major depression cognitive behavioral therapy

cognitive behavioral therapy for major depression The most widely studied psychotherapy for MAJOR DEPRESSION is cognitive therapy. This treatment is based on the model that the cognitions (conscious or readily accessible to consciousness) of depressed individuals are negatively biased. This negative bias is evident in negative beliefs about the self, the world, and the future. Such negative cognitions are one factor that plays a role in the initiation and maintenance of depressive symptoms. Cognitive therapy, typically consisting of 16 to 20 sessions over a period of 12 to 16 weeks, involves the application of both behavioral and cognitive techniques. The behavioral techniques serve to help patients engage in activities that give them pleasure, while cognitive techniques are used to help patients recognize negative cognitions and to evaluate the veracity of their beliefs.
Three meta-analyses of studies of cognitive therapy for MAJOR DEPRESSION concluded that it is at least equal and often superior to other forms of treatment, including antidepressant medications (Dobson, 1989; Gaffan, Tsaousis, & Kemp-Wheeler, 1995; Agency for Health Care Policy Research, 1993). However, the comparison of cognitive therapy to medication continues to be controversial. While several studies have supported the finding that cognitive therapy and medication yield similar outcomes, another study (Elkin et al., 1989) failed to demonstrate that cognitive therapy is superior to pill placebo and yielded some evidence that, for more severely depressed patients, medication (imipramine) is superior to cognitive therapy (Elkin et al., 1995). Practice guidelines have recommended
medication rather than psychotherapy for more severe depressions (American Psychiatric
Association, 2000; Depression Guideline Panel, 1993). However, a direct examination of
the comparative effects of cognitive therapy and medication across four studies revealed no evidence of a difference among those with moderate to severe depression (DeRubeis, Gelfand,
Tang, & Simons, 1999).
Some further evidence on this issue has emerged from a two-site study by Hollon and
DeRubeis (DeRubeis et al., in press) comparing standard cognitive therapy (N 60), antidepressant medication (Paxil with augmentation by other agents if clinically indicated) N 120; more patients were randomized to medication because of a subsequent continuation phase in which acute-phase medication responders were randomized to continuation medication or placebo), and placebo (N 60) as acute treatments for moderate to severe MAJOR DEPRESSION. At week 8, only 25% of placebo patients met criteria for clinical response, compared with 45% for cognitive therapy
and 50% for medication (placebo treatment was ended at week 8 for ethical reasons). At week
16 (end of acute treatment), response rates for medication and cognitive therapy were identical (57%) and comparable to response rates from previous studies of cognitive therapy and medication in MAJOR DEPRESSION.
Despite the lack of evidence that cognitive therapy is uniquely efficacious in the treatment
of MAJOR DEPRESSION, and some controversy over the comparative effects of medication and cognitive
therapy in more severely depressed patients, the overall weight of the evidence is that cognitive therapy is an efficacious acute-phase treatment for MAJOR DEPRESSION.