, USA. E-mail: beevers@psy.utexas.edu.
Key Finding: Non-depressed college students with the ss polymorphism of the serotonin transporter (5-HTTLPR) gene showed a more negative cognitive response to a sad mood induction than those with the ll polymorphism.
Bockting, C. L. H., Schene, A. H., Spinhoven, P., Koeter, M. W. J., Wouters, L. F., Huyser, J. & Kamphuis, J. H. (2005). Preventing relapse/recurrence in recurrent depression with cognitive therapy: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 73, 647-657.
Correspondence Address:
Claudi L. H. Bockting, Academic Medical Center of the University of Amsterdam, Psychiatric Center, P2-221 Tafelbergweg 25, Amsterdam, Netherlands, 1105 BC, c.l.bockting@amc.uva.nl.
Abstract
This article reports on the outcome of a randomized controlled trial of cognitive group therapy (CT) to prevent relapse/recurrence in a group of high-risk patients diagnosed with recurrent depression. Recurrently depressed patients (N = 187) currently in remission following various types of treatment were randomized to treatment as usual, including continuation of pharmacotherapy, or to treatment as usual augmented with brief CT. Relapse/recurrence to major depression was assessed over 2 years. Augmenting treatment as usual with CT resulted in a significant protective effect, which intensified with the number of previous depressive episodes experienced. For patients with 5 or more previous episodes (41% of the sample), CT reduced relapse/recurrence from 72% to 46%. Our findings extend the accumulating evidence that cognitive interventions following remission can be useful in preventing relapse/recurrence in patients with recurrent depression. (PsycINFO Database Record (c) 2005 APA, all rights reserved)
Carson, Ri. C., Hollon, S. D., Shelton, R. C. (2009). Depressive realism and clinical depression. Behaviour Research and Therapy, in press.
Correspondence Address:
Steven D. Hollon. Ph.D., Department of Psychology, Vanderbilt University, 306 Wilson Hall, Nashville, Tennessee 37240 USA
steven.d.hollon@vanderbilt.edu.
Abstract
Depressive realism suggests that depressed individuals make more accurate judgments of control than their nondepressed counterparts. However, most studies demonstrating this phenomenon were conducted in nonclinical samples. In this study, psychiatric patients who met criteria for major depressive disorder underestimated control in a contingent situation and were consistently more negative in their judgments than were nondepressed controls. Depressed patients were less likely than their nondepressed counterparts to overestimate control in a noncontingent situation, but largely because they perceived receiving less reinforcement. Depressed patients were no more likely to use the appropriate logical heuristic to generate their judgments of control than their nondepressed counterparts and each appeared to rely on different primitive heuristics. Depressed patients were consistently more negative than their nondepressed counterparts and when they did appear to be more “accurate” in their judgments of control (as in the noncontingent situation) it was largely because they applied the wrong heuristic to less accurate information. These findings do not support the notion of depressive realism and suggest that depressed patients distort their judgments in a characteristically negative fashion. (PsycINFO Database Record (c) 2009 (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007). Problem solving therapies for depression: A meta-analysis. European Psychiatry, 22, 9-15.
Correspondence Address:
Pim Cuijpers, Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van Der Boechorststraat 1, Amsterdam, Netherlands, 1081 BT, p.cuijpers@psy.vu.nl.
Abstract
Purpose: In the past decades, the effects of problem-solving therapy (PST) for depression have been examined in several randomized controlled studies. However, until now no meta-analysis has tried to integrate the results of these studies. Methods: We conducted a systematic literature search and identified 13 randomized studies examining the effects of PST, with a total of 1133 subjects. The quality of studies varied. Results: The mean standardized effect size was 0.34 in the fixed effects model and 0.83 in the random effects model, with very high heterogeneity. Subgroup analyses indicated significantly lower effects for individual interventions in studies with subjects who met criteria for major depression, studies in which intention-to-treat analyses were conducted instead of completers-only analyses, and studies with pill placebo and care-as-usual control groups. Heterogeneity was high, and the subgroup analyses did not result in clear indications of what caused this high heterogeneity. This indicates that PST has varying effects on depression, and that it is not known to date what determines whether PST has larger of smaller effects. Conclusion: Although there is no doubt that PST can be an effective treatment for depression, more research is needed to ascertain the conditions and subjects in which these positive effects are realized. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Den Boer, P. C. A. M, Wiersma, D., Ten Vaarwerk, I., Span, M. M., Stant, A. D., & Van Den Bosch, R. J. (2007). Cognitive self-therapy for chronic depression and anxiety: A multi-centre randomized controlled study. Psychological Medicine, 37, 329-339.
