Conclusions

This chapter has provided a description ofthe cognitive model ofdepression and the typical process of CT for depression. The typical behavioral, cognitive restructuring, and assumptive interventions employed in CT are associated with clinical outcomes that are as strong as those in any other treatment in depression, and potentially with stronger long-term effects that phar-macotherapy (Hollon, Stewart, & Strunk, 2006). It also appears that CT is effective across the range of depression severity, so it can be used in different clinical settings. Furthermore, given the concerns about side effects of some antidepressant medications, some treatment guidelines now recommend the use of CT or related models as the preferred treatment in less severe cases of depression (National Institute for Clinical Excellence, 2006). Despite the overall value of CT and the fact that it is generally recognized as an empirically supported therapy (Chambless & Ollendick, 2001), about one-third of patients fail to respond to this treatment model. Furthermore, relapse rates of about 25% at 1 year following treatment suggest that there is more to learn about treatment failure and relapse.

I concluded the chapter with a brief description of some of the research related to the CT model and therapy. Much remains to be known about CT for depression. We still do not know as much as would be ideal about the treatment factors associated with positive outcome in CT for depression. Additional dismantling and process studies are needed to explore these dimensions. Finally, we know relatively little about patient predictors of outcome in CT for depression. Although higher levels of initial depres sion severity, more chronicity, and more comorbidity are predictors of more negative outcomes, much more research is needed to explore factors such as depression subtypes or other factors that may affect patients' short- and long-term responses to this treatment model. Also, the field desperately needs studies that examine the predictors of outcome in CT relative to other evidence-based treatments. In summary, the field has at this point in the history of established its overall efficacy, but it now needs to address issues related to its effectiveness (Nathan, Stuart, & Dolan, 2000), and its efficacy relative to other empirically supported treatments for depression.

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