Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-26T12:44:19.542Z Has data issue: false hasContentIssue false
  • English
  • Français

Evidence for the cognitive mediational model of cognitive behavioural therapy for depression

Published online by Cambridge University Press:  26 June 2008

L. C. Quilty ,
C. McBride  and
R. M. Bagby
L. C. Quilty
Affiliation:
Clinical Research Department, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada
C. McBride
Affiliation:
Clinical Research Department, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada
R. M. Bagby*
Affiliation:
Clinical Research Department, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada
*
*Address for correspondence: R. M. Bagby, Ph.D., Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although empirical support for the efficacy of cognitive behavioural therapy (CBT) as a treatment for major depressive disorder (MDD) is well established, its mechanism of action is uncertain. In this investigation, we examined evidence for the cognitive mediational model in a randomized control trial involving CBT, interpersonal therapy (IPT) and pharmacotherapy (PHT) in patients with MDD.

Method

One hundred and thirty participants diagnosed with MDD were treated with CBT, IPT or PHT. Participants completed the Hamilton Depression Rating Scale, Beck Depression Inventory – II and Dysfunctional Attitudes Scale prior to and following treatment.

Results

The cognitive mediational model, in which dysfunctional attitudes are proposed to mediate depressive symptom reduction in response to treatment, provided a good fit to the data when contrasting CBT v. IPT, with results supporting a mediational role for dysfunctional attitude change in depressive symptom reduction. The complication model, in which dysfunctional attitudes are proposed to be a consequence of depressive symptom reduction, provided a good fit to the data when contrasting CBT v. PHT, with results supporting a mediational role for depressive symptom reduction in dysfunctional attitude change.

Conclusions

There was no evidence for a mediational role for dysfunctional attitude change in IPT. Changes in dysfunctional attitudes accompanied both CBT and PHT; however, empirical evidence suggests that the role of attitudes in treatment outcome may differ between these two treatments.

Keywords

Cognitive behavioural therapydysfunctional attitudesinterpersonal therapymediationtreatment outcome
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 11 , November 2008 , pp. 1531 - 1541
Copyright
Copyright © 2008 Cambridge University Press

