Cognitive-behavioral Treatment For Depression Research Articles

The Synergy of Percutaneous Coronary Intervention and Lifestyle Modification in Reducing Mortality and Blockage Prevention

In developed countries, cardiovascular diseases are the leading cause of death. Cardiovascular disease risk factors can be categorized as non modifiable (age, sex, race, and family history) or modifiable (hypertension, hyperlipidemia, diabetes, obesity, smoking, poor nutrition, stress, and sedentary lifestyle). Over 50% of cardiovascular events and deaths can be attributed to modifiable risk factors. The American Heart Association developed the “Life’s Simple 7” framework, which illustrates how lifestyle modifications—such as increasing physical activity, improving diet, giving up smoking, and managing weight—can contribute to heart-healthy living. Cardiac rehabilitation programs target these lifestyle modifications and result in a 35% reduction in 5-year mortality after myocardial infarction or bypass surgery. By promoting cardiac preconditioning, increasing coronary collateralization, and plaque regression, among other processes, physical exercise lowers the risk of cardiovascular death. It has been demonstrated that various diets, such as those high in fiber, low in saturated fats, low in sodium, and high in potassium, can reduce the risk of cardiovascular disease. Smoking destroys the vascular endothelium and produces free radicals, which trigger the start and advancement of atherosclerosis. Quitting smoking decreased cardiovascular mortality by 39% in one of the studies. Cognitive-behavioral treatment for depression and other psycho-behavioral and emotional therapies have been demonstrated to enhance heart function and lower the incidence of unfavorable cardiovascular events. Therefore, by following heart-healthy eating habits, getting regular exercise, giving up smoking, and controlling their stress, people can improve their quality of life and make their percutaneous coronary intervention operation more successful in the long run. This article addresses the above 4 lifestyle modalities, their pathophysiology, and their impact on cardiovascular outcomes post percutaneous interventions.

Virtual versus Face-to-Face Cognitive Behavioral Treatment of Depression: Meta-Analytic Test of a Noninferiority Hypothesis and Men's Mental Health Inequities.

Global rates of depression have increased significantly since the beginning of the COVID-19 pandemic. It is unclear how the recent shift of many mental health services to virtual platforms has impacted service users, especially for the male population which are significantly more likely to complete suicide than women. This paper presents the findings of a rapid meta-analytic research synthesis of 17 randomized controlled trials on the relative efficacy of virtual versus traditional face-to-face cognitive behavioral therapy (CBT) in mitigating symptoms of depression. Participants' aggregated depression scores were compared upon completion of the therapy (posttest) and longest follow-up measurement. The results supported the noninferiority hypothesis indicating that the two modes of CBT delivery are equally efficacious, but the results proved to be significantly heterogeneous indicating the presence of moderating effects. Indirect suggestive evidence was found to support moderation by gender; that is, depressed males may benefit more from virtual CBT. Perhaps, this field's most telling descriptive finding was that boys/men have been grossly underrepresented in its trials. Future trials ought to oversample those who have been at this field's margins to advance the next generation of knowledge, allowing us to best serve people of all genders, those who live in poverty, Indigenous, Black, and other Peoples of Colour, as well as any others at risk of being marginalized or oppressed in contemporary mental health care systems.

Blending Internet-based and tele group treatment: Acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression

The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms.Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session.Large treatment effects were observed for depression (CES-D: d = 0.99, p < .001; PHQ-9: d = 0.87, p = .002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d = 0.88–0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p = .289), or only exhibited statistical tendencies (p = .049 to .071). Client satisfaction, system usability, and treatment adherence were high.Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.

Depression in the Mirror: Depression Severity and Its Link to Negative Judgments of Symptoms.

