Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators and Mediators

https://doi.org/10.1016/j.psc.2010.04.005Get rights and content

Section snippets

Meta-analytic Findings

CBT has a medium effect size (d = 0.67) relative to a variety of control conditions ranging from the absence of treatment to nonspecific controls.8 Translated into numbers needed to treat (NNT), this effect size corresponds to an NNT of 2.75; this means that for just less than every 3 patients treated with CBT, one will get better solely because of having come into therapy. By way of comparison, medication treatment of severe hypertension produces an NNT of 15 and taking aspirin alone for

CBT to prevent relapse and recurrence

Depression is a chronically recurrent disorder. Although up to two-thirds of all patients respond to acute treatment with ADM (about half of whom fully remit), a sizable number experience a return of symptoms after treatment is over.28 According to conventions developed in the pharmacotherapy literature, symptom return during the first 6 to 12 months among remitted patients is assumed to represent a return of the treated episode (relapse) and treatment provided during that interval is called

CBT to prevent relapse in bipolar disorder

Whereas the distinction between relapse and recurrence is relevant to unipolar depression (patients are either in episode and thus at risk for relapse when asymptomatic or not in episode and thus at risk for recurrence), bipolar disorder is thought of as a chronic disorder that never goes away and is marked by periodic symptomatic relapses into mania and depression. Although stabilization on medications is the cornerstone of treatment of bipolar disorder, there has been considerable interest in

Predictors of CBT efficacy

Because different patients respond differently to different treatments, it is important to know who responds best to what with particular reference to CBT. Two types of information are relevant to this question: prognostic information in which you hold treatment constant and allow patient characteristics to vary, and prescriptive information in which you hold patient characteristics constant and allow treatment to vary.58 Prognostic factors predict outcome to a given treatment (or to treatment

Mediators of CBT efficacy

Although CBT has been found to be efficacious in the treatment and prevention of depression, questions remain about precisely how it works (mediation). Such questions are relevant to the identification of the active ingredients in the treatment process and the mechanisms of change within the patient. Cognitive theory posits that negative automatic thoughts and maladaptive information-processing proclivities play a causal role in the cause and maintenance of depression.7 According to this

Summary

CBT has been found superior to control conditions and as least as efficacious as other psychotherapies and ADM in the acute treatment of depression. When adequately implemented, CBT can be as efficacious as ADM for patients with more severe depressions. CBT may also be of use as an adjunct to medications in the treatment of bipolar disorder, although the evidence there is not so clear or extensive. CBT reduces relapse/recurrence rates, with a magnitude of effect that might be comparable to

First page preview

First page preview
Click to open first page preview

References (95)

  • R.C. Kessler et al.

    The epidemiology of major depressive disorder: results from the national comorbidity survey replication (NCS-R)

    JAMA

    (2003)
  • M.B. Keller

    Long-term treatment of recurrent and chronic depression

    J Clin Psychiatry

    (2001)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders, fourth edition, text review

    (2000)
  • A.T. Beck et al.

    Cognitive therapy of depression

    (1979)
  • Cuijpers P, van Straten A, Driessen E, et al. Depression and dysthymic disorders. In: Hersen M, Sturmey P, editors....
  • P. Cuijpers et al.

    Are individual and group treatments equally effective in the treatment of depression in adults? A meta-analysis

    Eur J Psychiatry

    (2001)
  • A.J. Rush et al.

    Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients

    Cognit Ther Res

    (1977)
  • I.M. Blackburn et al.

    The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination

    Br J Psychiatry

    (1981)
  • G.E. Murphy et al.

    Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression

    Arch Gen Psychiatry

    (1984)
  • S.D. Hollon et al.

    Cognitive therapy and pharmacotherapy for depression: singly and in combination

    Arch Gen Psychiatry

    (1992)
  • I. Elkin et al.