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

Arbuckle, JL (2005). Amos 6.0 User's Guide. Amos Development Corporation: Spring House, PA.Google Scholar
Bagby, RM, Ryder, AG, Schuller, DR, Marshall, MB (2004). The Hamilton Depression Rating Scale: has the gold standard become a lead weight? American Journal of Psychiatry 161, 2163–2177.CrossRefGoogle ScholarPubMed
Barnett, PA, Gotlib, IH (1988). Dysfunctional attitudes and psychosocial stress: the differential prediction of future psychological symptomatology. Motivation and Emotion 12, 251–270.CrossRefGoogle Scholar
Bech, P, Gram, LF, Dein, E, Jacobsen, O, Vitger, J, Bolwig, TG (1975). Quantitative rating of depressive states. Acta Psychiatrica Scandinavica 51, 161–170.CrossRefGoogle ScholarPubMed
Beck, AT (1983). Cognitive therapy of depression: new perspectives. In Treatment of Depression: Old Controversies and New Approaches (ed.Clayton, P. J. and Barret, J. E.), pp. 265–290. Raven Press: New York.Google Scholar
Beck, AT, Epstein, N, Harrison, R (1983). Cognitions, attitudes and personality dimensions in depression. British Journal of Cognitive Psychotherapy 1, 1–16.Google Scholar
Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. Guilford: New York.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Manual for the Beck Depression Inventory – II. Psychological Corporation: San Antonio, TX.Google Scholar
Blatt, SJ, Quinlan, DM, Pilkonis, PA, Shea, MT (1995). Impact of perfectionism and need for approval on the brief treatment of depression: The National Institute of Mental Health Treatment of Depression Collaborative Research Program revisited. Journal of Consulting and Clinical Psychology 63, 125–132.CrossRefGoogle ScholarPubMed
Burns, DD, Spangler, DL (2001). Do changes in dysfunctional attitudes mediate changes in depression and anxiety in cognitive behavioral therapy? Behavior Therapy 32, 337–369.CrossRefGoogle Scholar
Butler, AC, Chapman, JE, Forman, EM, Beck, AT (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review 26, 17–31.CrossRefGoogle ScholarPubMed
Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) (2001). Clinical guidelines for the treatment of depressive disorders. Canadian Journal of Psychiatry 46 (Suppl. 1), 1S–91S.Google Scholar
Cane, DB, Olinger, LJ, Gotlib, IH, Kuiper, NA (1986). Factor structure of the Dysfunctional Attitude Scale in a student population. Journal of Clinical Psychology 42, 307–309.3.0.CO;2-J>CrossRefGoogle Scholar
Clark, DA, Beck, AT, Alford, BA (1999). Scientific Foundations of Cognitive Theory and Therapy of Depression. Wiley: New York.Google Scholar
DeRubeis, RJ, Evans, MD, Hollon, SD, Garvey, MJ, Grove, WM, Tuason, VB (1990). How does cognitive therapy work? Cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology 58, 862–869.CrossRefGoogle ScholarPubMed
Dobson, KS, Shaw, BF (1986). Cognitive assessment with major depressive disorders. Cognitive Therapy and Research 10, 13–29.CrossRefGoogle Scholar
Dohr, KB, Rush, AJ, Bernstein, IH (1989). Cognitive biases and depression. Journal of Abnormal Psychology 98, 263–267.CrossRefGoogle ScholarPubMed
Faries, D, Herrera, J, Rayamajhi, J, DeBrota, D, Demitrack, M, Potter, WZ (2000). The responsiveness of the Hamilton Depression Rating Scale. Journal of Psychiatric Research 34, 3–10.CrossRefGoogle ScholarPubMed
First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, LS (1997). User's Guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). American Psychiatric Press: Washington, DC.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient edition (SCID – I/P), version 2. Biometric Research Department, New York State Psychiatric Institute: New York.Google Scholar
Frank, E, Prien, RF, Jarrett, RB, Keller, MT, Kupfer, DJ, Lavori, PW, Rush, AJ, Weissman, MM (1991). Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Archives of General Psychiatry 48, 851–855.CrossRefGoogle ScholarPubMed
Furlong, M, Oei, TPS (2002). Changes to automatic thoughts and dysfunctional attitudes in group CBT for depression. Behavioural and Cognitive Psychotherapy 30, 351–360.CrossRefGoogle Scholar
Garratt, G, Ingram, RE, Rand, KL, Sawalani, G (2007). Cognitive processes in cognitive therapy: evaluation of the mechanisms of change in the treatment of depression. Clinical Psychology: Science and Practice 14, 224–239.Google Scholar
Goldapple, K, Segal, Z, Garson, C, Lau, M, Bieling, P, Kennedy, S, Mayberg, H (2004). Modulation of cortical-limbic pathways in major depression: treatment-specific effects of cognitive behaviour therapy. Archives of General Psychiatry 61, 34–41.CrossRefGoogle Scholar
Greenberger, D, Padesky, CA (1995). Mind Over Mood: A Cognitive Therapy Treatment Manual for Clients. Guilford: New York.Google Scholar
Hamilton, EW, Abramson, LY (1983). Cognitive patterns and major depressive disorder: a longitudinal study in a hospital setting. Journal of Abnormal Psychology 92, 173–184.CrossRefGoogle ScholarPubMed
Hamilton, M (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278–296.CrossRefGoogle ScholarPubMed
Hollon, SD, DeRubeis, RJ, Evans, MD (1987). Causal mediation of change in treatment for depression: discriminating between nonspecificity and noncausality. Psychological Bulletin 102, 139–149.CrossRefGoogle ScholarPubMed
Hollon, SD, Kendall, PC, Lumry, A (1986). Specificity of depressotypic cognitions in clinical depression. Journal of Abnormal Psychology 95, 52–59.CrossRefGoogle ScholarPubMed
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 1–55.CrossRefGoogle Scholar
