How does cognitive therapy work? Cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression.

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.

[1]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[2]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[3]  A. Simons,et al.  Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression. , 1984, Archives of general psychiatry.

[4]  L. Abramson,et al.  Cognitive patterns and major depressive disorder: a longitudinal study in a hospital setting. , 1983, Journal of abnormal psychology.

[5]  R. Spitzer,et al.  Psychotherapy Research: Where Are We and Where Should We Go? , 1984 .

[6]  E. Robins,et al.  Research diagnostic criteria. , 1975, Psychopharmacology bulletin.

[7]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[8]  S D Imber,et al.  National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. , 1989, Archives of general psychiatry.

[9]  M. Seligman,et al.  Explanatory Style Change During Cognitive Therapy for Unipolar Depression , 1988 .

[10]  C Peterson,et al.  Causal explanations as a risk factor for depression: theory and evidence. , 1984, Psychological review.

[11]  R. DeRubeis,et al.  Causal mediation of change in treatment for depression: discriminating between nonspecificity and noncausality. , 1987, Psychological bulletin.

[12]  L. Abramson,et al.  Depressive attributional style. , 1979, Journal of abnormal psychology.

[13]  D Lester,et al.  The measurement of pessimism: the hopelessness scale. , 1974, Journal of consulting and clinical psychology.

[14]  C. Dancu,et al.  The role of self-directed in vivo exposure in cognitive, behavioral, and psychophysiological treatments of agoraphobia ** , 1986 .

[15]  David Rogosa,et al.  A critique of cross-lagged correlation , 1980 .

[16]  I. Blackburn,et al.  The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination , 1981, British Journal of Psychiatry.

[17]  S. Hollon,et al.  Specificity of depressotypic cognitions in clinical depression. , 1986, Journal of abnormal psychology.

[18]  A. Rush,et al.  Cognitive patterns in symptomatic and remitted unipolar major depression. , 1984, Journal of abnormal psychology.

[19]  C. Izard.  Emotions in Personality and Psychopathology , 1979 .

[20]  Jacob Cohen,et al.  Applied multiple regression/correlation analysis for the behavioral sciences , 1979 .

[21]  J. McKeon,et al.  Differential response to chlorpromazine, imipramine, and placebo. A study of subgroups of hospitalized depressed patients. , 1970, Archives of general psychiatry.

[22]  A. Beck.  Cognition and therapy. , 1984, Archives of general psychiatry.

[23]  A. Simons,et al.  The Process of Change in Cognitive Therapy and Pharmacotherapy for Depression , 1984 .

[24]  A. Beck,et al.  Cognitive-Affective Processes in Depression , 1979 .

[25]  D. Barlow,et al.  Couples treatment of agoraphobia , 1984 .

[26]  S. Hollon,et al.  Differential effects of cognitive therapy and pharmacotherapy on depressive symptoms. , 1981, Journal of affective disorders.

[27]  J. Endicott,et al.  A diagnostic interview: the schedule for affective disorders and schizophrenia. , 1978, Archives of general psychiatry.