Correspondence Address:
Peter C. A. M. Den Boer, Department of Psychiatry, University Medical Center, P.O. Box 30.001, Groningen, Netherlands, 9700 RB, p.c.a.m.den.boer@psy.umcg.nl.
Abstract
Background: Non-professional treatment programmes are presumed to relieve the extensive need for care of anxiety and depression disorders. This study investigates the effectiveness of cognitive self- therapy (CST) in the treatment of depression or generalized anxiety disorder. Method: Patients (n=151) were randomized to receive CST or treatment as usual (TAU) in a trial lasting for 18 months, measuring symptoms (SCL-90; main outcome), social functions, quality of life and utilization of care. Results: Patients in both conditions improved significantly, but no difference was found between the conditions. Reduction of symptoms, improvement of social functions and medical utilization were maintained at the end of the 18 months. Medical care utilization (therapist contact and hospitalization) was lower for CST than for TAU. No suicides occurred. Conclusions: Cognitive self-therapy is likely to decrease the need for care of chronic depression and anxiety disorders, but it has not been proven to be more effective than treatment as usual. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Gladis, M. M., Brown, L. L., & Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409-416.
Correspondence Address:
Robert J. DeRubeis, Department of Psychology, University of Pennsylvania, Philadelphia, PA, US, 19104-6196, derubeis@psych.upenn.edu.
Summary
This study compared the efficacy of antidepressant medication and cognitive therapy for the treatment of moderate to severe depression in a placebo-controlled trial, conducted at three settings (University of Pennsylvania, Philadelphia and Vanderbilt University, Nashville). Study subjects were 240 patients with moderate to severe Major Depressive Disorder. Each patient was randomly assigned to 16 weeks of antidepressant medications, or cognitive therapy, or 8 weeks of pill placebo. Response rates were assessed at 8 weeks using the Hamilton Depression Rating-Scale and were 50% for medication and 43% for cognitive therapy, both higher than the 25% placebo group. At 16 weeks, both medication and cognitive therapy had a 58% response rate; however medication had a remission rate of 46% and cognitive therapy had a remission rate of 40%. Of the three settings, only Vanderbilt showed a significant difference in site treatment interaction, which may be attributable to patient differences and a lesser degree of expertise among Vanderbilt’s cognitive therapists. Overall, cognitive therapy was shown to be as effective as antidepressant medication in the treatment of moderate to severe depression, when provided by highly experienced cognitive therapists.
For the abstract or full text of this articles, please visit the Archives of General Psychiatry.
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R., Addis, M., Gallop, R., McGlinchey, J. B., Markley, D. K., Gollan, J. K., Atkins, D. C., Dunner, D. L., & Jacobson, N. S. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658-670.
Correspondence Address:
Sona Dimidjian, Department of Psychology, University of Colorado, Boulder, CO, US, 80309-0345, sona.dimidjian@colorado.edu.
Abstract
Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed. (PsycINFO Database Record (c) 2006 APA, all rights reserved)
Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., Rizvi, S. L., Gollan, J. K., Dunner, D. L., & Jacobson, N. S. (2008). Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Prevention of Relapse and Recurrence in Major Depression. Journal of Consulting and Clinical Psychology, 76,(3) 468-477.
Correspondence Address:
Keith S. Dobson, Department of Psychology, University of Calgary, Calgary, AB, Canada, T2N
1N4, ksdobson@ucalgary.ca.
Abstract
This study followed treatment responders from a randomized controlled trial of adults with major
depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse
through 1 year of follow-up compared to patients who received prior behavioral activation, prior
cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication
withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons
indicated that patients previously exposed to cognitive therapy were significantly less likely to
relapse following treatment termination than patients withdrawn from medication, and patients
previously exposed to behavioral activation did almost as well relative to patients withdrawn from
medication, although the difference was not significantly different. Differences between behavioral
activation and cognitive therapy were small in magnitude and not significantly different across the
full 2-year follow-up, and each therapy was at least as efficacious as the continuation of
medication. These findings suggest that behavioral activation may be nearly as enduring as
cognitive therapy and that both psychotherapies are less expensive and longer lasting alternatives
to medication in the treatment of depression. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
Driessen, Ellen and Steven D. Hollon. “Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators, and Mediators.” Psychiatric Clinics of North America, Vol. 33, Issue 3 (September 2010): 537-555.