Imber, SD, Pilkonis, PA, Sotsky, SM, Elkin, I, Watkins, JT, Collins, JF, Shea, MT, Leber, WR, Glass, DR (1990). Mode-specific effects among three treatments for depression. Journal of Consulting and Clinical Psychology 58, 352–359.CrossRefGoogle ScholarPubMed
Jacobson, NS, Dobson, KS, Truax, PA, Addis, ME, Koerner, K, Gollan, JK, Gortner, E, Prince, SE (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology 64, 295–304.CrossRefGoogle ScholarPubMed
Kline, RB (2005). Principles and Practice of Structural Equation Modeling, 2nd edn. Guilford: New York.Google Scholar
Kraemer, HC, Stice, E, Kazdin, A, Offord, D, Kupfer, D (2001). How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. American Journal of Psychiatry 158, 848–856.CrossRefGoogle ScholarPubMed
Kraemer, HC, Wilson, T, Fairburn, CG, Agras, WS (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry 59, 877–883.CrossRefGoogle ScholarPubMed
Kwon, S, Oei, TPS (2003). Cognitive change processes in a group cognitive behavior therapy of depression. Journal of Behavior Therapy and Experimental Psychiatry 34, 73–85.CrossRefGoogle Scholar
McBride, C, Atkinson, L, Quilty, LC, Bagby, RM (2006). Attachment as moderator of treatment outcome in major depression: a randomized control trial of interpersonal psychotherapy versus cognitive behavior therapy. Journal of Consulting and Clinical Psychology 74, 1041–1054.CrossRefGoogle ScholarPubMed
Meyer, JH, Joule, S, Sagrati, S, Carella, A, Hussey, DF, Ginovart, N, Goudling, V, Kennedy, J, Wilson, AA (2004). Brain serotonin transporter binding potential measured with carbon 11-labeled DASB positron emission tomography: effects of major depressive episodes and severity of dysfunctional attitudes. Archives of General Psychiatry 61, 1271–1279.CrossRefGoogle ScholarPubMed
Oei, TPS, Free, ML (1995). Do cognitive behaviour therapies validate cognitive models of mood disorders? A review of the empirical evidence. International Journal of Psychology 30, 145–180.CrossRefGoogle Scholar
Oei, TPS, Sullivan, LM (1999). Cognitive changes following recovery from depression in a group cognitive-behaviour therapy program. Australian and New Zealand Journal of Psychiatry 33, 407–415.CrossRefGoogle Scholar
Oliver, JM, Baumgart, EP (1985). The Dysfunctional Attitude Scale: psychometric properties and relation to depression in an unselected adult population. Cognitive Therapy and Research 9, 161–167.CrossRefGoogle Scholar
Reda, MA, Carpiniello, B, Secchiaroli, L, Blanco, S (1985). Thinking, depression and antidepressants: modified and unmodified depressive beliefs during treatment with amitriptyline. Cognitive Therapy and Research 9, 135–143.CrossRefGoogle Scholar
Rush, AJ, Weissenburger, J, Eaves, G (1986). Do thinking patterns predict depressive symptoms? Cognitive Therapy and Research 10, 225–235.CrossRefGoogle Scholar
Scher, CD, Ingram, RE, Segal, ZV (2005). Cognitive reactivity and vulnerability: empirical evaluation of construct activation and cognitive diatheses in unipolar depression. Clinical Psychology Review 25, 478–510.CrossRefGoogle ScholarPubMed
Schrader, G, Gibbs, A, Harcourt, R (1986). Dysfunctional attitudes in former psychiatric inpatients. Journal of Nervous and Mental Disease 174, 660–663.CrossRefGoogle ScholarPubMed
Segal, ZV, Gemar, M, Williams, S (1999). Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression. Journal of Abnormal Psychology 108, 3–10.CrossRefGoogle ScholarPubMed
Shrout, PE, Bolger, N (2002). Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological Methods 7, 422–445.CrossRefGoogle ScholarPubMed
Siegle, GJ, Carter, CS, Thase, ME (2006). Use of fMRI to predict recovery from unipolar depression with cognitive behaviour therapy. American Journal of Psychiatry 163, 735–738.CrossRefGoogle Scholar
Simons, AD, Garfield, SL, Murphy, GE (1984). The process of change in cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry 41, 45–51.CrossRefGoogle ScholarPubMed
Ullman, JB (1996). Structural equation modeling. In Using Multivariate Statistics (ed.Tabachnick, B. G. and Fidell, L. S.), pp. 709–819. Harper Collins College Publishers: New York.Google Scholar
Wampold, BE, Minami, T, Baskin, TW, Tierney, SC (2002). A meta-(re)analysis of the effects of cognitive therapy versus ‘other therapies’ for depression. Journal of Affective Disorders 68, 159–165.CrossRefGoogle ScholarPubMed
Weissman, AN, Beck, AT (1978). Developmental validation of the Dysfunctional Attitude Scale. Paper presented at the Annual Meeting of the Association of Advancement of Behavioral Therapy, Chicago.Google Scholar
Weissman, MM, Markowitz, JC, Klerman, GL (2000). Comprehensive Guide to Interpersonal Psychotherapy. Basic Books: New York.Google Scholar
Whisman, MA (1993). Mediators and moderators of change in cognitive therapy of depression. Psychological Bulletin 114, 248–265.CrossRefGoogle ScholarPubMed
Whisman, MA, Perez, JE, Ramel, W (2000). Factor structure of the Beck Depression Inventory – Second Edition (BDI-II) in a student sample. Journal of Clinical Psychology 56, 545–551.3.0.CO;2-U>CrossRefGoogle Scholar
Zimmerman, M, Coryell, W, Corenthal, C, Wilson, S (1986). Dysfunctional attitudes and attribution style in healthy controls and patients with schizophrenia, psychotic depression and nonpsychotic depression. Journal of Abnormal Psychology 95, 403–405.CrossRefGoogle ScholarPubMed
Zuroff, DC, Blatt, SJ, Sanislow, CA, Bondi, CM, Pilkonis, PA (1999). Vulnerability to depression: reexamining state dependence and relative stability. Journal of Abnormal Psychology 108, 76–89.CrossRefGoogle ScholarPubMed