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Cognitive therapy and the prevention of depression

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Abstract

Recent studies suggest that cognitive therapy may reduce risk following successful treatment of depression. Although not conclusive, these studies suggest that patients treated with cognitive therapy may be at less than half the risk for subsequent symptom return following treatment termination than are patients treated pharmacologically. Change in explanatory style, the tendency to attribute negative events to internal, stable, and global factors, appears to mediate cognitive therapy's preventive capacity. Whether this prophylactic capacity extends to the prevention of new episodes (including the initial onset of the disorder) remains to be determined.

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... Individuals who have experienced a major depressive episode that has remitted have a substantially increased risk of having a relapse; there is a 50% chance of recurrence after one episode of major depression, 70% chance after two, and 90% chance after three (Depression Guideline Panel, 1993). An emotion regulatory perspective suggests that previously depressed individuals will be protected from relapse to the extent that they have developed new and more adequate means of regulating their emotions (Hollon, DeRubeis, & Seligman, 1992). In the case of pharmacotherapy, this may mean being on a maintenance dose of antidepressants. ...
... Our model suggests that measures of emotion regulation be included in batteries to identify hgh-risk groups in large-scale prevention stules. If such measures successfully predict new cases of depressive disorder, and if complementary efforts that aim to enhance emotion regulatory abilities reduce recurrence rates (see Hollon, DeRubeis, & Seligman, 1992), emotion regulation should be an explicit focus in the treatment and prevention of depression. ...
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In this article, we argue that emotion regulation is an essential (and traditionally underemphasized) feature of mental health. To develop this idea, we first define the terms emotion, emotion regulation, and mental health. We then chart the development of emotion regulation and describe its role in various facets of normal functioning. Next, we consider what happens when emotion becomes dysregulated in a major depressive episode. We suggest that an emotion regulatory perspective integrates diverse theoretical views of depression and has implications for the assessment, treatment, and prevention of depression. We conclude by speculating about the role of emotion regulation in the broader context of public mental health.
... It is tempting for depression researchers to aspire to the isolation of analogous psychological "defects," that is, personality characteristics that precipitate depression in vulnerable persons if they meet matching experiences. Although it would require a knowledge base that is far beyond what psychologists have currently, the ultimate goal of such a research program might be the recognition of those persons at risk before they become depressed (Hollon, DeRubeis, & Seligman, 1992). The psychological vulnerability of people at risk could, therefore, be modified, compensatory ways of coping could be developed, or they could learn to structure their lives so that they reduce their exposure to depressogenic experiences. ...
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A congruency between personality and life stress is assumed to pose a particular risk for depression. The authors review relevant research as a way of examining broader issues entailed in diathesis–stress models of depression. Topics include the identification of distinct personality modes and the differentiation of these modes from the phenomena of depression and the influence of the social context. Diathesis–stress models face formidable conceptual and methodological challenges. More complex models are needed to accommodate the dynamics of a person's life course, involvement in significant social contexts, and fluctuations in vulnerability to depression. Base rates of key phenomena favor development of models of depression recurrence in high-risk samples rather than its onset in the general population.
... Moreover, even though schemas are resistant to change without psychological intervention, 16,17 none of those two studies used cognitive therapy, which is specifically developed to reframe maladaptive schemas. 18 Addressing EMSs in AD may contribute to improved treatment outcomes, 19 particularly in terms of reducing the risk of relapse, as these fundamental beliefs determine how an individual responds to different circumstances. Hence, the present study aimed to address EMSs and examined the change in the schema and other outcomes following cognitive therapy in individuals with AD. ...
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Background Although early maladaptive schemas (EMSs) have been suggested as potential vulnerability markers for alcohol dependence (AD), there is less emphasis on addressing these schemas in substance abuse treatment programs. We thus aimed to examine the change in schemas in response to cognitive therapy in individuals with AD. Methods In this an open-label randomized controlled study, individuals with alcohol dependence syndrome (ADS, n = 84) were randomized to the intervention group ( n = 45), which received six cognitive therapy sessions combined with treatment as usual (TAU), or the control group ( n = 39), which was on TAU only. Participants were assessed on the measures of EMSs, alcohol use severity, and perceived stress at baseline and posttreatment. Results The intervention group showed significant improvement in 5 out of 18 EMSs, that is, emotional deprivation, defectiveness, self-sacrifice, unrelenting standard, and negativity, compared to the control group, at the end of the treatment. There was a significant between-group effect for perceived stress but not for alcohol use severity. Conclusion EMSs can be changed with cognitive therapy in individuals with AD and could be a crucial area to address in treatment programs. Further studies with long-term follow-up are warranted. The trial was registered with the Clinical Trials Registry—India (CTRI/2015/12/006441) on December 17, 2015.
... Consistent with this, studies have demonstrated a predictability nature of negative thinking and development of depressive symptoms in women. (Hollon et al., 1992;Paden et al., 2005). ...
... T he effectiveness of cognitive therapy (CT) 1 for major depressive disorder (MDD) has been established in controlled efficacy trials [2][3][4][5] and real-world effectiveness trials. 6,7 However, substantial debate is ongoing as to whether short-term dynamic psychotherapy (DT), which targets an individual's impairing relationship conflicts, has the research base to support its dissemination as an intervention for MDD. ...
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Importance: Dynamic psychotherapy (DT) is widely practiced in the community, but few trials have established its effectiveness for specific mental health disorders relative to control conditions or other evidence-based psychotherapies. Objective: To determine whether DT is not inferior to cognitive therapy (CT) in the treatment of major depressive disorder (MDD) in a community mental health setting. Design, setting, and participants: From October 28, 2010, to July 2, 2014, outpatients with MDD were randomized to treatment delivered by trained therapists. Twenty therapists employed at a community mental health center in Pennsylvania were trained by experts in CT or DT. A total of 237 adult outpatients with MDD seeking services at this site were randomized to 16 sessions of DT or CT delivered across 5 months. Final assessment was completed on December 9, 2014, and data were analyzed from December 10, 2014, to January 14, 2016. Interventions: Short-term DT or CT. Main outcomes and measures: Expert blind evaluations with the 17-item Hamilton Rating Scale for Depression. Results: Among the 237 patients (59 men [24.9%]; 178 women [75.1%]; mean [SD] age, 36.2 [12.1] years) treated by 20 therapists (19 women and 1 man; mean [SD] age, 40.0 [14.6] years), 118 were randomized to DT and 119 to CT. A mean (SD) difference between treatments was found in the change on the Hamilton Rating Scale for Depression of 0.86 (7.73) scale points (95% CI, -0.70 to 2.42; Cohen d, 0.11), indicating that DT was statistically not inferior to CT. A statistically significant main effect was found for time (F1,198 = 75.92; P = .001). No statistically significant differences were found between treatments on patient ratings of treatment credibility. Dynamic psychotherapy and CT were discriminated from each other on competence in supportive techniques (t120 = 2.48; P = .02), competence in expressive techniques (t120 = 4.78; P = .001), adherence to CT techniques (t115 = -7.07; P = .001), and competence in CT (t115 = -7.07; P = .001). Conclusions and relevance: This study suggests that DT is not inferior to CT on change in depression for the treatment of MDD in a community mental health setting. The 95% CI suggests that the effects of DT are equivalent to those of CT. Trial registration: clinicaltrials.gov Identifier: NCT01207271.
... Experientially, individuals may choose aspects of the events to attend (Gross and Munoz, 2006). Learning more effective emotion regulation strategies is useful in reducing psychopathological behavior (Hollon et al., 1992). Reappraisal reduces amygdala activation, thus an intensity of the emotional experience and physiological response is decreased (Phillips et al., 2008). ...
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This study examined task-switching abilities and emotion regulation strategies in euthymic bipolar patients (EBP). Forty EBP and 40 healthy individuals performed face categorization tasks where they switched between emotion and non-emotion (i.e., gender) features among faces and completed emotion regulation questionnaire (Gross and John, 2003). Subject groups showed substantial differences in task-switching abilities and emotion regulation strategies: (1) there was a dissociation between emotion and gender classification in EBP. The switch cost was larger [i.e., higher reaction times (RTs) on switch as compared to no-switch trials] for gender categorization as compared to the emotion categorization task. In contrast, such asymmetries were absent among healthy participants. The differential pattern of task switching reflected functional disturbances in frontotemporal neural system and an attentional bias to emotion features of the faces in EBP. This suggests that when a euthymic bipolar patient is preoccupied with emotion recognition, an instruction to perform gender categorization results in greater cost on RTs. (2) In contrast to healthy individuals, EBP reported more frequent use of emotion suppression and lesser use of cognitive reappraisal as emotion regulation strategy. (3) Emotion regulation was found to be a significant predictor of task-switching abilities. It is argued that task switching deficits rely on maladaptive emotion regulation strategies in EBP specifically when tasks of emotional significance are involved.