Background and Objectives: Depressive states represent a normal and physiological response to the experience of loss. However, it is possible to identify some elements that allow distinguishing physiological depressive states from pathological ones. Over the years, research has confirmed that a stable tendency to negative self-evaluation is a transdiagnostic factor that triggers and amplifies dysfunctional emotional reactivity, thus contributing to the shift from normal to pathological reaction. In this sense, the secondary problem, or meta-emotional problem, referring to the negative evaluation of one's depressive state and the consequent dysfunctional attempts to solve it, seems to play an important role. The aim of the present study is to investigate how dysfunctional beliefs and the evaluations of depressive symptoms (meta-emotional problems) are related to depression severity.Methods: We asked to a community sample to focus on the depressive symptoms they regard as most distressful and evaluate them through specific questionnaires. One-hundred and eighty nine participants were asked to complete a set of questionnaires: (1) the Meta-Emotional Problem Questionnaire; (2) the Center for Epidemiologic Studies Depression Scale; (3) the Beck Depression Inventory; (4) the Dysfunctional Attitude Scale-24 in order to investigate the relation between dysfunctional beliefs, meta-emotional problems, and depressive symptoms severity.Results: Our results show that higher levels of depression are associated both to more pervasive dysfunctional attitudes and increased evaluation of meta-emotional problem. In addition, we conduct a regression analysis to disentangle the impact of the two different measures of depressive symptoms (i.e., BDI-II and CES-D) with two explanatory variables (dysfunctional attitudes and meta-emotional problem). Results show that meta-emotional problem remains a significant and robust predictor of the severity of depressive symptomatology, while dysfunctional beliefs has a rather weak and non-significant relation with the criterion. In other words, meta-emotional problem consistently explains the higher variance of depressive symptoms than dysfunctional beliefs. In conclusion, our study shows a clear link between meta-emotional problem and depression severity. This is relevant for clinical practice, as it highlights the importance of specifically targeting beliefs about the depressive condition in cognitive-behavioral treatment of depression, since they represent crucial factors maintaining depressive symptomatologies.

Leveraging the Power of Nondisruptive Technologies to Optimize Mental Health Treatment: Case Study

Regular assessment of the effectiveness of behavioral interventions is a potent tool for improving their relevance to patients. However, poor provider and patient adherence characterize most measurement-based care tools. Therefore, a new approach for measuring intervention effects and communicating them to providers in a seamless manner is warranted. This paper provides a brief overview of the available research evidence on novel ways to measure the effects of behavioral treatments, integrating both objective and subjective data. We highlight the importance of analyzing therapeutic conversations through natural language processing. We then suggest a conceptual framework for capitalizing on data captured through directly collected and nondisruptive methodologies to describe the client’s characteristics and needs and inform clinical decision-making. We then apply this context in exploring a new tool to integrate the content of therapeutic conversations and patients’ self-reports. We present a case study of how both subjective and objective measures of treatment effects were implemented in cognitive-behavioral treatment for depression and anxiety and then utilized in treatment planning, delivery, and termination. In this tool, called Eleos, the patient completes standardized measures of depression and anxiety. The content of the treatment sessions was evaluated using nondisruptive, independent measures of conversation content, fidelity to the treatment model, and the back-and-forth of client-therapist dialogue. Innovative applications of advances in digital health are needed to disseminate empirically supported interventions and measure them in a noncumbersome way. Eleos appears to be a feasible, sustainable, and effective way to assess behavioral health care.

Lessons Learned: Conducting Cases of Manualized, Telephone-Based, Cognitive Behavioral Treatment for Depression in Parkinson’s Disease (dPD)

My current clinical practice has been shifted to a telehealth format for the last three months due to the COVID-19 pandemic, and it seems an apt moment to reexamine my participation in Dr. Roseanne Dobkin’s research on manualized telehealth therapy for depression in Parkinson’s disease patients (dPD), using a protocol titled "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short (Dobkin et al., 2020). My participation involved, in part, being the therapist in four case studies I have written about with "Alice," "Carl," "Ethan," and "Gary" (Durland, 2020). In these case studies, a subset of those in Dr. Dobkin’s group studies, I explored my clinical decision-making, seeking insight into how best to flexibly apply the dPD protocol to meet the needs of a heterogeneous clinical population. Here, my aim is to recontextualize and expand on the conclusions of my four case studies, based on my dissertation and conducted over three years ago (Durland, 2017), in light of both my recent experience providing mental health services and the Commentaries on the four case studies so perceptively contributed by Dr. Dobkin and her colleagues (Mann, Miller, St. Hill, &amp; Dobkin, 2020) and by Liza Pincus (2020). In particular, I will focus first on (a) continuing the analysis of clinical decision-making involved in the case studies described in my earlier article (Duland, 2020); and then on (b) general issues related to the delivery of telehealth treatment.

