Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression

This study examined the nature of cognitive reactivity to mood changes in formerly depressed patients. Patients who recovered either through cognitive-behavior therapy (CBT; N = 25) or through pharmacotherapy (PT; N = 29) completed self-reported ratings of dysfunctional attitudes before and after a negative mood induction procedure. In response to similar levels of induced sad mood, PT patients showed a significant increase in dysfunctional cognitions compared with patients in the CBT group. To evaluate the effects of such cognitive reactivity on the subsequent course of depression, follow-up analyses reassessed 30 patients several years after initial testing. Results indicated that patients' reactions to the mood induction procedure were predictive of depressive relapse. These findings argue for differential effects of treatment on cognitive reactivity to mood induction and for the link between such reactivity and risk for later depressive relapse.     

Working alliance as a predictor of change in depression during blended cognitive behaviour therapy

Blended Cognitive Behaviour Therapy (bCBT) is a new form of treatment, mixing internet-based modules and face-to-face therapist sessions. How participants rate the therapeutic alliance in bCBT has not yet been thoroughly explored, and neither is it clear whether therapist- and patient-rated alliances are predictors of change in depression during treatment. Depression and alliance ratings from 73 participants in a treatment study on bCBT (part of the E-COMPARED project) were analysed using growth curve models. Alliance, as rated by both patients and therapists, was high. The therapist-rated working alliance was predictive of subsequent changes in depression scores during treatment, whereas the patient-rated alliance was not. A therapeutic alliance can be established in bCBT. The role of the therapist-rated alliance seems to be of particular importance and should be carefully considered when collecting data in future studies on bCBT.     

Explanatory style and health

Explanatory style, the habitual way an individual explains the causes of bad and good events, is reliably associated with future health. In this article, we review evidence from three studies which demonstrate a significant relationship between pessimism (the belief that bad events are caused by internal, stable, and global factors and good events are caused by external, unstable, and specific factors) and an increased risk for infectious disease, poor health, and early mortality. We suggest two possible mechanisms which might mediate the link between pessimism and poor health. Finally, we propose that interventions aimed at changing a pessimistic outlook might lower the probability of future illness. Supported by a National Science Foundation Graduate Fellowship to Leslie P. Kamen; U.S. Public Health Service Grant MH-19064 and National Institute of Aging Grant AG05590 to Martin E. P. Seligman; U.S. Public Health Service Grant MH40142-01A1 to Martin E.P. Seligman, Joan S. Girgus, and Susan Nolen-Hoeksema. Supported in part by the MacArthur Foundation Research Network on Determinants and Consequences of Health-Promoting and Health-Damaging Behavior.     

Explanatory style and health

Explanatory style, the habitual way an individual explains the causes of bad and good events, is reliably associated with future health. In this article, we review evidence from three studies which demonstrate a significant relationship between pessimism (the belief that bad events are caused by internal, stable, and global factors and good events are caused by external, unstable, and specific factors) and an increased risk for infectious disease, poor health, and early mortality. We suggest two possible mechanisms which might mediate the link between pessimism and poor health. Finally, we propose that interventions aimed at changing a pessimistic outlook might lower the probability of future illness.     

It's not my fault,it's theirs: Explanatory style of bullying targets with unipolar depression and its susceptibility to short‐term therapeutical modification

Depression is one of the most frequent psychic impairments prevalent among bullying targets. It is typically characterized by an internal, global, and stable explanatory style. However, whether bullying targets with depression would apply this style to explain their social conflicts at work was unclear. Therefore, individuals who had been bullied and developed depression were compared to individuals with depression who had not been bullied. Both groups differed significantly regarding their explanatory style, as individuals with bullying experience made more external attributions to explain social conflicts they had experienced both at work and in their private lives. This preference did not change over the course of a 6‐week in‐patient psychotherapy programme.     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.     

Information processing and cognitive organization in unipolar depression: specificity and comorbidity issues

This study investigated information processing and cognitive organization in clinical depression. The specificity of various cognitive mechanisms to depression was also examined. Twenty-six depressed/anxious individuals, 24 pure depressives, 25 never-depressed anxious controls, and 25 nonpsychiatric controls completed a modified Stroop task, the Self-Referent Encoding Task, and two tasks designed to assess cognitive structure. Comorbid depressed/anxious, depressed, and anxious groups performed similarly to one another but differed significantly from nonpsychiatric controls, on the processing and organization of negative content. Specificity to depression was also obtained, as both depressed groups endorsed and recalled less positive information and organized positive self-relevant information with less interconnectedness than anxious individuals and nonpsychiatric controls. These results suggest that depressed individuals have an interconnected negative self-representational system and lack a well-organized positive template of self. These findings are discussed in terms of cognitive models of depression and the tripartite model of depression and anxiety.     

Prediction of outcome with group cognitive therapy for depression

This paper tested a social-cognitive model of depressive episodes and their treatment within a predictive study of treatment response. Clinically depressed volunteers were given self-efficacy questionnaires and other measures before and after they were treated with cognitive therapy, and their progress was monitored over the succeeding 12 months. Improvements in depression during treatment were closely associated with self-efficacy regarding control of mood and with self-monitored levels of negative cognition. Remission over the following 12 months was predicted by the initial response to treatment, by a shorter duration of the episode prior to treatment, and by a post-treatment assessment of self-efficacy regarding control of negative cognition. Self-efficacy remained a significant predictor after post-treatment depression scores and episode duration were entered in a prediction equation. However, a programme of additional treatment based on the depression model did not result in improved depression status. Apart from the failure of the additional treatment, the results are consistent with a social-cognitive model of depressive episodes that emphasises the role of self-efficacy and skills regarding control of negative moods.     