... There is substantial evidence supporting the efficacy of cognitive therapy (CT; Beck et al. 1979) in the treatment of MDD. The effects of CT have been shown to be equal to well-conducted pharmacotherapy (Hollon et al. 1992; Murphy et al. 1984; Rush et al. 1977; DeRubeis et al. 2005). In addition, there is evidence that CT has a relapse prevention effect (Evans et al. 1992; Kovacs et al. 1981; Simons et al. 1986; Hollon et al. 1991; Hollon et al. 2005). ...
Article
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There is substantial evidence that cognitive therapy is an effective intervention for the treatment of major depressive disorder. Although dynamic psychotherapies have been widely studied and are commonly practiced worldwide, there are few randomized comparisons of cognitive therapy and dynamic therapy for major depressive disorder. We are completing data collection on a randomized non-inferiority trial comparing the effectiveness of cognitive therapy and short-term dynamic psychotherapy in the treatment of major depressive disorder in the community mental health setting. Therapists employed in the community setting have been recruited for training in either short-term dynamic psychotherapy or cognitive therapy. Patients seeking services at the community site who meet criteria for major depressive disorder based on a blind independent diagnostic interview are randomized to 16 sessions of treatment. All patients are assessed at baseline and months 1, 2, 4, and 5 utilizing a comprehensive battery. This study adds to the growing literature evaluating the effectiveness of short-term dynamic psychotherapy for specific diagnostic groups. These results will have implications for the dissemination of effective interventions for major depressive disorder in community mental health settings. This trial is registered at ClinicalTrials.gov, a service of the United States National Institute of Health. NIH Identifier: NCT01207271. Registered 21 September 2010.
... Although the interest in cognitive styles in bipolar disorder (BD) is much more recent, it is evident from the literature that they show striking similarities to those of patients affected by major depression [20][21][22][23]. Patients with BD demonstrate similar patterns of cognitive style to unipolar patients but differ from controls particularly on self esteem [23] which persists beyond depressive symptomatology with euthymic bipolar patients showing significantly higher scores on the Dysfunctional Attitudes Scale (DAS) as well as the 'Need for Approval' and 'Perfectionism' subscales than healthy control [24]. ...
... Seligman et al. (1988) argued that modifying negative cognitive style is a key factor in the efficacy of cognitive behavioural therapy (CBT) for depression. Indeed, there are a variety of CBT interventions that may indirectly modify cognitive styles including cognitive restructuring or reattribution training (Beck, 1979; Hollon, DeRubeis, & Seligman, 1992). For instance, there are an increasing number of cognitive restructuring interventions that can be conducted with minimal resources over the internet (see Griffiths & Christensen, 2006 for a review). ...
Article
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Over the past 20 years, there has been considerable interest in the role of cognitive factors in the stress generation process. Generally, these studies find that depressed individuals, or individuals at cognitive risk for depression, are more likely to experience stressful life events that are in part influenced by their own characteristics and behaviours (i.e., negative dependent events). However, there is still much to be learnt about the mediators of these effects. For example, does the development of depression symptoms explain why individuals at cognitive risk for depression experience increased negative dependent events? Or, is it that increases in cognitive risk explain why depressed individuals experience increased negative dependent events? To explore these questions, a short-term prospective study was conducted with 209 college students who were given measures of depression, depressogenic risk factors (i.e., negative cognitive style and hopelessness), and negative dependent events at two time points 6 weeks apart. Support was found for three models: (1) depression symptoms mediated the relationship between negative cognitive style and negative dependent events; (2) depression symptoms mediated the relationship between hopelessness and negative dependent events; and (3) first hopelessness and then depression symptoms mediated the relationship between negative cognitive style and negative dependent events in a multiple-step model. In contrast, the reverse models were not confirmed, suggesting specificity in the direction of the mediational sequence.
... The current standard of care for psychopharmacologic management of most patients with recurrent MDD recovered with ADM is to maintain ADM indefinitely at the same dose used to achieve recovery (APA 2010). Several head-to-head maintenance comparisons of psychotherapy alone versus medication alone indicate psychotherapy is clearly superior in protecting against relapse if ADM is discontinued (Blackburn et al. 1986;Hollon et al. 1992Hollon et al. , 2005aKovacs et al. 1981;Simons et al. 1986), though some studies did not find this effect (Perlis et al. 2002, Shea et al. 1992. When ADM are maintained during follow-up, the data are more mixed; some studies still indicate a benefit for CBT , Simons et al. 1986), whereas others indicate no difference between treatment conditions (Evans et al. 1992, Frank et al. 1990). ...
Article
Major depressive disorder (MDD) is among the most frequent and debilitating psychiatric disorders. Efficacious psychotherapy and antidepressant medications have been developed, and two-thirds of depressed patients respond to single-modality treatment; however, only about one-third of patients remit to single-modality treatments with no meaningful differences in outcomes between treatment types. This article describes the major clinical considerations in choosing between single-modality or combination treatments for MDD. A review of the relevant literature and meta-analyses provides suggestions for which treatment to use for which patient and when each treatment or combination should be provided. The review summarizes the moderators of single-modality and combination-treatment outcomes. We describe models of mechanisms of treatment efficacy and discuss recent treatment-specific neurobiological mechanisms of change.
... Because many women prefer not to take medication for MDD during their childbearing years, the provision of alternative modes of psychotherapy is needed. Cognitive behavioral therapy and interpersonal psychotherapy (IPT) are two of the most widely investigated psychosocial treatments for MDD, and both have been found to be efficacious for treating MDD (i.e., Elkin et al., 1989;Hollon, DeRubeis, & Seligman, 1992;Hollon & Ponniah, 2010;Persons, Thase, & Crits-Cristoph, 1996). Unfortunately, the majority of RCTs that have contributed to the evidence base for these interventions have been conducted with predominantly nonminority middle to upper socioeconomic status populations. ...
Article
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A randomized clinical trial was conducted to evaluate the efficacy of interpersonal psychotherapy (IPT) for ethnically and racially diverse, economically disadvantaged women with major depressive disorder. Non-treatment-seeking urban women (N = 128; M age = 25.40, SD = 4.98) with infants were recruited from the community. Participants were at or below the poverty level: 59.4% were Black and 21.1% were Hispanic. Women were screened for depressive symptoms using the Center for Epidemiologic Studies Depression Scale; the Diagnostic Interview Schedule was used to confirm major depressive disorder diagnosis. Participants were randomized to individual IPT or enhanced community standard. Depressive symptoms were assessed before, after, and 8 months posttreatment with the Beck Depression Inventory-II and the Revised Hamilton Rating Scale for Depression. The Social Support Behaviors Scale, the Social Adjustment Scale-Self-Report, and the Perceived Stress Scale were administered to examine mediators of outcome at follow-up. Treatment effects were evaluated with a growth mixture model for randomized trials using complier-average causal effect estimation. Depressive symptoms trajectories from baseline through postintervention to follow-up showed significant decreases among the IPT group compared to the enhanced community standard group. Changes on the Perceived Stress Scale and the Social Support Behaviors Scale mediated sustained treatment outcome.
... Sessions 9–13: recognizing, challenging and remedying the schema (Beck et al., 1979). Sessions 14–16: identifying warning signs of relapse and keeping track of warning signs (Hollon et al., 1992; Persons, 1993). Sessions 17–19: consolidate stage of the treatment effect (Teasdale et al., 1995). ...
