Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-18T17:47:02.888Z Has data issue: false hasContentIssue false
  • English
  • Français

Conditional Beliefs of Primary-Care Patients with Treatment-Resistant Depression

Published online by Cambridge University Press:  04 November 2015

Alex Burrage ,
Samantha Green ,
Katrina Turner ,
Willem Kuyken ,
Chris Williams ,
Nicola Wiles  and
Glyn Lewis
Alex Burrage
Affiliation:
University of Bristol, UK
Samantha Green
Affiliation:
University of Bristol, UK
Katrina Turner
Affiliation:
University of Bristol, UK
Willem Kuyken
Affiliation:
University of Oxford, UK
Chris Williams
Affiliation:
University of Glasgow, UK
Nicola Wiles*
Affiliation:
University of Bristol, UK
Glyn Lewis
Affiliation:
University College London, UK
*
Reprint requests to Nicola Wiles, Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Cognitive behaviour therapy (CBT) for patients with treatment-resistant depression (TRD) aims to reframe underlying conditional beliefs that are thought to maintain depression. Aim: To systematically explore conditional beliefs expressed by primary-care based patients with TRD, defined as non-response to at least 6 weeks of antidepressants. Method: Conditional beliefs (stated in an “If. . .then. . .” format) were extracted from a random sample of 50 sets of therapist notes from the CoBalT trial, a large randomized controlled trial of CBT for TRD in primary care. The beliefs were separated into their two constituent parts; the demands (Ifs) and consequences (thens). An approach based on framework analysis provided a systematic way of organizing the data, and identifying key themes. Results: Four main themes emerged from the demand part of the conditional beliefs (Ifs): 1. High standards; 2. Putting others first/needing approval; 3. Coping; and 4. Hiding “true” self. Three main themes emerged from the consequence part of the conditional beliefs (thens): 1. Defectiveness; 2. Responses of others; 3. Control of emotions. Conclusions: Identifying common themes in the conditional beliefs of patients with TRD adds to our clinical understanding of this client group, providing useful information to facilitate the complex process of collaborative case conceptualization and working with conditional beliefs within CBT interventions.