Using CHIP coping strategies to guide cognitive-behavioral treatment of depression and anxiety during acute inpatient rehabilitation: A case study of a patient with paraplegia

Using CHIP coping strategies to guide cognitive-behavioral treatment of depression and anxiety during acute inpatient rehabilitation: A case study of a patient with paraplegia

Does Rumination Mediate the Association of Private Prayer, Stress, and Their Interaction with Depression among Christians? A Cross-Sectional Study

Mechanisms underlying significant associations between different types of prayer and depression are unknown. Based on the conceptualization of prayer as stress buffering coping style and the Response Style Theory, we proposed that rumination mediates the association of prayer types and stress with depression. This cross-sectional study (N = 227 Christians, Mage 41.74, SD 14.82, age range 18–82 years, 76% female) used path modeling to test whether rumination mediated the associations between prayer types and prayer types by stress interactions with depression. Rumination fully mediated the associations of the colloquial and ritual prayer by stress interactions with depressive symptoms, while meditative and petitionary prayer was directly associated with depressive symptoms. Further, petitionary prayer and the ritual prayer by stress interaction were associated with more and not with less rumination and depressive symptoms, respectively. Summarized, first empirical evidence supports an integration of prayer, stress, and rumination into one model of depression. However, the exact nature of their interplay depends on the prayer type. If replicated, our findings allow the integration of prayer into cognitive-behavioral treatment of depression in religious and spiritual clients.

Long-Term Associations of Justice Sensitivity, Rejection Sensitivity, and Depressive Symptoms in Children and Adolescents.

Depressive symptoms have been related to anxious rejection sensitivity, but little is known about relations with angry rejection sensitivity and justice sensitivity. We measured rejection sensitivity, justice sensitivity, and depressive symptoms in 1,665 9-to-21-year olds at two points of measurement. Participants with high T1 levels of depressive symptoms reported higher anxious and angry rejection sensitivity and higher justice sensitivity than controls at T1 and T2. T1 rejection, but not justice sensitivity predicted T2 depressive symptoms; high victim justice sensitivity, however, added to the stabilization of depressive symptoms. T1 depressive symptoms positively predicted T2 anxious and angry rejection and victim justice sensitivity. Hence, sensitivity toward negative social cues may be cause and consequence of depressive symptoms and requires consideration in cognitive-behavioral treatment of depression.

Leveraging Spousal Support to Improve Health Promotion in Serious Mental Illness

Although the majority of Veterans are overweight or obese, and many have comorbid mental health disorders, little is known about the most effective way to intervene in this complex population. This case describes a telephone-based cognitive-behavioral treatment for depression and weight management with an obese Veteran with bipolar disorder. His wife joined sessions to leverage spousal support. The Veteran evidenced variable levels of physical activity and mood fluctuations during treatment; although he reported some degree of positive behavior change and improved social support, he did not lose weight. He continued to endorse moderate levels of depressive symptomatology at the end of the nine-session intervention. This case illustrates the complexity of treating those with chronic serious mental illness and multimorbidities. Further research is needed to inform interventions that concurrently improve mental health symptomatology and weight-related outcomes in chronic, complex cases.

The therapeutic alliance and therapist adherence as predictors of dropout from cognitive therapy for depression when combined with antidepressant medication

BackgroundPrevious psychotherapy research has examined the therapeutic alliance and therapist adherence as correlates or predictors of symptom change. While some initial evidence suggests the alliance is associated with risk of dropout in cognitive behavioral treatment for depression, evidence of such relations has been limited to date. We examined the relation of these psychotherapy process variables and dropout in the context of cognitive therapy for depression when provided in combination with pharmacotherapy. MethodsPatients were randomized to the CT plus pharmacotherapy condition of a clinical trial for chronic or recurrent depression. Consistent with the spirit of personalized medicine, patients were treated until they met remission and recovery criteria (or reached the maximum allowable time in the study). In a sample of 176 patients, we examined observer-rated alliance and therapist adherence in the first three CT sessions as potential predictors of treatment dropout. ResultsThe therapeutic alliance and one facet of therapist adherence (i.e., Behavioral Methods/Homework) predicted reduced odds of dropout. Therapist use of Negotiating/Structuring predicted greater likelihood of dropout, but only when other variables were included in the model. LimitationsProcess ratings were not available for concurrent pharmacotherapy sessions. A minority of patients did not have session recordings available. ConclusionsResults are consistent with the possibility that the therapeutic alliance and therapists' focus on homework and behavioral methods promote treatment retention in combined treatment for depression.

Blended vs. face-to-face cognitive behavioural treatment for major depression in specialized mental health care: study protocol of a randomized controlled cost-effectiveness trial.