... Consistent with the extant literature on cognitive– behavioral treatments for individuals with RA, our findings underscore the importance of cognitive treatment components of self-management programs for depression in this population (e.g., Holman & Lorig, 1992 ). Numerous investigations have shown multicomponent interventions (e.g., education, cognitive restructuring, support ) to be valuable methods for promoting more realistic appraisals of illness, improving self-efficacy, generating appropriate coping responses, and reducing helplessness and depression in persons with RA (Lorig, Mazonson, & Holman, 1993; Parker et al., 1995; Rhee et al., 2000; Smarr et al., 1997). Much like depression in the general population, depression in RA is probably best conceptualized as a function of both ineffective cognitive appraisals and conditioned behavioral avoidance of health-promoting activities (see Hollon, DeRubeis, & Seligman, 1992). Because cognitive appraisals and depression early in the course of RA are important determinants of subsequent difficulties (e.g., Schiaffino & Revenson, 1995; Sharpe et al., 2001), it seems that preventive treatment measures aimed at facilitating realistic illness expectations and assisting individuals to generate flexible coping strategies could preempt the development of long-term difficulties (see Astin, Beckner, Soeken, Hochberg, & Berman, 2002; Blalock, DeVellis, Holt, & Hahn, 1993). ...
Article
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Objective: Examine longitudinal relationships between causal attributions and depression symptoms in adults with rheumatoid arthritis (RA). Study Design: Cross-lagged panel correlations tested the temporal precedence of attributions relative to depression symptoms over 1 year. Participants: Forty-two participants completed self-report instruments on 2 occasions. Main Outcome Measures: The Inventory to Diagnose Depression and the Attributional Style Questionnaire. Results: Time 1 attributions predicted increased levels of depression symptoms at Time 2 after perceived pain and disability were controlled: Time 1 depression symptoms were unrelated to Time 2 attributions. Cross-lagged correlation comparisons revealed statistical dominance for attribution-depression relationships relative to depression-attribution relationships. Conclusions: Results support cognitive diathesis conceptualizations of depression and support cognitive-behavioral treatments for depression in RA. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Problem-solving therapies may help pregnant women feel more control in their lives (Miu, 1993). Cognitive-behavioral therapies may also be effective for the development of perceived control, for depression alleviation, and for recurrent episode prevention (Hollon, DeRubeis, & Seligman, 1992). Therapies for changing explanatory style have also demonstrated changes in depression symptoms (Seligman et al., 1988). ...
Article
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Prenatal depression is a significant predictor of postpartum depression and is detrimental to fetal development. Locus of control was examined in this study as a potential predictor of prenatal depression. One hundred and thirty-three rural pregnant women recruited from obstetricians' offices completed the Levenson Scale on Locus of Control and the Edinburgh Postnatal Depression Scale. Multiple regression analysis indicated that after controlling for previous or current mental health problems, the External Locus of Control-Chance Scale accounted for 17% of the variance in depression scores.
... Lepore (1997) also found that expressive writing reduced the impact of negative intrusive throughts, leading to significant declines in depressive symptoms over time. These findings are curious in light of the efficacy of cognitive therapy for depression (e.g., Hollon et al. 1996) and the mounting evidence for the existence of a stable cognitive vulnerability to depression (e.g., Miranda et al. 1998; Alloy and Abramson 1999). These findings suggest that it is cognitive change, not simply the experience of emotion, that reduces both depressive symptoms and the risk of relapse/recurrence. ...
Article
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The effects of cognitive restructuring (CR), emotional processing (EP), and their combination were compared after a depressing life event. Individuals at risk for depressive symptoms secondary to the death, injury, or illness of a pet completed 3 days of expressive writing in one of the three conditions: CR, EP, or the combination. One month later, participants in the combined condition showed the greatest recovery from depressive symptoms, followed closely by those in the EP alone condition. For those whose pets had died, CR alone led to increases in depressive symptoms. Content analysis of CR and emotional arousal confirmed significant between group differences. Results suggest that EP might be important in the early stages of reaction to a negative event.
... Patients treated with CBT are less likely to relapse than patients treated with pharmacotherapy (e.g., Evans et al., 1992;Hollon, DeRubeis, Evans et al., 1992;Shea et al., 1990;Paykel et al., I999). The reason for this may be CBT provides patients with skills they can use when encountering stressful events or painful emotions long after therapy ends (Hollon, DeRubeis, & Seligman, 1992). If this is true, CBT techniques may be useful in preventing depression in individuals who have not yet experienced this disorder. ...
Article
Depression is one of the most common psychological disorders. It is associated with tremendous costs in terms of suffering, decrease in productivity, and loss of life. For many individuals, depression is a disorder that will recur throughout life. Recent findings suggest that the prevalence of depression is on the rise, particularly in young people. Clearly, depression prevention is an important goal. Can depression be prevented? In this article we review research on interventions designed to prevent episodes and symptoms of unipolar depression in adults and children. Our review focuses specifically on cognitive-behavioral and family interventions. We discuss what researchers have learned about the prevention of depression and conclude with recommendations for future investigations.
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Preventing mental illness has become increasingly emphasized as a priority for psychologists. Unfortunately, clinicians who want to incorporate prevention activities into their practice have few available models to guide how they might accomplish such a task. Using the literature on the prevention of depression, the authors make specific recommendations to clinicians who are interested in expanding their practice by offering preventive interventions in addition to their usual treatment activities. Topics discussed include choosing target populations for the intervention, using a theoretical orientation to guide the intervention, selecting specific ingredients to include in the intervention, deciding among different intervention modalities, and obtaining financial reimbursement for prevention work. Prevention work can be a novel solution to help meet the unsatisfied needs of patients, clinicians, and society.
Chapter
Without doubt, some people are at greater risk for depression than others. Depression tends to be both self-limiting and recurrent; that is, any given episode tends to go away, even in the absence of treatment, but the vast majority of people who get depressed will experience multiple episodes (Consensus Development Panel, 1985). Given that most people will never have even a single clinical episode, this means that risk for the disorder is bimodally distributed; a minority of people in the general population will suffer the majority of the episodes of clinical depression.
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The purpose of this paper is to examine the effects of computer/internet game play on depression and life satisfaction via perceived self-control among older adults in Korea. Data were collected from a survey of 237 community-dwelling older adults (age65) who reported internet users. A path analysis was used to examine the causal relationship among the main constructs. Results showed that the computer/internet game play had positive effects on perceived self-control. Perceived self-control was found to decrease depression and improve life satisfaction among older adults. Additional analysis indicated that the computer/internet game play in older adults did not directly affect mental health (depression and life satisfaction) but indirectly affected it via perceived self-control. Furthermore, perceived self-control had greater effects on depression than on life satisfaction. These findings have crucial implications in that perceived sense of self-control needs to be seriously considered when we develop mental health games for older adults.
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Cognitive and cognitive–behavioral interventions (CBT) have emerged over the last quarter century as efficacious and widely practiced approaches to treatment for a variety of psychological disorders. Cognitive Therapy and Research has played a major role in generating that interest in cognitive and cognitive–behavioral interventions. CBT interventions have been shown to have an enduring effect that extends beyond the end of treatment; they reduce risk for relapse in chronic disorders and risk for recurrence in episodic disorders. Whether CBT is truly curative remains to be seen, but there is more good evidence for CBT having an enduring effect than for any other intervention in the field today. The founders of the journal have much of which they can be proud.
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This column is designed to underscore relationally based creative interventions used by counselors and psychotherapists in their practices. Our intention is to provide examples of novel, innovative ways of working with clients in their efforts to deepen self-awareness and their connections with others. Although the interventions within this column will be presented in a linear “how-to” manner, an essential premise of this column is that interventions submitted for publication have a contextual and relational basis. Basic to this column is the therapeutic focus of working through latent hurts and impediments to our clients' health and happiness. Client goals generally involve creating the requisite emotional space needed for genuine relational choice for connection to manifest. If you have created a useful therapy tool or if you have adapted an existing creative tool that you would like to share with readers, please follow submission guidelines in the author information packet available at http://www.creativecounselor.org/Journal.htmlDepression is one of the most common mental health issues. Although drug therapy and cognitive-behavioral therapy remain popular and effective treatments, alternative interventions such as the use of music listening and mindfulness practice as interventions during therapy have gained ground. Research on the use of music listening and mindfulness practice shows each to be effective in treating depression. The authors propose a combined intervention called Mindful Music Listening, during which clients with depression use mindfulness skills while listening to music to notice, label, discuss, and learn to manage their emotions. Possible advantages include greater client self-awareness and emotional regulation as well as a strengthened counselor–client relationship.
