Cognitive-behavioral therapy for Depression

OVERVIEW

Cognitive-behavioral therapy is a type of psychotherapy based around the concept that changing the way a person thinks also changes his/her behaviors and the way that he/she feels. Multiple randomized control group and comparison group studies have supported the effectiveness of cognitive-behavioral therapy for treating depression.  More specifically, there is substantial evidence that cognitive-behavioral therapy is significantly more effective than no treatment. However, it is not as clear whether cognitive-behavioral therapy is more effective than alternative forms of psychotherapy such as interpersonal therapy.

DESCRIPTION OF PROGRAM

Target population: At-risk children, adolescents, and youth

Cognitive-behavioral therapy (CBT) is a form of psychotherapy that emphasizes the role of rational thinking in how individuals feel and behave. A central tenet of this approach is that an individual’s thoughts, not outside people or events, cause feelings and behaviors. When individuals experience unwanted feelings and behaviors, cognitive behavior therapists identify the root of these feelings and behaviors and aim to change the way the individual thinks in order to replace negative thoughts with positive ones.

EVALUATION(S) OF PROGRAM

Rossello, J. & Bernal, G. (1999). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology, 67, 734-745.

Evaluated population: Seventy-one Puerto-Rican adolescents and youth (13 to 18 years old) diagnosed with major depressive disorder, dysthymia, or both disorders in Puerto Rico were evaluated. Fifty-four percent of the sample was female.

Approach: Participants were randomly assigned to cognitive-behavioral therapy, interpersonal therapy, or the wait-list control group. Both treatments involved 12 weekly, one-hour sessions. For cognitive-behavioral therapy, the first 4 sessions focuses on how thoughts influence mood, the next four on how daily activities influence mood, and the last four on how interactions with others influence mood. The interpersonal therapy condition is described here.

Data were collected at baseline, post-treatment, and 3-month follow-up on depressive symptoms, self-esteem, social adaptation, family expressed emotion, and behavior problems.

Results: The researchers found that cognitive-behavioral therapy and interpersonal therapy both significantly reduced depressive symptoms compared with the control group, but there were not significant differences between the cognitive-behavioral and interpersonal therapy groups on depressive symptoms. Cognitive-behavioral therapy did not have a significant impact on self-esteem, social adaptation, family expressed emotion, or behavior problems.

Brent, D.A., Holder, D., Kolko, D., Birmaher, B., Baugher, M., Rother, C., Iyengar, S., & Johnson, B.A. (1997).  A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy.  Archives of General Psychiatry, 54, 877-885.

Evaluated population: A total of 107 adolescents and youth (13 to 18 years old) with major depressive disorder in the Pittsburgh area were evaluated. The majority of the sample was Caucasian (83%) and female (76%).

Approach:  Researchers randomly assigned participants to one of three groups: cognitive-behavioral therapy, systemic behavior family therapy, or nondirective supportive treatment. All treatments involved 12 to 16 weekly sessions, plus 2 to 4 monthly booster sessions. In all three groups parents received a psychoeducational manual about affective illness and its treatment and were given up to one hour to discuss their questions and concerns. Systemic behavior family therapy is described here [INSERT LINK TO SBFT WRITE_UP]. Nondirective supportive treatment served as a control treatment in that it involved the same amount of contact with a skilled professional who provided support and used reflective listening to help the patient identify and express feeling and discuss options for addressing personal problems, but therapists in this condition did not give advice, set limits, or teach specific skills.

Data were collected at baseline, at 6 weeks, and at the end of treatment (or after 12 to 16 weeks for those who did not complete the treatment) on depression, suicidality, and functional impairment. Depressive symptoms were also assessed during every treatment session.

Results: Participants in the cognitive-behavioral therapy treatment were less likely than those in the control group to have major depression at the end of treatment. In addition, cognitive-behavioral therapy reduced therapist-rated depressive symptoms at a faster rate than systemic behavior family therapy or the control treatment and it decreased self-reported depressive symptoms at a marginally faster rate than systemic behavior family therapy. Participants in the cognitive-behavioral therapy treatment were also less likely than those in both of the other conditions to have achieved remission (no major depression and depressive symptoms lower than a certain threshold for at least three consecutive weeks and sustained through the rest of the treatment), and those in the cognitive-behavioral therapy condition reduced their symptoms to below that threshold for three consecutive weeks sooner than those in systemic behavior family treatment.

There were no differences between the groups on suicidality or functional impairment.

SOURCES FOR MORE INFORMATION

References:

Brent, D. A., Holder, D., Kolko, D., et al. (1997). A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Archives of General Psychiatry, 54, 877-885.

Rosselo, J., & Bernal, G. (1999). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology, 67, 734-745.

Website: http://www.starcenter.pitt.edu/

Manuals are available for free online: http://www.starcenter.pitt.edu/DownloadManuals/54/Default.aspx

The cost of implementation is estimated to be $40 per hour, based on information provided by NREPP (http://nrepp.samhsa.gov/ViewIntervention.aspx?id=106) in 2012.

KEYWORDS: Adolescents, youth, young adults, males and females (co-ed),  Hispanic/Latino, clinic/provider-based, counseling/therapy, parent or family component, depression/mood disorders, high risk, manual, cost, other mental health, self-esteem/self-concept, other social/emotional health, other behavioral problems

Program information last updated 7/2/2012.