BackgroundDepression is a prevalent disorder, associated with a high disease burden and substantial societal, economic and personal costs. Cognitive behavioural treatment has been shown to provide adequate treatment for depression. By offering this treatment in a blended format, in which online and face-to-face treatment are combined, it might be possible to reduce the number of costly face-to-face sessions required to deliver the treatment protocol. This could improve the cost-effectiveness of treatment, while maintaining clinical effects. This protocol describes the design of a pilot study for the evaluation of the feasibility, acceptability and cost-effectiveness of blended cognitive behavioural therapy for patients with major depressive disorder in specialized outpatient mental health care.Methods/designIn a randomized controlled trial design, adult patients with major depressive disorder are allocated to either blended cognitive behavioural treatment or traditional face-to-face cognitive behavioural treatment (treatment as usual). We aim to recruit one hundred and fifty patients. Blended treatment will consist of ten face-to-face and nine online sessions provided alternately on a weekly basis. Traditional cognitive behavioural treatment will consist of twenty weekly sessions. Costs and effects are measured at baseline and after 10, 20 and 30 weeks. Evaluations are directed at cost-effectiveness (with depression severity and diagnostic status as outcomes), and cost-utility (with costs per quality adjusted life year, QALY, as outcome). Costs will encompass health care uptake costs and productivity losses due to absence from work and lower levels of efficiency while at work. Other measures of interest are mastery, working alliance, treatment preference at baseline, depressive cognitions, treatment satisfaction and system usability.DiscussionThe results of this pilot study will provide an initial insight into the feasibility and acceptability of blended cognitive behavioural treatment in terms of clinical and economic outcomes (proof of concept) in routine specialized mental health care settings, and an indication as to whether a well-powered clinical trial of blended cognitive behavioural treatment for depression in routine practice would be advisable. This will be determined based on the perspective of various stakeholders including patients, mental health service providers and health insurers. Strengths and limitations of the study are discussed.Trial registrationNetherlands Trial Register NTR4650. Registered 18 June 2014.

A Cognitive-Behavioral Treatment for Depression in Rural American Indian Middle School Students

Rural American Indian (AI) middle school students with depressive symptoms who participated in a culturally modified version of the Adolescent Coping with Depression (CWD-A) course (n = 8) reported significant improvement in depressive symptoms at post-intervention and at 3-month follow-up. There was also a nonsignificant but clinically relevant decrease in participants' anxiety symptoms. Students reported satisfaction with the intervention, and it was potentially more cost-effective and less stigmatizing than the individualized treatment-as-usual interventions to which it was compared. These results suggest the CWD-A is a promising approach for reducing depressive and anxiety symptoms in rural AI students and should be further evaluated with a larger sample of students.

Cognitive Behavioral Treatment of Depression in Youth

Cognitive Behavioral Treatment of Depression in Youth

Cognitive-Behavior Therapy for Depressed Cancer Patients in a Medical Care Setting

Major depression is the most common psychiatric disorder among cancer patients and is associated with decreased quality of life, significant deterioration in recreational and physical activities, relationship difficulties, sleep problems, more rapidly progressing cancer symptoms, and more metastasis and pain relative to nondepressed cancer patients. Although some research has explored the utility of psychological interventions with cancer patients, only one study to date has explored the potential benefits of cognitive-behavior therapy among cancer patients with well-diagnosed depression. Addressing this gap in the literature, this study represents an open clinical trial to assess the effectiveness of a brief Cognitive-Behavioral Treatment for Depression (CBTD) among depressed cancer patients in a medical care setting. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the CBTD protocol, and significant pre-post treatment gains across a breadth of outcome measures assessing depression, anxiety, quality of life, and medical outcomes. These gains also were associated with strong effect sizes and generally maintained at 3-month follow-up. Behavioral activation interventions, especially when paired with cognitive techniques, may represent a practical medical care treatment that may improve psychological outcomes and quality of life among cancer patients. Study limitations and future research directions are discussed.