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This study investigated the role of perceived control and self-reinforcement in depression among community-dwelling elders from different ethnic backgrounds. The first purpose of this study was to determine the extent to which the behavioral competencies of self-reinforcement and perceived control covary with and predict depression scores among 205 elderly individuals (77 Asian American and 128 Caucasian American). The second purpose was to examine possible cultural differences in depression, self-reinforcement, and perceived control scores. It was found that self-reinforcement predicted depression for the total sample and each ethnic subsample concurrently and 5 months later. Perceived control predicted depression concurrently and subsequently for the Caucasian elders only. Implications for the multicultural assessment of depression among the elderly are discussed.
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Examined the moderating influence of perceived daily illness control on the relationship between disease-unrelated causal attributions and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) depressive symptomatology in a sample of 58 patients (aged 25–75 yrs) with rheumatoid arthritis (RA). Eight of the Ss met DSM-IV criteria for major depression. All Ss completed paper-and-pencil instruments measuring depression, attributional style, arthritis-specific helplessness, disease severity and pain and disability. As predicted, attribution ×  perceived control interactions contributed significant variance to depression, after controlling for disease variables and arthritis helplessness. Specifically, internal and global attributions for negative events were associated with increased levels of depression under conditions of decreased perceived illness control. The findings provide support for examining general attributional style in studies of depression in RA and for cognitive diathesis-stress conceptualizations of adjustment to chronic illness. Clinical implications of the results for cognitive-behavioral treatment approaches in RA are also discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Preventing mental illness has become increasingly emphasized as a priority for psychologists. Unfortunately, clinicians who want to incorporate prevention activities into their practice have few available models to guide how they might accomplish such a task. Using the literature on the prevention of depression, the authors make specific recommendations to clinicians who are interested in expanding their practice by offering preventive interventions in addition to their usual treatment activities. Topics discussed include choosing target populations for the intervention, using a theoretical orientation to guide the intervention, selecting specific ingredients to include in the intervention, deciding among different intervention modalities, and obtaining financial reimbursement for prevention work. Prevention work can be a novel solution to help meet the unsatisfied needs of patients, clinicians, and society. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The importance of psychological treatments in forthcoming national health care plans has been deempha-sized in federally sponsored clinical practice guidelines published to date, and questioned by certain policymakers and consumer groups. Many critics impugn the clinical efficacy and effectiveness of psychological treatment compared to drug treatments. This article reviews evidence suggesting that psychological interventions from a variety of theoretical perspectives have demonstrated effectiveness for a wide range of disorders—either alone or, in some cases, in combination with medications. In most cases these treatments are more effective and often longer lasting than credible alternative psychological interventions serving as “psychological placebos.” Political and public relations issues, as well as problems with dissemination, must be overcome if the public is to benefit fully from powerful and effective psychological interventions in any national health care plan.
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This article reviews the extant literature involving maintenance of treatment effects for depression and provides specific recommendations for future research directions and current clinical practice. Regarding research directions, we emphasize the following strategies: use consistent operational definitions, use consistent measurement criteria, provide complete descriptions of subject samples, test specific treatment components, use dismantling and constructive treatment outcome strategies, use parametric research approaches, use primary and secondary prevention approaches, view depression from a public health perspective, measure maintenance effects often, conduct matching studies, conduct more prediction investigations, and broaden population samples. Clinically, we recommend the following three guidelines: apply a problem-solving model of case formulation, take predictors of relapse into account when designing individual treatment plans, and, in general, conceptualize depression as a recurrent disorder.
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This article describes a three-stage model that can be used to guide the cognitive-behavioral treatment of depression. During the first stage, the therapist establishes a sound therapeutic alliance, conducts a thorough assessment of depression, and uses differential diagnosis to guide the preliminary treatment plan. During the second stage, a series of modules are used to match the treatment plan with the particular needs of each client. The modules target different areas that are often related to depression: reduced activity, social impairment, ineffective coping, cognitive biases, problem-solving deficits, and inadequate self-esteem. During the third stage, depressed clients can learn specific strategies to reduce the risk of relapse and manage the possible recurrence of depressive feelings. The three-stage model promotes an integration of treatment strategies and allows the therapist to provide a structured treatment plan that remains responsive to the needs of each particular client.
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Diurnal variations of surface ozone and NOx* (oxides of nitrogen) at Kannur University campus (12.26N, 75.39E), a rural location and at Kannur Town, an urban location in Kannur (11.86N, 75.35E), a tropical coastal site in India have been studied during winter months in 2009 and 2010. The study revealed that surface ozone abundance is high at Kannur University campus than at Kannur Town. The maximum mixing ratios of surface ozone during winter at rural and urban sites were found to be (44.01±3.1) ppbv and (36.3±5.4) ppbv respectively, which is a clear indication of the air quality over these two locations during the season. Likewise, the ozone production is higher in the afternoon in winter months which in turn reveal the finger print of photolysis of NO2* over these locations. The NOx mixing ratio shows a strong diurnal variability which substantiates the production of ozone from NOx.
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Homework assignments are an integral part of most cognitive therapy treatments for depression. Although investigations of the association between homework adherence and outcome are relatively few in number, recent studies suggest that clients who adhere to homework assignments show greater improvement than those who do not. Following our assessment of the potential impact of homework adherence on outcome, we explore some of the reasons for client nonadherence and attempt to describe characteristics of those individuals who do cany out the assigned work. Given that adherence with homework appears to lead to better outcomes, yet many clients fall to carry out their assignments, we next explore methods for enhancing adherence. Finally, we propose a model of homework adherence and suggest directions for future research.
Article
Purpose: Although cognitive-behavioral interventions have been successful in treating depression, no studies were found that focused solely on reducing negative thinking via group intervention as a means of preventing depression in at-risk groups. The purpose of this randomized controlled trial was to test the effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, decreasing negative thinking, and enhancing self-esteem in young women at risk for depression. Design: A randomized controlled trial with 92 college women ages 18 to 24 who were at risk for depression was conducted. Methods: Participants were randomly assigned to either the control or experimental group. The experimental group participated in a 6-week cognitive-behavioral group intervention. Data on self-esteem, depressive symptoms, and negative thinking were collected via selfreport questionnaires from control and experimental groups at baseline, 1 month after the intervention, and at 6-month follow-up. Data were analyzed using mixed-model methodology and the Cochran-Mantel-Haenszel chi-square test. Findings: Compared to those in the control group, women who received the intervention had a greater decrease in depressive symptoms and negative thinking and a greater increase in self-esteem, and these beneficial effects were maintained over 6-months. Conclusions: The findings document the effectiveness of this cognitive-behavioral group intervention and indicate empirical support for the beneficial effects of reducing negative thinking by the use of affirmations and thought-stopping techniques on women's mental health.
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This is an English translation of the 1999 George Albee Lecture on Primary Prevention, presented by Ricardo F. Muoz at the World Congress of the World Federation for Mental Health in Santiago, Chile, September 8, 1999. The English version is true to the original and maintains the colloquial style of the verbal presentation. Muoz highlights the need for prevention efforts to address the many public health problems linked to depression. He reviews empirical evidence regarding these links including depression and substance abuse, and the effect of providing mood management interventions to ameliorate problems linked to depression. He ends by describing past and current studies being carried out at San Francisco General Hospital which illustrate the feasibility of influencing many public health problems by providing prevention interventions focused on depression.
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The cognitive flexibility inventory (CFI) was developed to be a brief self-report measure of the type of cognitive flexibility necessary for individuals to successfully challenge and replace maladaptive thoughts with more balanced and adaptive thinking. It was designed to measure three aspects of cognitive flexibility: (a) the tendency to perceive difficult situations as controllable; (b) the ability to perceive multiple alternative explanations for life occurrences and human behavior; and (c) the ability to generate multiple alternative solutions to difficult situations. The two studies presented in this manuscript describe the initial development of the CFI and a 7-week longitudinal study. Results from these studies indicate the CFI has a reliable two-factor structure, excellent internal consistency, and high 7-week test–retest reliability. Preliminary evidence was obtained for the CFI’s convergent construct validity via the CFI’s correlations with other measures of cognitive flexibility (Cognitive Flexibility Scale) and coping (Ways of Coping Checklist-Revised), respectively. Support was also demonstrated for the concurrent construct validity of the CFI via its correlation with the BDI-II. Further research is needed to investigate the reliability and validity of the CFI among clinical populations. KeywordsCognitive flexibility-Cognitive flexibility inventory (CFI)-Coping-Cognitive behavior therapy (CBT)-Depression
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Self-report measures of mindfulness have consistently demonstrated positive relationships with well-being and inverse relationships with depression symptoms. The goal of this study was to extend the existing literature to include a test of the incremental validity of the components of mindfulness (as measured by the four factors of the Kentucky Inventory of Mindfulness Skills [KIMS]; Baer et al. Assessment, 11, 191–206, 2004) and the Mindful Attention Awareness Scale (MAAS; Brown and Ryan Journal of Personality and Social Psychology, 84, 822–848, 2003) in the prediction of satisfaction with life (relative to self-esteem) and depression (relative to negative cognitions) among a sample of 365 college students. Results revealed only KIMS Observe accounted for a significant amount variance relative to self-esteem in the prediction of satisfaction with life, and in the prediction of depression symptoms, only KIMS Accept without Judgment accounted for a significant amount of variance relative to negative cognitions. These results are discussed in relation to the measurement of mindfulness and methods used to assess the validity of these scales.
