Moderate to severely depressed clients showed greater improvement in cognitive therapy when therapists emphasized changing how they think rather than how they behave, new research has found.
The results suggest cognitive therapists should concentrate, at least during the first few sessions, on using cognitive techniques to help those with more severe depression to break out of negative thought patterns and to see events in their lives more realistically.
The study found that a concentration on changing behavior -- such as having patients schedule activities to get them out of the house, and tracking how they spent their time -- did not significantly predict subsequent change in depressive symptoms.
"There has been a lot of attention recently on behavioral approaches to treating severe depression, and that may lead some people to suspect that cognitive techniques are not important for more severely depressed patients," said Daniel Strunk, co-author of the study and assistant professor of psychology at Ohio State University.
"But our results suggest that it was the cognitive strategies that actually helped patients improve the most during the first critical weeks of cognitive-behavioral therapy."
Strunk conducted the study with Melissa Brotman of the National Institute of Mental Health and Robert DeRubeis of the University of Pennsylvania. Their results appear online in the journal Behaviour Research and Therapy and will appear in a later print edition.
The study involved 60 patients who were diagnosed with major depression and who were being treated at two university clinics.
The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains.
Daniel R. Strunk, Melissa A. Brotman, Robert J. DeRubeis.
Behaviour Research and Therapy, 2010; article in press DOI: 10.1016/j.brat.2010.03.011
Link to Behav Res Therapy abstract