Correspondence Address:
Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1018 BX Amsterdam, The Netherlands. e.driessen@psy.vu.nl
Abstract
“Cognitive behavioral therapy (CBT) is efficacious in the acute treatment of depression and may provide a viable alternative to antidepressant medication (ADM) for even more severely depressed unipolar patients when implemented in a competent fashion. CBT also may be of use as an adjunct to medication treatment of bipolar patients, although there have been few studies and they are not wholly consistent. CBT does seem to have an enduring effect that protects against subsequent relapse and recurrence following the end of active treatment, which is not the case for medications. Single studies that require replication suggest that patients who are married or unemployed or who have more antecedent life events may do better in CBT than in ADM, as might patients who are free from comorbid Axis II disorders, whereas patients with comorbid Axis II disorders seem to do better in ADM than in CBT. There also are indications that CBT may work through processes specified by theory to produce change in cognition that in turn mediate subsequent change in depression and freedom from relapse following treatment termination, although evidence in that regard is not yet conclusive.”
Ehring, T., Ehlers, A., & Glucksman, E. (2008). Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study. Journal of Consulting and Clinical Psychology, 76(2), 219-230.
Correspondence Address:
Anke Ehlers, Department of Psychology, Institute of Psychiatry, King's College London, PO77, De Crespigny Park, London, England, SE5 8AF, anke.ehlers@iop.kcl.ac.uk.
Abstract
The study investigated the power of theoretically derived cognitive variables to predict posttraumatic stress disorder (PTSD), travel phobia, and depression following injury in a motor vehicle accident (MVA). MVA survivors (N = 147) were assessed at the emergency department on the day of their accident and 2 weeks, 1 month, 3 months, and 6 months later. Diagnoses were established with the Structured Clinical Interview for DSM-IV. Predictors included initial symptom severities; variables established as predictors of PTSD in E. J. Ozer, S. R. Best, T. L. Lipsey, and D. S. Weiss's (2003) meta-analysis; and variables derived from cognitive models of PTSD, phobia, and depression. Results of nonparametric multiple regression analyses showed that the cognitive variables predicted subsequent PTSD and depression severities over and above what could be predicted from initial symptom levels. They also showed greater predictive power than the established predictors, although the latter showed similar effect sizes as in the meta-analysis. In addition, the predictors derived from cognitive models of PTSD and depression were disorder-specific. The results support the role of cognitive factors in the maintenance of emotional disorders following trauma. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
Floyd, M., Rohen, N., Shackelford, J. A. M., Hubbard, K. L., Parnell, Marsha B; Scogin, F., & Coates, A. (2006). Two-year follow-up of bibliotherapy and individual cognitive therapy for depressed older adults. Behavior Modification, 30, 281-294.
Correspondence Address:
Mark Floyd, Psychology Department, University of Nevada, Box 455030, Las Vegas, NV, US, 89154-5030, mfloyd@ccmail.nevada.edu.
Abstract
This study examined the stability of treatment gains after receiving either cognitive bibliotherapy or individual cognitive psychotherapy for depression in older adults. A 2-year follow-up of 23 participants from Floyd, Scogin, McKendree-Smith, Floyd, and Rokke (2004) was conducted by comparing pre- and posttreatment scores with follow-up scores on the Hamilton Rating Scale for Depression (HRSD) and the Geriatric Depression Scale (GDS). Results indicated that treatment gains from baseline to the 2-year follow-up period were maintained on the HRSD and GDS, and there was not a significant decline from posttreatment to follow-up. There were no significant differences between the treatments on the GDS or HRSD at the 2-year follow-up; however, bibliotherapy participants had significantly more recurrences of depression during the follow-up period. (PsycINFO Database Record (c) 2006 APA, all rights reserved)
Floyd, M., Scogin, F., McKendree-Smith, N. L., Floyd, D. L., Rokke, P. D. (2004). Cognitive Therapy for Depression: A Comparison of Individual Psychotherapy and Bibliotherapy for Depressed Older Adults, Behavior Modification, 28(2), 297-318.
Correspondence Address:
Mark Floyd, Psychology Department, University of Nevada, Box 455030, Las Vegas, NV, US, 89154-5030, mfloyd@ccmail.nevada.edu.
Abstract
Thirty-one community-residing older adults age 60 or over either received 16 sessions of individual cognitive psychotherapy (Beck, Rush, Shaw, & Emery, 1979) or read Feeling Good (Burns, 1980) for bibliotherapy. Posttreatment comparisons with the delayed-treatment control indicated that both treatments were superior to a delayed-treatment control. Individual psychotherapy was superior to bibliotherapy at posttreatment on self-reported depression, but there were no differences on clinician-rated depression. Further, bibliotherapy participants continued to improve after posttreatment, and there were no differences between treatments at 3-month follow-up. Results suggest that bibliotherapy and that individual psychotherapy are both viable treatment options for depression in older adults. (PsycINFO Database Record (c) 2004 APA, all rights reserved)
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 772-799.