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Cognitive-behavioral therapy has been found effective in the treatment of depression. However, most guides to conducting cognitive-behavioral therapy focus on a session-by-session description of treatment issues. The present manuscript describes the first in a series of interrelated therapy modules to help guide the treatment of depression. The use of modules helps the therapist adapt the therapy to the unique needs of each individual client, emphasizing some elements while omitting others. Also, the use of modules can maximize the short-term application of psychotherapy, allowing therapists to select certain elements to be omitted or repeated as needed for a specific client. Procedures are described for assessing the severity of depression, evaluating the need for medications, and determining when hospitalization is needed. Also, recommendations are provided for monitoring suicide risk factors and preventing self-injury in depressed and suicidal clients.
Article
Cognitive therapy has become a well established and widely used treatment for depression. However, most treatment guidelines describe a session-by-session focus that may not adequately conform with the individualized nature of individual psychotherapy used in most clinical settings. The present manuscript describes strategies for helping clients to reduce their cognitive biases by: (1) identifying their cognitive biases, (2) appreciating the relationship between cognitions, emotions, and behavior, (3) distancing themselves from their perspective, (4) developing realistic positive self-statements, (5) altering maladaptive thought processes, (6) shortening the temporal delay required to challenge their thoughts, and (7) learning to find positive elements in predominantly negative situations. These strategies for reducing cognitive biases can be incorporated into a comprehensive treatment plan that includes modules for the assessment of depression severity and suicide risk, enhancing social performance, and improving problem-solving skills. The modules are meant to be used in a flexible manner, allowing the therapist to address a variety of treatment goals while still responding to the unique needs of each client.
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Several controlled treatment-outcome studies have demonstrated the clinical efficacy of group behavioral and cognitive behavioral treatments for depression. However, there is a significant lack of evidence on mental health outcome evaluation studies for depression conducted in nonresearch clinical settings. Subjects in research settings may represent only about 20% of the clinical population because of stringent inclusion criteria, requirements to accept random assignment to conditions, etc. The present study is a clinical replication series of the effectiveness of group cognitive behavior therapy for depression administered in a nonresearch community setting. The subjects included 138 adult patients referred by mental health clinic providers for participation in a six-session (12-hour) depression management group. Outcome measures using the Beck Depression Inventory indicated that the level of depression was decreased for 84% of the participants, the average reduction in depression as measured by the BDI was 38%, and 43% of the patients had a greater than 50% reduction in their BDI score. The results indicated that group cognitive behavior therapy can be effectively applied in a clinical setting with a heterogeneous patient population, although the magnitude of the treatment effect was somewhat less than found in research settings (38% reduction on the BDI as compared to 57%). Group cognitive behavior therapy is a cost-effective treatment approach and the potential for benefits significantly outweighs the cost. In this era of managed care initiatives, group cognitive behavior therapy for depression should be considered as a first-line treatment intervention for many patients with depression as part of a stepped-care treatment approach to provide “the best treatment at the best value.”
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The empirical status of cognitive approaches to schizophrenia is presented. A review of outcome studies identifies patient characteristics, describes treatment components, delineates outcome and follow-up status (if available), and considers commonalties among therapy components. A “clinical section,” synthesized largely from the successful outcome studies, presents cognitive therapy principles and strategies adapted to treatment of schizophrenia. Theoretical issues, such as ecological validity and the necessity to target both disordered cognitive content and processing, are briefly addressed. Finally, eight “burning questions” or issues for future research are suggested.
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This article is a response to Coyne, Thompson, Palmer, Kagee, and Maunsell's (2000) article, “Should We Screen for Depression? Caveats and Potential Pitfalls.” We address four points that we view as central to their argument: (1) current screening measures are inadequate; (2) correct identification of depressed patients does not result in improved clinical outcomes; (3) screening is too expensive; and (4) screening may have harmful negative effects. We discuss the following important issues: (1) screening and prevention are still in the research and development phase; (2) the kindling phenomenon is an important reason to screen; (3) there is a need to focus screening and prevention efforts on ethnic minorities; and (4) high depressive symptoms have a substantial public health impact. Finally, we present reasons why screening is advisable, both for prevention and treatment purposes, and provide our recommendations. Our stance is that, in order for screening and prevention to become practical, they need to be implemented in both research and practice contexts. Therefore, we should make screening for major depression a priority.
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There is a robust association between marital adjustment and depressive symptoms, and many scholars identify marital discord as a cause of depression. Outcome research shows that marital interventions are effective for increasing marital adjustment and that they may have considerable potential both in the treatment of episodes of depression and in the prevention of depressive symptomatology. To encourage further development of marital interventions for depression, a model is offered that incorporates individual difference and development perspectives.
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In 1984, a National Institute of Mental Health public information pamphlet titled Depression: What We Know stated that “In general, the onset of a clinical depression cannot be prevented” (Lobel & Hirschfeld, 1984, p. 4). This paper examines the current evidence on this question. After the scope of depression prevention research has been specified, studies focused on preventing clinical episodes of depression, preventing high symptom levels, and reducing symptom levels in high-risk groups will be reviewed. This will represent what has been done to date in terms of preventive interventions. Next, several research areas that have potential contributions to make in the quest for future depression prevention strategies will be explored.
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In two studies we tested the hypothesis that endorsement of dysfunctional beliefs depends on current mood state for persons who are vulnerable to depression. The first study showed that reports of dysfunctional beliefs vary with spontaneous diurnal mood fluctuations in 47 depressed psychiatric patients. The effect of mood state was highly significant (p < .01) ; dysfunctional thinking increased when mood was worst and decreased when mood was best. The second study conceptually replicated this finding in a population of asymptomatic subjects. As predicted, reports of dysfunctional beliefs varied as a function of mood state in 14 persons who had experienced a depressive episode but not in 27 who had never been depressed. These findings support the cognitive theory of depression, which proposes that dysfunctional beliefs are vulnerability factors for depression but also that reporting of dysfunctional beliefs depends on current mood state.
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In the NIMH Treatment of Depression Collaborative Research Program (TDCRP), 250 depressed outpatients were randomly assigned to interpersonal psychotherapy, cognitive–behavioral therapy, imipramine plus clinical management, or pill placebo plus clinical management treatments. Although all treatments demonstrated significant symptom reduction with few differences in general outcomes, an important question concerned possible effects specific to each treatment. The therapies differ in rationale and procedures, suggesting that mode-specific effects may differ among treatments, each of which was precisely specified, applied appropriately, and shown to be discriminable. Outcome measures were selected for presumed sensitivity to the different treatments. Findings provided only scattered and relatively insubstantial support for mode-specific differences. None of the therapies produced consistent effects on measures related to its theoretical origins.
