Review Of Efficacy Research

One of the strengths of CT is its strong empirical base, and this is well established in relation to acute depression. Much of the research evidence that addresses the effectiveness of CT on persistent symptoms comes from small-scale studies that have not been rigorously controlled. The earliest studies (e.g., Fennell & Teasdale, 1982) sounded a note of caution due to the low response rate. Response rates in subsequent studies (Harping, Letterman, Marks, Stern, & Johann, 1982; Gonzales, Levin, & Clarke, 1985; Stravynski, Shah, & Verreault, 1991; Fava, Rafanelli, Grandi, Canestrari, & Morphy, 1998; Fava, Savron, Grandi, & Rafanelli, 1997) have varied widely between 20 and 75%. The small sample sizes mean that such studies are highly susceptible to biases. In addition, only two of these studies (Harpin et al., 1982; Moore & Blackburn, 1997) included any kind of control condition. There were however, signs of promise that CT might be of benefit in some cases of chronic depression (Teasdale, Scott, Moore, Hayhurst, Pope, & Paykel, 2001).

The approach to CT for chronic depression described briefly here (and elaborated in Moore & Garland, 2003) was first developed for use in a rigorous, randomized controlled trial of CT for chronic depression, known as the Cambridge-Newcastle Depression Study (Paykel et al., 1999; Scott et al., 2000). This study (the results of which are described in detail in Moore & Garland, 2003) indicated that CT, as outlined here, produced a significant but modest additional improvement in remission rates, overall symptom functioning, and social functioning when added to good clinical management and medication. CT also resulted in significant improvement in the key symptoms of hopelessness and low self-esteem. Most importantly, it achieved a worthwhile reduction in the rate of relapse into full major depression, over and above the effects of continued medication. Analysis of the mechanism of change by which CT prevented relapse found little evidence to support the idea that this occurs by changing the content of cogni tion. In contrast, substantial evidence indicated that CT may prevent relapse by enabling patients to influence the way they process depression-related material rather than thought content. CT also demonstrated a reduction in the extremity of emotionally relevant thinking and an increase in patients' ability to experience upsetting cognitions as thoughts rather than facts. Both of these types of change were associated with reduced relapse.

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