Severe Depression

Sona Dimidjian Christopher R. Martell Sandra J. Coffman Steven D. Hollon

In the treatment of major depression, severity has emerged as one of the more controversial variables with respect to the performance of cognitive therapy (CT). Empirical studies investigating the efficacy of CT with severely depressed patients have yielded mixed findings, and recent data suggest the possibility that when CT works for more severely depressed patients, its success may be attributable to the importance of the behavioral strategies.

In this chapter we propose a series of guidelines for the practice of CT with moderate to severely depressed patients. Guidelines pertinent to conceptualization and assessment, as well as treatment intervention, are discussed; in particular, adaptations of standard CT for use with this population are emphasized. A case illustration is included to highlight key strategies in case conceptualization and intervention. In a concluding section we review the findings from clinical trials CT that have included moderately to severely depressed patients and highlight implications of these data for clinical practitioners.

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