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143 undergraduates completed an attributional style scale designed by the authors, the short form of the Beck Depression Inventory, and the Multiple Affect Adjective Check List. Results show that depressed Ss, compared to nondepressed Ss, attributed bad outcomes to internal, stable, and global causes, as measured by the attributional style scale. This attributional style was predicted by the reformulated helplessness model of depression. In addition, relative to nondepressed Ss, depressed Ss attributed good outcomes to external, unstable causes. (8 ref)
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Cognitive therapy (CT) for depression has generated considerable interest in recent years. Comparisons with tricyclic pharmacotherapy in nonbipolar outpatients have suggested that (a) CT may be roughly comparable in the treatment of the acute episode; (b) combined CT-pharmacotherapy does not appear to be clearly superior to either modality (although indications of potential enhancement do exist to justify additional studies with larger samples), and (c) treatment with CT during the acute episode (either alone or with medications) may reduce the risk of subsequent relapse following termination. Nonetheless, for a variety of reasons (e.g., limitations in study design and execution, inadequate design power, and possible differential retention), these conclusions can be considered only suggestive at this time. More than a decade after the publication of the first controlled study involving CT, the approach remains a promising, but not adequately tested, alternative to pharmacotherapy in the treatment of depression. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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We present a revision of the 1978 reformulated theory of helplessness and depression and call it the hopelessness theory of depression. Although the 1978 reformulation has generated a vast amount of empirical work on depression over the past 10 years and recently has been evaluated as a model of depression, we do not think that it presents a clearly articulated theory of depression. We build on the skeletal logic of the 1978 statement and (a) propose a hypothesized subtype of depression— hopelessness depression, (b) introduce hopelessness as a proximal sufficient cause of the symptoms of hopelessness depression, (c) deemphasize causal attributions because inferred negative consequences and inferred negative characteristics about the self are also postulated to contribute to the formation of hopelessness and, in turn, the symptoms of hopelessness depression, and (d) clarify the diathesis—stress and causal mediation components implied, but not explicitly articulated, in the 1978 statement. We report promising findings for the hopelessness theory and outline the aspects that still need to be tested. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Criticizes and reformulates the learned helplessness hypothesis. It is considered that the old hypothesis, when applied to learned helplessness in humans, has 2 major problems: (a) It does not distinguish between cases in which outcomes are uncontrollable for all people and cases in which they are uncontrollable only for some people (universal vs personal helplessness), and (b) it does not explain when helplessness is general and when specific, or when chronic and when acute. A reformulation based on a revision of attribution theory is proposed to resolve these inadequacies. According to the reformulation, once people perceive noncontingency, they attribute their helplessness to a cause. This cause can be stable or unstable, global or specific, and internal or external. The attribution chosen influences whether expectation of future helplessness will be chronic or acute, broad or narrow, and whether helplessness will lower self-esteem or not. The implications of this reformulation of human helplessness for the learned helplessness model of depression are outlined. (92 ref)
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In the NIMH Treatment of Depression Collaborative Research Program (TDCRP), 250 depressed outpatients were randomly assigned to interpersonal psychotherapy, cognitive-behavioral therapy, imipramine plus clinical management, or pill placebo plus clinical management treatments. Although all treatments demonstrated significant symptom reduction with few differences in general outcomes, an important question concerned possible effects specific to each treatment. The therapies differ in rationale and procedures, suggesting that mode-specific effects may differ among treatments, each of which was precisely specified, applied appropriately, and shown to be discriminable. Outcome measures were selected for presumed sensitivity to the different treatments. Findings provided only scattered and relatively insubstantial support for mode-specific differences. None of the therapies produced consistent effects on measures related to its theoretical origins.
Article
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In two studies we tested the hypothesis that endorsement of dysfunctional beliefs depends on current mood state for persons who are vulnerable to depression. The first study showed that reports of dysfunctional beliefs vary with spontaneous diurnal mood fluctuations in 47 depressed psychiatric patients. The effect of mood state was highly significant (p less than .01); dysfunctional thinking increased when mood was worst and decreased when mood was best. The second study conceptually replicated this finding in a population of asymptomatic subjects. As predicted, reports of dysfunctional beliefs varied as a function of mood state in 14 persons who had experienced a depressive episode but not in 27 who had never been depressed. These findings support the cognitive theory of depression, which proposes that dysfunctional beliefs are vulnerability factors for depression but also that reporting of dysfunctional beliefs depends on current mood state.
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The effects of changes in depression-relevant cognition were examined in relation to subsequent change in depressive symptoms for outpatients with major depressive disorder randomly assigned to cognitive therapy (CT; n = 32) versus those assigned to pharmacotherapy only (NoCT; n = 32). Depression severity scores were obtained at the beginning, middle, and end of the 12-week treatment period, as were scores on 4 measures of cognition: Attributional Styles Questionnaire (ASQ), Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS), and the Hopelessness Scale (HS). Change from pretreatment to midtreatment on the ASQ, DAS, and HS predicted change in depression from midtreatment to posttreatment in the CT group, but not in the NoCT group. It is concluded that cognitive phenomena play mediational roles in cognitive therapy. However, data do not support their status as sufficient mediators.
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In this article we attempt to distinguish empirically between psychosocial variables that are concomitants of depression, and variables that may serve as antecedents or sequelae of this disorder. We review studies that investigated the relationship between depression and any of six psychosocial variables after controlling for the effects of concurrent depression. The six variables examined are attributional style, dysfunctional attitudes, personality, social support, marital distress, and coping style. The review suggests that whereas there is little evidence in adults of a cognitive vulnerability to clinical depression, disturbances in interpersonal functioning may be antecedents or sequelae of this disorder. Specifically, marital distress and low social integration appear to be involved in the etiology of depression, and introversion and interpersonal dependency are identified as enduring abnormalities in the functioning of remitted depressives. We attempt to integrate what is known about the relationships among these latter variables, suggest ways in which they may influence the development of depression, and outline specific issues to be addressed in future research.
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To test the hypothesis that self-report of dysfunctional attitudes is mood-state dependent, dysfunctional attitudes were assessed in 43 women before and after they received a depressed or elated mood induction. As predicted, the mood induction produced reliable changes in mood and in dysfunctional attitudes, although the increase in dysfunctional attitudes following the negative mood induction was not large enough to be statistically significant. We also tested the hypothesis, from the cognitive theory of depression, that subjects with previous episodes of depression would report more dysfunctional attitudes than would subjects without such a history. As predicted, subjects who reported previous episodes of depression endorsed more dysfunctional attitudes than did subjects who did not report such a history. However, this effect occurred only for subjects who were in a negative mood state when their dysfunctional attitudes were assessed. These findings support the proposition of the cognitive theory that dysfunctional attitudes are traits but suggest that these traits are mood-state dependent. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In recent empirical trials testing causal mediational models of cognitive therapy for depression, researchers have found comparable change in cognition regardless of intervention, leading some to reject any mediational role for cognition. Such an interpretation is premature because alternative models exist that allow potential mediators to exhibit nonspecific change across diverse interventions yet still play a causal mediational role in one or all of those interventions. A failure to distinguish between the mediator's role as a consequence of the manipulation and its role as a potential cause of the dependent outcome is seen as contributory to this premature rejection. We suggest strategies that can facilitate the testing of causal mediational models.
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
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Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominated in men were antisocial personality and alcohol abuse and dependence. Disorders that most clearly predominated in women were depressive episodes and phobias. The age group with highest rates for most disorders was found to be young adults (aged 25 to 44 years). Correlates with race, education, and urbanization are presented.
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In a double-blind, long-term follow-up study, 117 bipolar patients received lithium carbonate, imipramine hydrochloride, or both and 150 unipolar patients received lithium carbonate, imipramine, both lithium carbonate and imipramine, or placebo. With bipolar patients, lithium carbonate and the combination treatment were superior to imipramine in preventing manic recurrences and were as effective as imipramine in preventing manic recurrences and were as effective as imipramine in preventing depressive episodes. The combination treatment provided no advantage over lithium carbonate alone. With unipolar patients, imipramine and the combination treatment were more effective than lithium carbonate and placebo in preventing depressive recurrences. The combination treatment provided no advantage over imipramine alone. The lithium carbonate-treated group had fewer manic episodes than the other groups. Treatment outcome, which was evaluated primarily in terms of the occurrence of major depression or manic episodes, was significantly related to characteristics of the index episode, ie, the episode that brought the patient into the study.
Chapter
For the majority of individuals suffering from depression, any given episode is likely to remit without intervention, but subsequent episodes are apt to occur in the future (Zis & Goodwin, 1979). Given this high rate of renewed subsequent symptomaticity, increased attention has been paid in recent years to the distinction between blocking relapse, the return of symptoms associated with a prior episode, versus the prevention of recurrence, the onset of a wholly new episode (Post, 1959; Prien, 1984; Prien & Caffey, 1977; Prien & Kupfer, 1986; Quitkin, Rifkin, & Klein, 1976). In this chapter we focus on the issue of the long-term stability of treatment gains. We do so with particular reference to a recently completed comparative trial contrasting cognitive therapy and imipramine tricyclic pharmacotherapy, each alone and in combination, in the treatment of depressed outpatients (Hollon, DeRubeis, Evans, Wierner, Garvey, Grove, & Tuason, 1990). In addition to contrasting the efficacy of each intervention with respect to the reduction of acute symptomatology, we also evaluated the long-term efficacy of each over a two-year posttreatment follow-up period (Evans, Holton, DeRubeis, Piasecki, Grove, Garvey, & Tuason, 1990). As we shall see, our initial goal was to evaluate the impact of the different interventions on the prevention of subsequent episodes (recurrence). While differential effects were found (Evans et al., 1990), it is not clear that these findings were so much informative about recurrence as about clinical relapse.
