Parameters of Depression

As previously noted, it is important to evaluate the severity, history, and persistence of depression. These are important parameters to evaluate, because they may provide important information regarding the cognitive factors targeted in treatment. According to the severity-persistence hypothesis of the cognitive theory of depression, the "extent of negative self-referent cognition, reduced positive thinking, and negativity processing bias are linearly related to depression severity and persistence" (Clark et al., 1999, p. 168). This means that patients with more severe or more long-standing and persistent depression should have more frequent and pervasive negative self-referent automatic thoughts and more prominent negative processing biases. As reviewed by Clark et al., there is considerable empirical support for this hypothesis. As applied to CT for depression, the implication of this perspec tive is that negative cognition is likely to be particularly pronounced among these types of patients (i.e., patients with severe or persistent depression may be defined, in part, by the degree of endorsement of negative cognition). Furthermore, it is important to consider parameters related to history of illness, such as number of prior major depressive episodes, evidence of extended periods of residual symptomatology, or whether the patient has experienced multiple failed treatment attempts. Indeed, such historical parameters may impact the patient's level of hopelessness and expectations for treatment.

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