Sudden gains and critical sessions in cognitive-behavioral therapy for depression.

In this study of cognitive-behavioral therapy for depression, many patients experienced large symptom improvements in a single between-sessions interval. These sudden gains' average magnitude was 11 Beck Depression Inventory points, accounting for 50% of these patients' total improvement. Patients who experienced sudden gains were less depressed than the other patients at posttreatment, and they remained so 18 months later. Substantial cognitive changes were observed in the therapy sessions preceding sudden gains, but few cognitive changes were observed in control sessions, suggesting that cognitive change in the pregain sessions triggered the sudden gains. Improved therapeutic alliances were also observed in the therapy sessions immediately after the sudden gains, as were additional cognitive changes, suggesting a three-stage model for these patients' recovery: preparation?→?critical session/sudden gain?→?upward spiral. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported individual and group psychological treatments for adult mental disorders.

The experimental literature on individual and group psychological treatments for adult disorders is reviewed. For each of the 11 disorders or problems covered, treatments that fall into the following categories, as defined by D. L. Chambless and S. D. Hollon (1998), are identified: efficacious and specific, efficacious, and possibly efficacious. Behavioral and cognitive–behavioral treatments dominate the lists, especially in the anxiety disorders, with notable exceptions. Reasons for the hegemony of the behavioral and cognitive modalities are discussed, and some limitations of the empirically supported treatment concept are addressed. Continued research is recommended on Aptitude?×?Treatment interactions, cost–benefit ratios, and generalization of treatments to a variety of patient populations, therapists, and treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can psychotherapies for depression be discriminated? A systematic investigation of cognitive therapy and interpersonal therapy.

Determined whether it is possible to identify distinct and theoretically meaningful differences between 2 forms of therapy used in the treatment of depression: cognitive-behavioral therapy (C/B) and interpersonal therapy (IPT). Six videotapes of actual therapy sessions in each of the treatment modes were presented to 12 naive raters (professionals and graduate students). Each listened to and/or viewed 4 tapes, 2 from each of the therapeutic schools. For each tape, Ss completed a 48-item Likert-type scale designed for use in this study. In addition, experts in both of the therapeutic modes were asked to indicate the characteristics of a "good, typical" C/B or IPT session using the same scale. Analysis indicated that 38 of the items discriminated significantly between the types of therapy. The direction of the differences was generally consistent with the experts' predictions. Factor analysis yielded 4 principal factors, 2 related to modality-specific techniques and 2 to nonspecific factors. No consistent bias attributable to observational medium was obtained. It is concluded that relatively naive raters working from taped samples of actual clinical practice can detect clear procedural differences between 2 types of therapy and that these detected differences are related to the differences expected by experts associated with each approach. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Placebo-psychotherapy combinations: Inappropriate representations of psychotherapy in drug-psychotherapy comparative trials.

Argues that placebo-plus-psychotherapy combinations involve potential additive or interactive effects derived from the patient's or the therapist's perception that the patient is receiving an active medication. The perception renders this condition nonrepresentative of psychotherapy as it is typically practiced. Further, these combinations (in the absence of a psychotherapy-alone cell) are logically incapable of providing the controls that are necessary to rule out the existence of drug taking-by-psychotherapy interactions, precisely the hypothesis that their inclusion is intended to test. Finally, a review of the existing drug–psychotherapy literature points to bidirectionality in the noncomparability of placebo-plus-psychotherapy relative to psychotherapy alone. That is, the combination may sometimes overestimate, but appears more typically to underestimate, the efficacy of psychotherapy alone. Suggestions are provided for the appropriate selection of control conditions in drug–psychotherapy comparisons. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Causal mediation of change in treatment for depression: Discriminating between nonspecificity and noncausality.

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Progressive resistance to a selective serotonin reuptake inhibitor but not to cognitive therapy in the treatment of major depression.

Recent research suggests that there may be a reduction in therapeutic response after multiple administrations of antidepressant drug (AD) therapy in patients with major depressive disorder. This study assessed the response to AD therapy and cognitive therapy (CT) of patients with a history of prior AD exposures. A sample of 240 patients with moderate-to-severe major depressive disorder entered a randomized controlled trial comparing pharmacotherapy with paroxetine to CT. Treatment was administered for 16 weeks. History of prior AD exposure was assessed with structured interviews, self-report, and medical records. Analyses were conducted using hierarchical linear models on the intent-to-treat sample. After controlling for various demographic and clinical factors, more prior AD exposures predicted poor response to paroxetine therapy but not to CT, as measured by the Hamilton Rating Scale for Depression (Hamilton, 1960; Williams, 1988). Whereas CT outcome was not significantly related to the number of prior AD exposures, a higher number of prior AD exposures was significantly associated with a lower response to paroxetine. If these findings are replicated in methodologically rigorous studies of paroxetine and other antidepressants, CT should be recommended, in preference to AD, for patients with multiple prior AD exposures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' competence in and performance of cognitive therapy skills: Relation to the reduction of relapse risk following treatment for depression.

Cognitive therapy (CT) for depression is designed to teach patients material that is believed to help prevent relapse following successful treatment. This study of 35 moderately to severely depressed patients who responded to CT provides the 1st evidence to suggest that both development and independent use of these competencies predict reduced risk for relapse. Among patients who responded to treatment, both CT coping skills and in-session evidence of the independent implementation of CT material predicted lower risk for relapse in the year following treatment. These relationships were not accounted for by either symptom severity at the end of treatment or symptom change from pre- to posttreatment. Self-esteem, assessed at posttreatment, failed to predict risk for relapse in the year following treatment. Thus, CT coping skills and independent use of CT principles, but not overall satisfaction with oneself, appear to play an important role in relapse prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden gains in cognitive therapy of depression and depression relapse/recurrence.

Cognitive therapy (CT) may have significant advantages over antidepressants in preventing depression relapses. Many CT patients experience sudden gains: large symptom improvement in 1 between-session interval. Past studies have associated CT sudden gains with in-session cognitive changes but not with life events. This study examined sudden gains and depression relapse/recurrence among 60 CT clinical-trial patients. Survival analyses showed that only one third of sudden-gain-responders relapsed in 2 years, and they had 74% lower relapse risks than did non-sudden-gain-responders. Among patients with sustained responses, 73% experienced sudden gains. The authors also replicated J. R. Vittengl, L. A. Clark, and R. B. Jarrett's (see record 2005-01321-021) finding that sudden gains identified with their unique criteria did not predict relapse. The current authors' findings suggest that CT sudden gains are not measurement artifacts, and that sudden gains and their causes and consequences might be important in preventing relapses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)