    Treatment of depression collaborative research program: general effectiveness of treatments

    Arch Gen Psychiatry

    (1989)
  • I. Elkin et al.

    Initial severity and differential treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program

    J Consult Clin Psychol

    (1995)
  • American Psychiatric Association

    Practice guideline for the treatment of patients with major depressive disorder [revision]

    Am J Psychiatry

    (2000)
  • N.S. Jacobson et al.

    Cognitive behavior therapy vs. pharmacotherapy: now that the jury's returned its verdict, its time to present the rest of the evidence

    J Consult Clin Psychol

    (1996)
  • N.S. Jacobson et al.

    Prospects for future comparisons between drugs and psychotherapy: lessons from the CBT vs. pharmacotherapy exchange

    J Consult Clin Psychol

    (1996)
  • R.B. Jarrett et al.

    Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial

    Arch Gen Psychiatry

    (1999)
  • R.J. DeRubeis et al.

    Cognitive therapy vs medications in the treatment of moderate to severe depression

    Arch Gen Psychiatry

    (2005)
  • J.C. Fournier et al.

    Antidepressant medications versus cognitive therapy in depressed patients with or without personality disorder

    Br J Psychiatry

    (2008)
  • S. Dimidjian et al.

    Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression

    J Consult Clin Psychol

    (2006)
  • S. Coffman et al.

    Extreme non-response in cognitive therapy: can behavioral activation succeed where cognitive therapy fails?

    J Consult Clin Psychol

    (2007)
  • M.B. Keller et al.

    A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression

    N Engl J Med

    (2000)
  • S.D. Hollon et al.

    Treatment and prevention of depression

    Psychol Sci Publ Interest

    (2002)
  • E. Frank et al.

    Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence

    Arch Gen Psychiatry

    (1991)
  • S.D. Hollon et al.

    Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety

    Annu Rev Psychol

    (2006)
  • J.R. Vittengl et al.

    Reducing relapse and recurrence in unipolar depression, a comparative meta-analysis of cognitive-behavioral therapy's effects

    J Consult Clin Psychol

    (2007)
  • S.D. Hollon et al.

    Prevention of relapse following cognitive therapy vs medications in moderate to severe depression

    Arch Gen Psychiatry

    (2005)
  • K.S. Dobson et al.

    Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression

    J Consult Clin Psychol

    (2008)
  • D.F. Klein

    Preventing hung juries about therapy studies

    J Consult Clin Psychol

    (1996)
  • G.A. Fava et al.

    Prevention of recurrent depression with cognitive behavioral therapy

    Arch Gen Psychiatry

    (1998)
  • G.A. Fava et al.

    Six-year outcome of cognitive behavior therapy for prevention of recurrent depression

    Am J Psychiatry

    (2004)
  • E.S. Paykel et al.

    Prevention of relapse in residual depression by cognitive therapy. A controlled trial

    Arch Gen Psychiatry

    (1999)
  • E.S. Paykel et al.

    Duration of relapse prevention after cognitive therapy for residual depression: follow-up of controlled trial

    Psychol Med

    (2005)
  • C.L.H. Bockting et al.

    Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial

    J Consult Clin Psychol

    (2005)
  • J.D. Teasdale et al.

    Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy

    J Consult Clin Psychol

    (2000)
  • S.H. Ma et al.

    Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects

    J Consult Clin Psychol

    (2004)
  • R.H. Perlis et al.

    Effects of adding cognitive therapy to fluoxetine dose increase on risk of relapse and residual depressive symptoms in continuation treatment of major depressive disorder

    J Clin Psychopharmacol

    (2002)
  • R.B. Jarrett et al.

    Preventing recurrent depression using cognitive therapy with and without a continuation phase. A randomized clinical trial

    Arch Gen Psychiatry

    (2001)
  • Cited by (212)

    View all citing articles on Scopus

    Preparation of this manuscript was supported by National Institute of Mental Health Grant MH01697 (K02) to the second author.

    View full text