Article
This report represents the consensus of a panel of representatives from psychiatry, psychology, pharmacology, epidemiology, internal medicine, and the general public regarding the use of pharmacologic agents to prevent recurrences of mood disorders. The panel concluded that recurrent mood disorders, which have a high prevalence and serious consequences, are underdiagnosed and undertreated. Applying appropriate strategies to the management and use of pharmacologic agents will enhance the likelihood of compliance and the prevention of recurrence with a minimum of bothersome side effects. Such strategies should be used within the context of a supportive relationship among doctor, patient, and family.
Article
• Using a controlled, clinical-trial format, 44 nonpsychotic, nonbipolar, depressed outpatients were treated with cognitive therapy or imipramine hydrochloride over a 12-week period. Although both interventions were associated with significant reductions in levels of depression, the cognitive-therapy patients showed greater symptomatic improvement and a higher treatment-completion rate. A one-year naturalistic follow-up of the 35 subjects who completed the protocol revealed that although many of the patients had a variable clinical course, both original treatment groups remained generally well. Self-rated depressive symptomatology was significantly lower for those who, one year earlier, had completed cognitive therapy than for those who had been in the clinical trial's pharmacotherapy cell. While there were several other interesting trends in favor of the cognitivetherapy patients, none of the between-group differences were significant. The pragmatic and clinical implications of the followup results are discussed.
Article
• Twenty-eight moderately depressed outpatients were randomly assigned to 12 weeks of cognitive therapy (N =14) or pharmacotherapy (N =14). Significant changes in mood, cognitive processes, and content were similar to those found in previous studies demonstrating effectiveness of cognitive therapy. Patients treated with medication, however, demonstrated nearly identical change on all measures, including cognitive measures, despite the absence of direct focus on cognitive activity. Further analyses disclosed that cognitive change may be an important feature of overall clinical improvement, as patients whose conditions did not improve (regardless of treatment modality) showed significantly less change on cognitive measures. These findings suggest that cognitive change may be more accurately seen as a part of improvement rather than the primary cause of improvement. This suggests a more complex conceptualization of the role of cognitions in the change secured by cognitive therapy.
Article
• We conducted a randomized 3-year maintenance trial in 128 patients with recurrent depression who had responded to combined short-term and continuation treatment with imipramine hydrochloride and interpersonal psychotherapy. A five-cell design was used to determine whether a maintenance form of interpersonal psychotherapy alone or in combination with medication could play a significant role in the prevention of recurrence. A second question was whether maintaining antidepressant medication at the dosage used to treat the acute episode rather than decreasing to a "maintenance" dosage would provide prophylaxis superior to that observed in earlier trials in which a maintenance dosage strategy was employed. Survival analysis demonstrated a highly significant prophylactic effect for active imipramine hydrochloride maintained at an average dose of 200 mg and a modest prophylactic effect for monthly interpersonal psychotherapy. We conclude that active imipramine hydrochloride maintained at an average dose of 200 mg is an effective means of preventing recurrence and that monthly interpersonal psychotherapy serves to lengthen the time between episodes in patients not receiving active medication.
Article
• In a double-blind, long-term follow-up study, 117 bipolar patients received lithium carbonate, imipramine hydrochloride, or both and 150 unipolar patients received lithium carbonate, imipramine, both lithium carbonate and imipramine, or placebo. With bipolar patients, lithium carbonate and the combination treatment were superior to imipramine in preventing manic recurrences and were as effective as imipramine in preventing manic recurrences and were as effective as imipramine in preventing depressive episodes. The combination treatment provided no advantage over lithium carbonate alone. With unipolar patients, imipramine and the combination treatment were more effective than lithium carbonate and placebo in preventing depressive recurrences. The combination treatment provided no advantage over imipramine alone. The lithium carbonate-treated group had fewer manic episodes than the other groups. Treatment outcome, which was evaluated primarily in terms of the occurrence of major depression or manic episodes, was significantly related to characteristics of the index episode, ie, the episode that brought the patient into the study.
Article
• Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominated in men were antisocial personality and alcohol abuse and dependence. Disorders that most clearly predominated in women were depressive episodes and phobias. The age group with highest rates for most disorders was found to be young adults (aged 25 to 44 years). Correlates with race, education, and urbanization are presented.
Article
Recent advances in delineating basic cognitive and social cognitive processes may hold great promise for furthering our understanding of important clinical issues, in particular theories of psychopathology, theories of therapeutic change, and theories of clinical inference. In this article, the role of knowledge structures (including schemata), processing heuristics, biases, and products are explored with particular emphasis on their potential role in the clinical change process. Therapies which are explicitly metacognitive in nature are seen as frequently, but not invariably, most closely approximating the active intervention components most likely to produce alterations in important mechanisms mediating change. Suggestions for refinements in both clinical practice and clinical research are offered.
Article
\s=b\ Twenty-eight moderately depressed outpatients were randomly assigned to 12 weeks of cognitive therapy (N =14) or pharmacotherapy (N =14). Significant changes in mood, cognitive processes, and content were similar to those found in previous studies demonstrating effectiveness of cognitive therapy. Patients treated with medication, however, demonstrated nearly identical change on all measures, including cognitive measures, despite the absence of direct focus on cognitive activity. Further analyses disclosed that cognitive change may be an important feature of overall clinical improvement, as patients whose conditions did not improve (regardless of treatment modality) showed significantly less change on cognitive measures. These findings suggest that cognitive change may be more accurately seen as a part of improvement rather than the primary cause of improvement. This suggests a more complex conceptualization of the role of cognitions in the change secured by cognitive therapy. (Arch Gen Psychiatry 1984;41:45-51)
Chapter
Attribution theory is concerned with the attempts of ordinary people to understand the causes and implications of the events they witness. It deals with the “naive psychology” of the “man in the street” as he interprets his own behaviors and the actions of others. For man—in the perspective of attribution theory—is an intuitive psychologist who seeks to explain behavior and draw inferences about actors and their environments. To better understand the perceptions and actions of this intuitive scientist, his methods must be explored. The sources of oversight, error, or bias in his assumptions and procedures may have serious consequences, both for the lay psychologist himself and for the society that he builds and perpetuates. These shortcomings, explored from the vantage point of contemporary attribution theory, are the focus of the chapter. The logical or rational schemata employed by intuitive psychologists and the sources of bias in their attempts at understanding, predicting, and controlling the events that unfold around them are considered. Attributional biases in the psychology of prediction, perseverance of social inferences and social theories, and the intuitive psychologist's illusions and insights are described.
