Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting

Abstract

The efficacy of cognitive therapy was examined for 70 depressed private practice patients. Although these patients had a broader range of psychopathology than patients in controlled outcome studies of cognitive therapy, they had comparably large reductions in Beck Depression Inventory (BDI) scores. Patients who completed treatment had an average reduction in BDI scores of 65.5%. Initial BDI scores, endogenous symptoms, compliance with homework, and the interaction between homework and initial BDI scores were statistically significant predictors of end-of-treatment BDI scores. The squared correlation between the observed end-of-treatment BDI scores and the estimated expected value was .81. Controlling for other factors, patients who did homework improved three times as much as those who did not. The effect of homework was substantially larger for patients with high initial BDI scores; thus, studies that include only patients with high initial BDI scores may overstate the importance of homework on a general population. In spite of significant improvement, 50% of patients terminated treatment prematurely, premature termination was most likely in patients with personality disorders, high initial BDI scores, and no endogeneous symptoms.