Bupropion and cognitive-behavioral treatment for depression in smoking cessation

This study is a randomized, double-blind, placebo-controlled clinical trial examining the effects of an intensive cognitive-behavioral mood management treatment (CBTD) and of bupropion, both singularly and in combination, on smoking cessation in adult smokers. As an extension of our previous work, we planned to examine the synergistic effects of CBTD and bupropion on smoking cessation outcomes in general and among smokers with depression vulnerability factors. Participants were 524 smokers (47.5% female, M (age) = 44.27 years) who were randomized to one of four 12-week treatments: (a) standard, cognitive-behavioral smoking cessation treatment (ST) plus bupropion (BUP), (b) ST plus placebo (PLAC), (c) standard cessation treatment combined with cognitive-behavioral treatment for depression (CBTD) plus BUP, and (d) CBTD plus PLAC. Follow-up assessments were conducted 2, 6, and 12 months after treatment, and self-reported abstinence was verified biochemically. Consistent with previous studies, bupropion, in comparison with placebo, resulted in better smoking outcomes in both intensive group treatments. Adding CBTD to standard intensive group treatment did not result in improved smoking cessation outcomes. In addition, neither CBTD nor bupropion, either alone or in combination, was differentially effective for smokers with single-past-episode major depressive disorder (MDD), recurrent MDD, or elevated depressive symptoms. However, findings with regard to recurrent MDD and elevated depressive symptoms should be interpreted with caution given the low rate of recurrent MDD and the low level of depressive symptoms in our sample. An a priori test of treatment effects in smokers with these depression vulnerability factors is warranted in future clinical trials.

The association between depressive personality and treatment outcome for depression following a group cognitive–behavioral intervention

The present study investigated the association of depressive personality traits to treatment outcome for depression. One hundred and nineteen patients with a primary diagnosis of major depression were divided into high- and low-depressive personality groups, and depression symptomatology was assessed pre- and postparticipation in a standardized group cognitive-behavioral intervention. Analyses revealed poorer pre-state and end-state functioning for the high-depressive personality group. However, rate of improvement pre- to posttreatment was comparable between the two groups. Subsequent multiple regression analyses revealed that when controlling for pretreatment depression severity, depressive personality was not a predictor of depression treatment outcome. Within the methodological parameters of the current study, depressive personality traits were not associated with a poorer response to cognitive-behavioral treatment for depression.

Cognitive-Behavioral Treatment for Depression in Adolescents

The goal of this article is to briefly review and summarize the rationale and research support for cognitivebehavioral therapy (CBT) as a treatment for depressed adolescents. A primary focus of the paper is on our group CBT treatment for adolescent depression, entitled “The Adolescent Coping with Depression Course”. In addition, initial findings from a large, recently-completed study contrasting individual CBT with fluoxetine for depressed adolescents (Treatment of Adolescents with Depression Study) are presented. Although the research support for CBT as a treatment for depressed adolescents is generally encouraging, we need to better understand which depressed adolescents benefit from CBT, how and when to incorporate medication and family-based interventions into CBT treatment, how to treat depressed adolescents with comorbid psychiatric conditions, and how CBT interventions fare with non-European-American depressed adolescents.

Sudden gains in cognitive behavioral treatment for depression: when do they occur and do they matter?

Despite the use of efficacious treatments for depression, individuals differ in both the degree to which they recover and the rate at which recovery occurs. Tang and colleagues found that depressed patients who had sudden improvements in their symptomatology not only maintained these gains, but also enjoyed more improvement and higher rates of recovery than those without sudden gains (J. Consulting Clin. Psychol. 67(6) (1999) 894; J. Consulting Clin. Psychol. 70(2) (2002) 444). Our study examined the role of sudden gains in a cognitive-behavioral group treatment for depression. Results indicated that 41.9% of patients experienced sudden gains. Furthermore, sudden gains occurring in the first third of treatment appear to have special importance. Participants enjoying early sudden gains had significantly larger changes in depressive symptom scores over the course of treatment than those without sudden gains and were marginally more likely to be treatment responders compared to those without early sudden gains. In contrast to Tang and DeRubeis (J. Consulting Clin. Psychol. 67(6) (1999) 894), however, sudden gains were not associated with cognitive changes.

Group Cognitive-Behavioral Treatment of Depression and the Interaction of Demographic Variables

Response levels of 92 depressed subjects with differing demographic profiles to a standardized small-group CBT intervention were examined. Findings were based on combined groups wherein adults participated in 12 two-hour skill-building sessions conducted in 8-week periods. Participants were assessed for levels of depression, hopelessness, anxiety, and social adjustment at pre- and post-test, and 1, 6, 12, 18, and 24 months following treatment. The intervention was effective in the treatment of unipolar depression for all groups, and demographic variables were found to have various significant functional relationships with treatment outcome. Gender combined with marital status, and the separate results of education level, employment status, and income level all indicate different treatment effects.