Correspondence Address:
Evan M. Forman, Department of Psychology, Drexel University, 245 N. 15th Street, MS 515, Philadelphia, PA, US, 19102, evan.forman@drexel.edu.
Abstract
Acceptance and commitment therapy (ACT) has a small but growing database of support. One hundred and one heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned to traditional cognitive therapy (CT) or to ACT. To maximize external validity, the authors utilized very minimal exclusion criteria. Participants receiving CT and ACT evidenced large, equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction, and clinician-rated functioning. Whereas improvements were equivalent across the two groups, the mechanisms of action appeared to differ. Changes in "observing" and "describing" one's experiences appeared to mediate outcomes for the CT group relative to the ACT group, whereas "experiential avoidance," "acting with awareness," and "acceptance" mediated outcomes for the ACT group. Overall, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Fournier, J. C., DeRubeis, R. J., Shelton, R. C., Hollon, S. D., Amsterdam, J. D., & Gallop, R. (2009). Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. Journal of Consulting and Clinical Psychology, 77(4), Aug 2009, 775-787. Psychotherapy: Theory, Research, Practice, Training, 46(1), 42-51.
Correspondence Address:
Jay C. Fournier, Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA, US, 19104, jcf@sas.upenn.edu .
Abstract
A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks. Chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three prescriptive variables—marriage, unemployment, and having experienced a greater number of recent life events—were identified, and each predicted superior response to cognitive therapy relative to antidepressant medications. Thus, 6 markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The 3 prognostic variables identify subgroups that might benefit from alternative treatment strategies; the 3 prescriptive variables identify groups who appear to respond particularly well to cognitive therapy. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Gallagher-Thompson, D., Gray, H.L., Tang, P. C-Y., Pu, C-Y, Leung, L.Y.L., Wang, P-C, Tse, C., Hsu, S., Kwo, E., Tong, H-Q, Long, J., & Thompson, L. W. (2007). Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese caregivers: Results of a pilot study. American Journal of Geriatric Psychiatry, 15, 425- 434.
Correspondence Address:
Dolores Gallagher-Thompson, Stanford University School of Medicine/ VA Health Care System, 795 Willow Road (182C/MP), Menlo Park, California, USA, 94025, dolorest@stanford.edu.
Abstract
Recent work has shown that Chinese Americans caring for a family member with dementia experience considerable psychological distress. However, few studies evaluate traetments for them. This study evaluated the efficacy of in-home intervention, base don cognitive/behavior therapy principles, to relieve stress and depression in female Chinese American caregivers (CGs). Methods: Fifty-five CGs who met inclusion criteria were randomly assigned to a telephone support condition (TSC) or to an in-home behavior management program (IHBMP) for 4 months. In the TSC, biweekly calls were made and relevant material was mailed. In the IHBMP, specific psychological skills were taught to deal with caregiving stress. CGs were assessed before and after treatment. Outcome measures evaluated overall perceived stress, caregiving-specific stress, and depressive symptoms. Results: CGs in IHBMP were less bothered by caregiving-specific stressors and had lower depression levels than CGs in TSC. There was no difference in overall stress. CGs with low baseline level of self-efficacy for obtaining respite benefited from IHBMP, but showed little improvement in the TSC. CGs with higher self-efficacy benefited from both treatments. Conclusion: This intervention is promising and warrants replication in future studies. Additional research is needed to evaluate longer-term effects and to identify individual differences associated with improvement. A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. (journal abstract)
Gregory, R. J., Schwer Canning, S., Lee, T. W., & Wise, J. C. (2004). Cognitive bibliotherapy for depression: A meta-analysis. Professional Psychology - Research & Practice, 35, 275-280.
Correspondence Address:
Robert Gregory, Department of Psychology, Wheaton College, 501 College Avenue, Wheaton, Illinois, 60187-5593, robert.j.gregory@wheaton.edu/
Abstract
Do you want to use bibliotherapy with clients but wonder about the size and mechanism of effectiveness? The authors report a meta-analysis of 29 outcome studies of cognitive forms of bibliotherapy for depression. Seventeen studies with stronger research designs (pretest-posttest waiting list control group) yielded a respectable effect size of 0.77, considered the best estimate of effect size from this study. This result compares favorably with outcomes from individual psychotherapy. In light of the substantial positive effects associated with bibliotherapy for depression, the authors discuss clinically relevant questions related to the use of cognitive bibliotherapy. These include why practitioners might consider the use of this technique, which individuals can benefit from this approach, and how professionals can structure care. (PsycINFO Database Record (c) 2004 APA, all rights reserved)
Haby, M. M., Donnelly, M., Corry, J., & Vos, T. (2006). Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: A meta-regression of factors that may predict outcome. Australian and New Zealand Journal of Psychiatry, 40, 9-19.
