Cognitive Treatment

It has been frequently reported that management of refractory depression requires modifications from standard CT (Beck, Rush, Shaw, & Emery, 1979). Cole, Brittlebank, and Scott (1994) emphasized the importance of brief but frequent (20 minutes, three times a week) initial sessions, as well as incorporating techniques developed in CT of personality disorders. Thase and Howland (1994) suggested the need for frequent sessions to enhance learning and retention of homework assignments and in-session rehearsal, and of involvement of the spouse or significant others to provide psychoed-ucation.

Treatment of drug-resistant major depressive disorder may consist of 10-20 sessions, once every week. Treatment is articulated in three phases.

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