Explanatory pluralism in cognitive science

This brief commentary has three goals. The first is to argue that "framework debate" in cognitive science is unresolvable. The idea that one theory or framework can singly account for the vast complexity and variety of cognitive processes seems unlikely if not impossible. The second goal is a consequence of this: We should consider how the various theories on offer work together in diverse contexts of investigation. A final goal is to supply a brief review for readers who are compelled by these points to explore existing literature on the topic. Despite this literature, pluralism has garnered very little attention from broader cognitive science. We end by briefly considering what it might mean for theoretical cognitive science.     

Treatment outcome of a group cognitive therapy program for depression

A 12-session group program of cognitive therapy, designed by the first author, was evaluated with 35 persons suffering from major or minor depressive disorders. Effect-size scores were generated using the method of Nietzel, Russel, Hemmings, and Gretter (1987) and compared with cut-off points calculated using the method of Jacobson and Revenstorf (1988) and the norms established by Nietzel et al. (1987) in their meta-analysis. The effects of the Group Cognitive Therapy Program were found to be clinically significant according to the criteria of Jacobson and colleagues (Jacobson and Revenstorf, 1988; Jacobson, Follette and Revenstorf, 1984) for 73% of patients. It is concluded that the Group Cognitive Therapy Program is a clinically efficacious and cost-effective treatment for persons suffering from nonpsychotic, primary, unipolar depression.     

The neuropsychology of depression and its implications for cognitive therapy

The past few years have witnessed a growing interest in the specialty of neuropsychology as well as continued support for cognitive therapy of depression. The purpose of this paper is the examination of the neuropsychology of depression and its implications for A. T. Beck's cognitive theory and therapy of depression ([1963] Thinking and Depression: Idiosyncratic Content and Cognitive Distortions,Archives of General Psychiatry, Vol. 9, pp. 324–333; [1964] Thinking and Depression,Archives of General Psychiatry, Vol. 10, pp. 561–571; [1967]Depression: Clinical, Experimental, and Theoretical Aspects, New York: Harper & Row). Specifically, the neuropsychological and cognitive theory and therapy literatures related to depression are reviewed followed by an antegration of these areas. Neuropsychological evidence is presented that both supports cognitive theory and therapy of depression and helps explain why such therapy may prove ineffective in treating depression. Implications for clinical practice, including neuropsychological assessment of depressives, and potential future research directions are also provided.     

Effects of cognitive therapy for depression on daily stress-related variables

This study used a daily diary design to evaluate depressed patients' changes on daily stress-related variables during cognitive therapy (CT). Patients completed daily diaries on two week-long occasions: after the intake interview and again after the sixth session of CT. Patients also completed a measure of depressive symptoms before every treatment session. After six sessions of CT, patients reported a significant reduction in: (a) depressive symptoms; (b) daily sad affect (SA); (c) daily negative thoughts associated with the day's most stressful event; and (d) SA reactivity to daily stressors. In addition, patients reported a significant increase in: (e) daily positive affect (PA); and (f) SA reactivity to daily negative thoughts. The results suggest that CT has its intended effects on the daily lives of depressed adults, and highlight the value of a daily diary methodology for research on CT.     

Anxiety symptom focus in sessions of cognitive therapy for depression

The comorbid patient presents an especially difficult problem to a therapist who is attempting to implement a short-term, focused therapy. The current study investigates the effect of comorbid anxiety on cognitive therapy for depression. Participants were a subset of patients (N=24) assigned to the cognitive therapy arm of a large, randomized, controlled trial of treatment for depression. From intake assessments, patients were classified as having low or high levels of comorbid anxiety. Two videotapes of each patient's therapy sessions were coded. Irrespective of intake anxiety level, more time and effort spent addressing anxiety in session was found to predict less improvement in both depression and anxiety symptoms over the course of treatment.     

Explanatory style and immunoglobulin A (IgA)

The construct of explanatory style has been related to numerous aspects of human psychology, including health. Our research has focused on the effects of various psychological variables on the immune system, in particular Immunoglobulin A (IgA). We had participants fill out the Attributional Style Questionnaire (ASQ), the predominant measure of explanatory style, and assayed saliva samples for secretory IgA. No relationship was observed between overall ASQ score and IgA, or composite optimism score and IgA. However we observed significant negative correlations between both the composite pessimism score and IgA, as well as the hopelessness score and IgA. Pessimistic explanatory style may therefore be related to immune system deficits and poor health.     

Explanatory style and Immunoglobulin A (IgA).

The construct of explanatory style has been related to numerous aspects of human psychology, including health. Our research has focused on the effects of various psychological variables on the immune system, in particular Immunoglobulin A (IgA). We had participants fill out the Attributional Style Questionnaire (ASQ), the predominant measure of explanatory style, and assayed saliva samples for secretory IgA. No relationship was observed between overall ASQ score and IgA, or composite optimism score and IgA. However, we observed significant negative correlations between both the composite pessimism score and IgA, as well as the hopelessness score and IgA. Pessimistic explanatory style may therefore be related to immune system deficits and poor health.     

Rumination-focused cognitive behaviour therapy for residual depression: a case series

The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.     

Dimensions of perfectionism in unipolar depression

We tested the hypothesis that self-oriented perfectionism, other-oriented perfectionism, and socially prescribed perfectionism are related differentially to unipolar depression. The Multidimensional Perfectionism Scale was administered along with measures of depression and anxiety to 22 depressed patients, 22 matched normal control subjects, and 13 anxiety patients. It was found that the depressed patients had higher levels of self-oriented perfectionism than did either the psychiatric or normal control subjects. In addition, depressed patients and anxious patients reported higher levels of socially prescribed perfectionism than did the normal control subjects. The results suggest that various dimensions of perfectionism may play an important role in clinical depression.