Correspondence Address:
Michelle M. Haby, Health Surveillance and Evaluation Section, Public Health Group, Department of Human Services, Level 18, 120 Spencer Street, Melbourne, VIC, Australia, 3000, michelle.haby@dhs.vic.gov.au.
Abstract
Objective: Objective: To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial. Method: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment. Results: Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% 01 = 0.51-0.84, n = 33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size. Conclusions: Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups. (PsycINFO Database Record (c) 2006 APA, all rights reserved)
Hamilton, K. E., & Dobson, K. (2002). Cognitive therapy of depression: Pretreatment patient predictors of outcome. Clinical Psychology Review, 22(6), 875-894. Psychotherapy: Theory, Research, Practice, Training, 46(1), 42-51.
Correspondence Address:
Keith Dobson, University of Calgary, Dept of Psychology, Calgary, AB, Canada, ksdobson@acs.ucalgary.ca .
Abstract
This review examines the role of patient predictors of outcome in cognitive therapy of depression. Studies that meet eligibility criteria are reviewed for demonstrated linkage between various predictors (i.e., pretreatment severity, historical features, demographic predictors, dysfunctional attitudes and other cognitive features, and treatment acceptability) and outcome, and several effects are found. Notably, high pretreatment severity scores are associated with poorer response to cognitive therapy, as are high chronicity, younger age at onset, an increased number of previous episodes, and marital status. High pretreatment levels of dysfunctional attitudes and certain beliefs about the nature of depression were also found to predict differential response to cognitive therapy of depression. Limitations of the research and directions for further investigations of patient predictors of outcome in cognitive therapy of depression are provided. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Hensley, P. L., Nadiga, D., Uhlenhuth, E. H. (2004). Long-term effectiveness of cognitive therapy in major depressive disorder. Depression & Anxiety, 20, 1-7.
Correspondence Address:
Paula L. Hensley - phensley@salud.unm.edu.
Abstract (from the journal abstract):
Cognitive therapy of depression, based on the cognitive theory of depression, is an established treatment for major depressive disorder. Although few clinicians expect acute treatment of depression with antidepressant medication to prevent long-term relapse of the illness, some practitioners of cognitive therapy report long-term effectiveness in preventing relapse after short-term treatment. We set out to reanalyze follow-up studies in the literature, using intent-to-treat principles to assess the long-term effects of acute treatment with cognitive therapy. From an initial reference list of 97 citations that met our search criteria (controlled clinical trials of cognitive therapy in depression with follow-up), we found five trials that met our inclusion criteria. This report reviews and reanalyzes these five trials, published between 1981 and 1992, which compare cognitive therapy and tricyclic antidepressant therapy. Overall, the evidence favors a longer-term effect for cognitive therapy over tricyclic antidepressants alone. (PsycINFO Database Record (c) 2004 APA, all rights reserved)
Hofmann SG, Sawyer AT, Witt AA, Oh D. “The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review.” Journal of Consult Clinical Psychology,2010 Apr;78(2):169-83.
Correspondence Address:
Not Available
Abstract
OBJECTIVE: Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples. METHOD: We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. RESULTS: Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges's g = 0.63) and mood symptoms (Hedges's g = 0.59) from pre- to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges's g) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up. CONCLUSIONS: These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations. PMID: 20488270 [PubMed - indexed for MEDLINE]
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Freeman, B. B., & Gallop, R. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62, 417-422.
Correspondence Address:
Steven D. Hollon, Department of Psychology, 306 Wilson Hall, Vanderbilt University, Nashville, TN, US, 37203, steven.d.hollon@vanderbilt.edu.
Summary
This study evaluated the enduring effects of cognitive therapy as compared to antidepressant medication for the treatment of moderate to severe depression, in a 12-month naturalistic follow-up. Patients who responded to initial cognitive therapy were withdrawn from treatment and placed on continuation treatment (no more than 3 booster sessions during the follow-up period), and were compared to those who responded to medication treatment. Successfully treated medication participants were randomly assigned to continuation medication (full dosage) or placebo withdrawal. Relapse was defined by a Hamilton Depression Rating Scale score of 14 for at least 2 weeks or higher, or a return of symptoms that meet criteria for Major Depression. Those who did not relapse during the continuation phase were withdrawn from all treatment and monitored for recurrence during a second year. Cognitive therapy continuation patients were significantly less likely to relapse as compared to medication continuation patients (30.8% vs 76.2%). The authors conclude that receiving successful prior Cognitive therapy is as effective as continued medication in reducing the risk of relapse following successful treatment. This study also indicates that cognitive therapy may have an enduring effect that helps prevent recurrence.
