The compensation and capitalization models: A test of two approaches to individualizing the treatment of depression

Despite long-standing calls for the individualization of treatments for depression, modest progress has been made in this effort. The primary objective of this study was to test two competing approaches to personalizing cognitive-behavioral treatment of depression (viz., capitalization and compensation). Thirty-four adults meeting criteria for Major Depressive Disorder (59% female, 85% Caucasian) were randomized to 16-weeks of cognitive-behavioral treatment in which strategies used were selected based on either the capitalization approach (treatment matched to relative strengths) or the compensation approach (treatment matched to relative deficits). Outcome was assessed with a composite measure of both self-report (i.e., Beck Depression Inventory) and observer-rated (i.e., Hamilton Rating Scale for Depression) depressive symptoms. Hierarchical linear modeling revealed a significant treatment approach by time interaction indicating a faster rate of symptom change for the capitalization approach compared to the compensation approach (d = .69, p = .03). Personalizing treatment to patients' relative strengths led to better outcome than treatment personalized to patients' relative deficits. If replicated, these findings would suggest a significant change in thinking about how therapists might best adapt cognitive-behavioral interventions for depression for particular patients.     

Efficacy of Guided iCBT for Depression and Mediation of Change by Cognitive Skill Acquisition

Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change in cognitive skills or behavioral activation mediated subsequent change in depression. The sample was 89 individuals randomized to guided iCBT (n = 59) or waitlist (n = 30). Participants were 75% female, 72% Caucasian, and 33 years old on average. The PHQ9 was the primary outcome measure. Mediators were the Competencies of Cognitive Therapy Scale–Self Report and the Behavioral Activation Scale for Depression–Short Form. Treatment was Beating the Blues plus manualized coaching. Outcomes were analyzed using linear mixed models, and mediation with a bootstrap resampling approach. The iCBT group was superior to waitlist, with large effect sizes at posttreatment (Hedges’ g = 1.45). Dropout of iCBT was 29% versus 10% for waitlist. In the mediation analyses, the acquisition of cognitive skills mediated subsequent depression change (indirect effect = -.61, 95% bootstrapped biased corrected CI: -1.47, -0.09), but increases in behavioral activation did not. iCBT is an effective treatment for depression, but dropout rates remain high. Change in iCBT appears to be mediated by improvements in the use of cognitive skills, such as critically evaluating and restructuring negative thoughts.     

Depressive symptoms are associated with unrealistic negative predictions of future life events

This study examined the relationship between depressive symptoms and bias in the prediction of future life events. Responding to internet announcements, 153 participants varying widely in self-reported depression symptom severity estimated the probability of 40 events occurring over the succeeding 30 days. After the 30-day period, participants reported which events occurred. Optimistic/pessimistic biases were related to level of depressive symptoms. A non-significant optimistic bias characterized participants with low depressive symptoms whereas a significant pessimistic bias characterized participants with high depressive symptoms. Those reporting mild symptoms did not exhibit a systematic pessimistic or optimistic bias. General imprecision in predictions for undesirable events was associated with depressive symptoms. These findings suggest that depression is associated with pessimistic bias rather than accuracy in judgment.     

Reviews of current books

Pastoral Psychology -     

New faces of spiritual pride

Contemporary counseling and psychotherapy, including pastoral counseling and psychotherapy, frequently claim as their domain the total person, including the spiritual dimension. Within the traditions of spiritual direction is a deep concern for the phenomenon of spiritual pride, If counseling and psychotherapy are to deal with the person's spiritual development, counselors ought to be aware of this disruptive dynamic. It is suggested that the counselor's own personhood may be a primary condition for leading to spiritual pride and that the process of termination may be a specific illustration of this phenomenon. The negative power of spiritual pride is significant in that it leads to premature closure relative to the growth process.     

The role of visioning in the pastoral counseling movement

Throughout its history, pastoral counseling has manifested a dynamic play between visioning and praxis. Frequently this interface has taken the form of issues, e.g., the identity issue, the theological question, the ecclesiastical relationship, and the paradigm matter. Such visioning and revisioning provide the movement with élan and should be encouraged through greater interaction with classical fields and scholars, by intensive research focused on the kinds of theological students attracted to pastoral counseling, and by stressing the importance of responsible visioning to those presently committed to the pastoral counseling movement.Dr. Strunk is Professor of Psychology of Religion and Pastoral Psychology in the Boston University School of Theology and in the Division of Theological and Religious Studies of the Graduate School of Arts and Sciences; a Clinical Supervisor in the Albert V. Danielsen Institute for Pastoral Counseling; and a consulting psychologist to the Ecumenical Counseling Service, Inc. in Melrose, Massachusetts.