Article
Examined the effects of cognitive therapy and imipramine on hopelessness and self-concept in 35 unipolar nonpsychotic depressed outpatients who were treated with either modality over approximately 11 wks. Ss were evaluated with the Beck Depression Inventory, Hamilton Rating Scale for Depression, and the Miskimins Self-Goal-Other II. Compared with imipramine, cognitive therapy resulted in significantly greater improvements in hopelessness and more generalized gains in self-concept. It is suggested that cognitive change techniques that reduce hopelessness may be combined with chemotherapy to decrease the risk of suicide during initial treatment phases. (19 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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describes work in progress on the first (to our knowledge) randomized, controlled preventive trial focusing on clinical depression focus primarily on issues of identifying, recruiting, and retaining a representative sample of persons from a high risk population (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Coping with Depression Course (CWD) description of the CWD Course summary of the results of several treatment outcome studies potential applications to prevention and directions for future research (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Describes a multimodal, psychoeducational group treatment course for unipolar depression offered at the University of Oregon Depression Research Unit. The course teaches people techniques and strategies for coping with the problems that are assumed to be related to their depression, focusing on target behaviors such as social skills, thinking, pleasant activities, and relaxation, and on cognitive-behavioral therapy for depression. The rationale and theoretical framework of the course are reviewed, and a course overview is presented. The course consists of 12 2-hr sessions conducted over 8 wks, and participants are selected from respondents to newspaper, TV, and radio advertisements. Efficacy of the course was evaluated by comparing Ss who received immediate treatment with Ss who were on a waiting list for 8 wks before starting treatment. Findings reveal more clinical improvement for all of the active conditions compared with the delayed treatment condition, and improvement continued to be substantial at 1- and 6-mo follow-up. A syllabus of the course is presented, emphasizing the goals, assignments, and thoughts to consider for each session. (23 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
reviews the theoretical and design specifications for a community-based prospective preventive intervention study currently in process in San Diego, California goal is to prevent the onset of depression and high levels of depressive symptoms among Mexican-American women between thirty-five and fifty years of age using a three-group design, including a control and two intervention groups (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Reviews studies that compared cognitive therapy (COT) and pharmacotherapy (PHT), alone or combined, for the treatment of depression. Evidence suggests that COT is comparable to tricyclic PHT in the treatment of nonpsychotic, nonbipolar depressed outpatients, although no evidence favors either single modality over the other. COT appears to provide some protection against relapse following termination of treatment, and combined COT/PHT treatment appears to provide as much protection against subsequent relapse as COT alone. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Several recent studies have suggested that negative patterns of thinking are not predictive of future depression. Such conclusions are inconsistent with some current theories of depression (e.g., Abramson, Seligman, & Teasdale, 1978; Beck, 1976; Ellis & Harper, 1975) that assign a major causal role to cognitions. In the present article some possible reasons for the null findings are discussed. First, it is suggested that individuals who are vulnerable to depression may differ from other persons by having highly negativistic thinking patterns, but that these patterns may be latent and less cognitively accessible than neutral or even positively valenced thinking patterns, except when it happens that the negativistic cognitions have been primed by situations (e.g., failure) analogous to the original situations in which they were learned. One important implication of these views concerns the type of testing situation in which responses to measures of an insidious cognitive style or negativistic thinking patterns will be most predictive of naturally occurring depression. Second, it is suggested that further attention needs to be given to certain measurement considerations that have proven important in the broader field of personality (e.g., Epstein, 1979).
Article
In this paper, we attempt to put forward an oft-ignored model for describing cognitive change during cognitive therapy for depression, while discussing the strengths and weaknesses of the three models of change described by Hollon, Evans, and DeRubeis. Along the way we point out some of the conceptual ambiguities regarding cognitive processes and contents as they have been applied in the cognitive therapy literature. We propose that short-term cognitive therapy works primarily through the teaching of compensatory skills. Our proposal is motivated, in part, by the paucity of differential effects of cognitive therapy when compared with antidepressant medications on existing cognitive measures, when at the same time there are reports of differential relapse prevention for these two treatments. In addition, we describe a set of features that a measure of compensatory skills should possess.
Article
Both biological and psychological factors have been implicated in the etiology and treatment of depression. Simple deficit theories in both domains have given way to more complex models that emphasize multiple regulatory systems. Evidence has accumulated that both biological and psychological factors are important, but questions remain as to how they relate to one another and the extent that each contributes to the etiologies of the various subtypes within the disorder. Current research evidence supports the effectiveness of both pharmacological and psychosocial interventions in the treatment of depression. Although the efficacy of the former is more firmly established, the latter (particularly the cognitive-behavioral approaches) may have a preventive capacity that survives the termination of treatment.
Article
143 undergraduates completed an attributional style scale designed by the authors, the short form of the Beck Depression Inventory, and the Multiple Affect Adjective Check List. Results show that depressed Ss, compared to nondepressed Ss, attributed bad outcomes to internal, stable, and global causes, as measured by the attributional style scale. This attributional style was predicted by the reformulated helplessness model of depression. In addition, relative to nondepressed Ss, depressed Ss attributed good outcomes to external, unstable causes. (8 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Depressed patients who had responded to either cognitive therapy, pharmacotherapy or the 2 treatments combined, were followed up retrospectively over a period of 2 years. There were significantly more relapses at 6 months in the pharmacotherapy group compared to the combined treatment group and the 2 cognitive therapy groups together. The number of individuals who relapsed at some point over the 2 years was significantly higher in the pharmacotherapy group than in either of the cognitive therapy groups. When hospital patients were considered separately, significantly more patients in the pharmacotherapy group relapsed over the 2 years compared to the 2 cognitive therapy groups combined. Methodological problems of naturalistic follow-up studies are discussed and the prophylactic potential of cognitive therapy is discussed relative to continuation drug treatment.
Article
A major problem for the practitioner is the lack of satisfactory guidelines as to how long continuation drug treatment of depressive episodes must be maintained to ensure that the episode is over. This often leads to either premature withdrawal of the drug and subsequent relapse or unnecessarily prolonged treatment. Results from a collaborative project of the National Institute of Mental Health provide the first study-derived guidelines on the length of continuation therapy. Findings indicate that withdrawal of such therapy is safe only after the patient has been free of significant symptoms for 16 to 20 weeks and that focusing on mild as well as severe symptoms is critical in this decision.
Article
Two hypotheses concerning cognitive vulnerability to depression were examined. One suggested that there are persistent individual differences in cognitive processing related to neuroticism which predispose to depression. The other suggested that individuals in whom depressogenic processes are activated by mildly depressed mood are particularly vulnerable to becoming more seriously depressed. Compared to women who had never met Research Diagnostic Criteria for depressive disorders, women who had recovered from such disorders scored higher on measures of depression as an enduring characteristic; scored higher on measures of neuroticism; used more globally negative words, highly descriptive of depressed patients, to describe their personality; showed poorer recall of self-referred positive words, suggesting reduced activation of positive aspects of the self-schema; and in induced depressed mood showed better recall of self-referred global negative words, suggesting greater activation of related aspects of the self-schema. Results provided support for both hypotheses.
Article
Seventy patients with nonbipolar affective disorder who completed a 12-week course of either cognitive therapy (CT), pharmacotherapy, CT plus active placebo, or CT plus pharmacotherapy were assessed one month, six months, and one year after termination of active treatment. Of the 44 patients who had originally responded to treatment, 16 relapsed as defined by reentry into treatment or by self-reported depression scores in the moderately depressed range. Twenty-eight patients remained well during the one-year follow-up. Patients with relatively high levels of remaining depressive symptoms on completion of treatment relapsed more often than those who had little or no residual depression. Further, at treatment termination, patients who relapsed had significantly higher scores on a measure of dysfunctional attitudes. Patients who had received CT (with or without tricyclic antidepressants) were less likely to relapse in the one-year follow-up period than patients who received pharmacotherapy.
Article
Synopsis A detailed analysis of the results of a multi-centre clinical trial shows that, while the relapse rate following recovery from an operationally defined depressive illness was smaller among patients subsequently treated with either amitryptiline or lithium than with a placebo, there was no clinically significant difference between the prophylactic efficacy of the 2 antidepressants. An account is given of the relative adverse effects of the treatments, and the implications of the findings are discussed.
Article
The attributional reformulation of the learned helplessness model as outlined by L. Y. Abramson et al (see record 1979-00305-001) claims that an explanatory style in which bad events are explained by internal, stable, and global causes is associated with depressive symptoms. This style is claimed to be a risk factor for subsequent depression when bad events are encountered. A variety of new investigations of the helplessness reformulation are described that have employed 5 research strategies: cross-sectional correlational studies, longitudinal studies, experiments of nature, laboratory experiments, and case studies. Ss in these investigations included children, college students, poor women, depressed patients, and prisoners. Most of these studies involved the use of the Attributional Style Questionnaire and measures such as the Beck Depression Inventory and Multiple Affect Adjective Check List. These studies converge in their support for the learned helplessness reformulation. (120 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A treatment trial comparing cognitive therapy and pharmacotherapy, alone and in combination, in depressed out-patients, indicated that outcome on cognitive variables was similar to outcome on mood and severity measures, pharmacotherapy being less effective than cognitive therapy or the combined treatment in a hospital and a general practice sample. While combined treatment was superior to cognitive therapy in the hospital out-patients, the two treatments were equivalent in the general practice. Significant effects were obtained on measures of views of self, the world and the future, whose validity was demonstrated. The pattern of change through treatment showed the same order of progress for responders, while non-responders to cognitive therapy tended to do worst. The specificity of treatment effect is discussed.