For the abstract or full text of this articles, please visit the Archives of General Psychiatry.
Kennard, B. D., Silva, S. G., Tonev, S., Rohde, P., Hughes, J. L., Vitiello, B., Kratochvil, C. J., Curry, J. F., Emslie, G. J., Reinecke, M., March, J. (2009). Remission and recovery in the Treatment for Adolescents With Depression Study (TADS): Acute and long-term outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 48, (2), 186-195.
Correspondence Address:
Betsy D. Kennard, University of Texas, Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, US, 75390-8589,
Beth.kennard@utsouthwestern.edu.
Abstract
Objective: We examine remission rate probabilities, recovery rates, and residual symptoms across 36 weeks in the Treatment for Adolescents with Depression Study (TADS). Method: The TADS, a multisite clinical trial, randomized 439 adolescents with major depressive disorder to 12 weeks of treatment with fluoxetine, cognitive/behavioral therapy, their combination, or pill placebo. The pill placebo group, treated openly after week 12, was not included in the subsequent analyses. Treatment differences in remission rates and probabilities of remission over time are compared. Recovery rates in remitters at weeks 12 (acute phase remitters) and 18 (continuation phase remitters) are summarized. We also examined whether residual symptoms at the end of 12 weeks of acute treatment predicted later remission. Results: At week 36, the estimated remission rates for intention-to-treat cases were as follows: combination, 60%; fluoxetine, 55%; cognitive/behavioral therapy, 64%; and overall, 60%. Paired comparisons reveal that, at week 24, all active treatments converge on remission outcomes. The recovery rate at week 36 was 65% for acute phase remitters and 71% for continuation phase remitters, with no significant between-treatment differences in recovery rates. Residual symptoms at the end of acute treatment predicted failure to achieve remission at weeks 18 and 36. Conclusions: Most depressed adolescents in all three treatment modalities achieved remission at the end of 9 months of treatment. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Kuyken, W., Byford, S., Taylor, R. S., Watkins, E., Holden, E., White, K., Barrett, B., Byng, R., Evans, A., Mullan, E., Teasdale, J. D. (2008). Mindfulness-Based Cognitive Therapy to Prevent Relapse in Recurrent Depression. Journal of Consulting and Clinical Psychology, 76 (6), 966-978.
Correspondence Address:
Willem Kuyken, Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, United Kingdom, EX4 4QG,
w.kuyken@exeter.ac.uk.
Abstract
For people at risk of depressive relapse, mindfulness-based cognitive therapy (MBCT) has an additive benefit to usual care (H. F. Coelho, P. H. Canter, & E. Ernst, 2007). This study asked if, among patients with recurrent depression who are treated with antidepressant medication (ADM), MBCT is comparable to treatment with maintenance ADM (m-ADM) in (a) depressive relapse prevention, (b) key secondary outcomes, and (c) cost effectiveness. The study design was a parallel 2-group randomized controlled trial comparing those on m-ADM (N = 62) with those receiving MBCT plus support to taper/discontinue antidepressants (N = 61). Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04). MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains. There was no difference in average annual cost between the 2 groups. Rates of ADM usage in the MBCT group was significantly reduced, and 46 patients (75%) completely discontinued their ADM. For patients treated with ADM, MBCT may provide an alternative approach for relapse prevention. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
Leykin, Y., Amsterdam, J. D., DeRubeis, R. J., Gallop, R., Shelton, R. C., Hollon, S. D. (2007). Progressive resistance to a selective serotonin reuptake inhibitor but not to cognitive therapy in the treatment of major mepression. Journal of Consulting and Clinical Psychology, 75(2) 267-276.
Correspondence Address:
Yan Leykin, Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA, US, 19104-6196, leykin@psych.upenn.edu.
Abstract
Recent research suggests that there may be a reduction in therapeutic response after multiple administrations of antidepressant drug (AD) therapy in patients with major depressive disorder. This study assessed the response to AD therapy and cognitive therapy (CT) of patients with a history of prior AD exposures. A sample of 240 patients with moderate-to-severe major depressive disorder entered a randomized controlled trial comparing pharmacotherapy with paroxetine to CT. Treatment was administered for 16 weeks. History of prior AD exposure was assessed with structured interviews, self-report, and medical records. Analyses were conducted using hierarchical linear models on the intent-to-treat sample. After controlling for various demographic and clinical factors, more prior AD exposures predicted poor response to paroxetine therapy but not to CT, as measured by the Hamilton Rating Scale for Depression (Hamilton, 1960; Williams, 1988). Whereas CT outcome was not significantly related to the number of prior AD exposures, a higher number of prior AD exposures was significantly associated with a lower response to paroxetine. If these findings are replicated in methodologically rigorous studies of paroxetine and other antidepressants, CT should be recommended, in preference to AD, for patients with multiple prior AD exposures. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Luty, S. E., Carter, J. D., McKenzie, J. M., Rae, A. M., Framptom, C. M. A., Mulder, R. T., & Joyce, P. R. (2007). Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression. British Journal of Psychiatry, 190, 496-502.
