Cognitive reactivity and dysfunctional attitudes in cognitive behavioral and psychodynamic therapy for adult depression.

OBJECTIVE It is unclear whether cognitive reactivity (CR), an indicator of depression vulnerability, is reduced after cognitive behavioral therapy (CBT), as theorized. It is also unclear whether baseline CR and dysfunctional attitudes (DA) are associated with treatment outcome in CBT for depression. This study aims to examine these questions and assess if these effects are specific to CBT for depression.

METHOD Depressed adult outpatients (n = 159) randomized to 16 sessions CBT or short-term psychodynamic supportive therapy (SPSP) completed measures of depression severity and CR at baseline and post-treatment (week 22), DA at week 5, and depression severity at baseline, week 5 and 10, and post-treatment. Mixed-model analyses were applied to estimate CR change and the moderating effect of DA and CR on depression levels at post-treatment.

RESULTS CR decreased significantly with a medium effect size. CR was negatively associated with post-treatment depression levels. DA was inconsistently associated with treatment outcome. We found no indications that these findings were specific to CBT.

CONCLUSION CR decreases in both CBT and SPSP, broadening treatment options. CR, and possibly DA, appear to be prognostic factors for treatment outcome, potentially indicating the need to consider additional or alternativetreatment.