Keywords

Treatment-resistant depressionchronic depressionCBTconditional beliefs
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 44 , Issue 5 , September 2016 , pp. 513 - 526
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barnes, M., Sherlock, S., Thomas, L., Kessler, D., Kuyken, W., Owen-Smith, A., et al. (2013). “No pain, no gain: depressed clients' experiences of cognitive behavioural therapy”. British Journal of Clinical Psychology, 52, 347–364.CrossRefGoogle ScholarPubMed
Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. New York: Penguin.Google Scholar
Beck, A. T., Freeman, A. and Associates (1990). Cognitive Therapy of Personality Discorders. New York: Guilford Press Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. and Emery, G. (1979). Cognitive Therapy of Depression. New York: Wiley.Google Scholar
Beck, A., Steer, R. A. and Brown, G. K. (1996). Beck Depression Inventory – Second edition: manual. San Antonio: The Psychological Corporation.Google Scholar
Beck, J. (1995). Cognitive Therapy: basics and beyond. New York: Guilford Press.Google Scholar
Beevers, C. G., Strong, D. R., Meyer, B., Pilkonis, P. A. and Miller, I. W. (2007). Efficiently assessing negative cognition in depression: an item response theory analysis of the Dysfunctional Attitude Scale. Psychological Assessment, 19, 199–209.Google Scholar
Clark, D. M. and Beck, A. T. (1999). Scientific Foundations of Cognitive Theory and Therapy of Depression. New York: John Wiley & Sons Inc.Google Scholar
Craighead, W. E., Sheets, E. S., Brosee, A. L. and Ilardi, S. S. (2007). Psychosocial treatments for major depressive disorder. In Nathan, P. E. and Gorman, J. M. (Eds.), A Guide to Treatments that Work (3rd ed.), pp. 289–308. New York: Oxford Press.CrossRefGoogle Scholar
Fennell, M.J.V. (1997). Low self-esteem: a cognitive perspective. Behavioural and Cognitive Psychotherapy, 25, 1–25.Google Scholar
Fostick, L., Silberman, A., Beckman, M., Spivak, B. and Amital, D. (2010). The economic impact of depression: resistance or severity? European Neuropsychopharmacology, 20, 671–675.Google Scholar
George, C. F., Peveler, R. C., Heiliger, S. and Thompson, C. (2000). Compliance with tricylic antidepressants: the value of four different methods of assessment. British Journal of Clinical Pharmacology, 50, 166–171.Google Scholar
Halvorsen, M., Wang, C. E., Eisemann, M. and Waterloo, K. (2010). Dysfunctional attitudes and early maladaptive schemas as predictors of depression: a 9-year follow-up study. Cognitive Therapy Research, 34, 368–379.CrossRefGoogle Scholar
Jarrett, R. B., Vittengl, J. R., Doyle, K. and Clark, L. A. (2007). Changes in cognitive content during and following cognitive therapy for recurrent depression: substantial and enduring, but not predictive of change in depressive symptoms. Journal of Consulting and Clinical Psychology, 75, 432–446.Google Scholar
Judd, L. L., Akiskal, H. S., Zeller, P. J., Paulus, M., Leon, A. C., Maser, J. D., et al. (2000). Psychosocial disability during the long-term course of unipolar major depressive disorder. Archives of General Psychiatry, 57, 375–380.Google Scholar
Kuyken, W., Padesky, C. A. and Dudley, R. (2009). Collaborative Case Conceptualization: working effectively with clients in cognitive-behavioral therapy. New York: Guildford Press.Google Scholar
Lewis, G. (1994). Assessing psychiatric disorder with a human interviewer or a computer. Journal of Epidemiology and Community Health, 48, 207–210.Google Scholar
Lewis, G., Pelosi, A. J., Araya, R. and Dunn, G. (1992). Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychological Medicine, 22, 465–486.Google Scholar
Moore, R. G. and Garland, A. (2003). Cognitive Therapy for Chronic and Persistent Depression. Chichester: John Wiley & Sons.Google Scholar
Mooney, K. A. and Padesky, C. A. (2000). Applying client creativity to recurrent problems: constructing possibilities and tolerating doubt. Journal of Cognitive Psychotherapy: An International Quarterly, 14, 149–161.Google Scholar
Morisky, D. E., Green, L. W. and Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence, Medical Care, 1, 67–74.CrossRefGoogle Scholar
National Institute for Health and Clinical Excellence (2009). Depression: the treatment and management of depression in adults (updated). Retrieved 17.03.2013 from http://guidance.nice.org.uk/CG90.Google Scholar
Padesky, C. A. (1994). Schema change processes in cognitive therapy. Clinical Psychology and Psychotherapy, 1, 267–278.Google Scholar
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.Google Scholar
Power, M. J., Katz, R., McGuffin, P., Duggan, C. F., Lam, D. and Beck, A. T. (1994). The Dysfunctional Attitude Scale (DAS): a comparison of Forms A and B and proposals for a new subscaled version. Journal of Research in Personality, 28, 263–276.CrossRefGoogle Scholar
Riso, L. P., du Toit, P. L., Blandino, J. A., Penna, S., Dacey, S., Duin, J. S., et al. (2003). Cognitive aspects of chronic depression. Journal of Abnormal Psychology, 112, 72–80.Google Scholar
Riso, L. P. and Newman, C. F. (2003). Cognitive therapy for chronic depression. Journal of Clinical Psychology, 59, 817–831.Google Scholar
Ritchie, J. and Spencer, L. (1994). Qualitative data analysis for applied policy research. In Bryman, A. and Burgess, R. G. (Eds.), Analysing Qualitative Data. London: Routledge.Google Scholar
Schindler, A., Hiller, W. and Witthoft, M. (2013). What predicts outcome, response, and drop out in CBT of depressive adults? A naturalistic study, Behavioural and Cognitive Psychotherapy, 41, 365–370.Google Scholar
Thomas, L. J., Abel, A., Ridgway, N., Peters, T., Kessler, D., Hollinghurst, S., et al. (2012). Cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment resistant depression in primary care: the CoBalT randomised controlled trial protocol. Contemporary Clinical Trials, 33, 312–319.CrossRefGoogle ScholarPubMed
Thomas, L., Kessler, D., Campbell, J., Morrison, J., Peters, T. J., Williams, C., et al. (2013). Prevalence of treatment-resistant depression in primary care: cross sectional data. British Journal of General Practice, 63, e852–e858.Google Scholar
Trivedi, M. H., Rush, A. J., Wisniewski, S. R., Nierenberg, A. A., Warden, D., Ritz, L., et al. (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. American Journal of Psychiatry, 163, 28–40.Google Scholar
Vittengl, J. R., Clark, L. A., Dunn, T. W. and Jarrett, R. B. (2007). Reducing relapse and recurrence in unipolar depression: a comparative meta-analysis of cognitive-behavioral therapy's effects. Journal of Consulting and Clinical Psychology, 73, 475–488.CrossRefGoogle Scholar
Vittengl, J. R., Clark, L. A. and Jarrett, R. B. (2010). Moderators of continuation phase cognitive therapy's effects on relapse, recurrence, remission, and recovery from depression. Behaviour Research and Therapy, 48, 449–458.CrossRefGoogle ScholarPubMed
Weissman, A. N. (1979). The Dysfunctional Attitude Scale: a validation study. Unpublished doctoral dissertation, University of Pennsylvania, Philadelphia.Google Scholar
Wiles, N., Thomas, L., Abel, A., Ridgway, N., Turner, N., Campbell, J., et al. (2013). Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. The Lancet, 381, 375–384.Google Scholar
Young, J. E. and Brown, G. (1990). Young Schema Questionnaire. New York: Cognitive Therapy Center of New York.Google Scholar
Submit a response

Comments

No Comments have been published for this article.