Correspondence Address:
Suzanne Luty, Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, P.O. Box 4345, Christchurch, New Zealand, sue.luty@chmeds.ac.nz.
Abstract
Abstract Background. Interpersonal psychotherapy and cognitive-behavioural therapy (CBT) are established as effective treatments for major depression. Controversy remains regarding their effectiveness for severe and melancholic depression. Aims. To compare the efficacy of interpersonal psychotherapy and CBT in people receiving out-patient treatment for depression and to explore response in severe depression (Montgomery Asberg Depression Rating Scale (MADRS) score above 30), and in melancholic depression. Method. Randomised clinical trial of 177 patients with a principal Axis I diagnosis of major depressive disorder receiving16 weeks of therapy comprising 8-19 sessions. Primary outcome was improvement in MADRS score from baseline to end of treatment. Results. There was no difference between the two psychotherapies in the sample as a whole, but CBT was more effective than interpersonal psychotherapy in severe depression, and the response was comparable with that for mild and moderate depression. Melancholia did not predict poor response to either psychotherapy. Conclusions. Both therapies are equally effective for depression but CBT may be preferred in severe depression. (journal abstract)
Ma, S. H. & Teasdale, J. D. (2004). Mindfulness-Based Cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting & Clinical Psychology, 72, 31-40.
Correspondence Address:
Helen S. Ma, S. Helen. MRC Cognition & Brain Sciences Unit, 15 Chaucer Road, Cambridge United Kingdom CB2 2EF.
Abstract
Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes; but in 18 patients with only 2 (recent) episodes corresponding figures were 20% and 50%. MBCT was most effective in preventing relapses not preceded by life events. Relapses were more often associated with significant life events in the 2-episode group. This group also reported less childhood adversity and later first depression onset than the 3-or-more-episode group, suggesting that these groups represented distinct populations. MBCT is an effective and efficient way to prevent relapse/ recurrence in recovered depressed patients with 3 or more previous episodes. (PsycINFO Database Record (c) 2004 APA, all rights reserved)
Segal ZV, Bieling P, Young T, MacQueen G, Cooke R, Martin L, Bloch R, Levitan RD. “Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.” Arch Gen Psychiatry,2010 Dec;67(12):1256-64.
Correspondence Address:
Not Available
Abstract
CONTEXT: Mindfulness-based cognitive therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse. OBJECTIVE: To compare rates of relapse in depressed patients in remission receiving MBCT against maintenance antidepressant pharmacotherapy, the current standard of care. DESIGN: Patients who met remission criteria after 8 months of algorithm-informed antidepressant treatment were randomized to receive maintenance antidepressant medication, MBCT, or placebo and were followed up for 18 months. SETTING: Outpatient clinics at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and St Joseph's Healthcare, Hamilton, Ontario. PARTICIPANTS: One hundred sixty patients aged 18 to 65 years meeting DSM-IV criteria for major depressive disorder with a minimum of 2 past episodes. Of these, 84 achieved remission (52.5%) and were assigned to 1 of the 3 study conditions. INTERVENTIONS: Patients in remission discontinued their antidepressants and attended 8 weekly group sessions of MBCT, continued taking their therapeutic dose of antidepressant medication, or discontinued active medication and were switched to placebo. MAIN OUTCOME MEASURE: Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV. RESULTS: Intention-to-treat analyses showed a significant interaction between the quality of acute-phase remission and subsequent prevention of relapse in randomized patients (P = .03). Among unstable remitters (1 or more Hamilton Rating Scale for Depression score >7 during remission), patients in both MBCT and maintenance treatment showed a 73% decrease in hazard compared with placebo (P = .03), whereas for stable remitters (all Hamilton Rating Scale for Depression scores ≤7 during remission) there were no group differences in survival. CONCLUSIONS: For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters. PMID: 21135325 [PubMed - in process]
Simon, J., Pilling, S., Burbeck, R., & Goldberg, D. (2006). Treatment options in moderate and severe depression: Decision analysis supporting a clinical guideline. British Journal of Psychiatry, 189(6) 494-501.
Correspondence Address:
Judit Simon, Health Economics Research Centre, Old Road Campus, Headington, Oxford, United Kingdom, OX3 7LF, judit.simon@dphpc.ox.ac.uk.
Abstract
Background: Treatment options for depression include antidepressants, psychological therapy and a combination of the two. Aims: To develop cost-effective clinical guidelines. Method: Systematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK. Results: Over the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was £4056 (95% CI 1400-18300); the cost per quality-adjusted life year gained was £5777 (95% CI 1900-33800) for severe depression and £14540 (95% CI 4800-79400) for moderate depression. Conclusions: Combination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
.
Smit, F., Willemse, G., Koopmanschap, M., Onrust, S., Cuijpers, P., & Beekman, A. (2006). Cost-effectiveness of preventing depression in primary care patients: Randomised trial. British Journal of Psychiatry, 188(4), 330-336.
Correspondence Address:
Filip Smit, Department of Prevention and Early Intervention, Trimbos Institute, PO Box 725, Utrecht, Netherlands, 2500 AS, fsmit@trimbos.nl.
Abstract
Background: Little is known about the cost-effectiveness of preventing mental disorders. Aims: To study the cost-effectiveness of care as usual plus minimal contact psychotherapy relative to usual care alone in preventing depressive disorder. Method: An economic evaluation was conducted alongside a randomised clinical trial. Primary care patients with sub-threshold depression were assigned to minimal contact psychotherapy plus usual care (n=107) or to usual care alone (n=109). Results: Primary care patients with sub-threshold depression benefited from minimal contact psychotherapy as it reduced the risk of developing a full-blown depressive disorder from 18% to 12%. In addition, this intervention had a 70% probability of being more cost-effective than usual care alone. A sensitivity analysis indicated the robustness of these results. Conclusions: Over 1 year adjunctive minimal contact psychotherapy improved outcomes and generated lower costs. This intervention is therefore superior to usual care alone in terms of cost-effectiveness. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
.
Strauman, T. J., Vieth, A. Z., Merrill, K. A., Kolden, G. G., Woods, T. E., Klein, M. H., Papadakis, A. A., Schneider, K. L., & Kwapil, L. (2006). Self-system therapy as an intervention for self-regulatory dysfunction in depression: A randomized comparison with cognitive therapy. Journal of Consulting and Clinical Psychology, 74, 367-376.
Correspondence Address:
Timothy J. Strauman, Department of Psychology, Social and Health Sciences, Duke University, Box 90085, 9 Flowers Drive, Durham, NC, US, 27708, tjstraum@duke.edu.
Abstract
Self-system therapy (SST) is a new therapy based on regulatory focus theory (E. T. Higgins, 1997) for depressed individuals unable to pursue promotion goals effectively. The authors conducted a randomized trial comparing SST with cognitive therapy (CT) in a sample of 45 patients with a range of depressive symptoms to test 2 hypotheses: that SST would be more efficacious for depressed individuals characterized by inadequate socialization toward pursuing promotion goals and that SST would lead to greater reduction in dysphoric responses to priming of promotion goals. There was no overall difference in efficacy between treatments, but patients whose socialization history lacked an emphasis on promotion goals showed significantly greater improvement with SST. In addition, SST patients showed a greater reduction in dysphoric responses to promotion goal priming than did CT patients. The results illustrate the value of a theory-based translational approach to treatment design and selection. (PsycINFO Database Record (c) 2006 APA, all rights reserved)
Strunk, D. R.; Brotman, M. A.; DeRubeis, R. J.; Hollon, S. D.Therapist competence in cognitive therapy for depression: Predicting subsequent symptom change. Journal of Consulting and Clinical Psychology , 78(3), Jun 2010, 429-437.
Correspondence Address:
Strunk, Daniel R.: Department of Psychology, Ohio State University, 1835 Neil Avenue, Columbus, OH, US, 43210,
strunk.20@osu.edu .
Abstract
Objective: The efficacy of cognitive therapy (CT) for depression has been well established. Measures of the adequacy of therapists' delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have shown an association between CT competence and outcome, researchers have yet to address whether competence ratings predict subsequent outcomes. Method: In a sample of 60 moderately to severely depressed outpatients from a clinical trial, we examined competence ratings (using the Cognitive Therapy Scale) as a predictor of subsequent symptom change. Results: Competence ratings predicted session-to-session symptom change early in treatment. In analyses focused on prediction of symptom change following 4 early sessions through the end of 16 weeks of treatment, competence was shown to be a significant predictor of evaluator-rated end-of-treatment depressive symptom severity and was predictive of self-reported symptom severity at the level of a nonsignificant trend. To investigate whether competence is more important to clients with specific complicating features, we examined 4 patient characteristics as potential moderators of the competence-outcome relation. Competence was more highly related to subsequent outcome for patients w