depressed indivs have stable core beliefs that develop as a consequence of learning.
core beliefs predispose people to negative interpretations of life events (cognitive distortions, automatic thoughts).Cognitive distortions, automatic thoughts lead depressed person to engage in depressive behavior.So treatment is progressive to first target observable, overt behavior, then dysfunctional automatic thoughts, correct situation-specific distortions in thinking, then identification and modification of core beliefs.
REF for CT as effective if not more effective as pharmacotherapy, behavior therapy, and other therapies.
Elkin et al. 1989-TDCRP
Hollon et al. 1991-based on TDCRP data
Shea et al. 1992--CT long term effects, more durable than pharmacotherapy.
What does Beck 1979 manual specifically state is the core mechanism of change in CT?
Interventions aimed at cognitive structures or core schema.
Jacobson 2000 aim?
Despite Beck's claim that the main mechanism of action of CT is the modification of schema (cognitive change), CT is so multifaceted, there must be other components that contribute to change, and those must be examined: behavior change, automatic thought identification.
They called these: "activation hypothesis" and "coping skills hypothesis" because one was behavioral activation and the other enabled individuals to elect better coping strategies in situ when they identified automatic thoughts.
Also wanted to see: do the three conditions effect change via different mechanisms (independently of how well they work)?
Jacobson 2000 hypothesis
according to beck's ct theory, ct condition should work better than at should work better than ba
Pros of the study:
all 4 therapists in the study were CT therapists
all therapists were given a year of training in the treatment they would be administering for the study
manuals were created for each of the treatment conditions (all were based on the original beck ct manual 1979)
20% audiotaped sessions listened to for treatment fidelity
automatic thought condition
behavioral activation plus identification of automatic thoughts and cognitive distortions.
cognitive distortion: negative construals of events that precipitate sad feelings or depressed behavior.
1. notice mood shifts, thoughts that preceded
2. dysfunctional thought record
3. examining evidence for thoughts/conclusions surrounding specific events
4. examine possibility of attributional biases
5. homework assignments to assess validity of negative interpretations.
Jacobson 2000 outcome measures
evaluated before therapy, termination, and 6, 12, 18, and 24 month follow-up.
At follow-up gave the: LIFE (Longitudinal Interval Follow-up Evaluation) to assessfor major depression.
Also given HRSD and BDI
none of the follow-up analyses uncovered differences between groups. CTdid not lead to decreased relapse, or better long-term functioning in terms of depressivesymptoms, than did either of the component treatments.
Clients in all conditions increased their frequency andenjoyability of pleasant events; decreased their negative thinking; and showed significantlylowered tendencies to attribute negative events to internal, stable, and global factors.
What is the important take home message of the findings?
The finding that BA alone is equal in efficacy to more complete versions of CT is importantfor both the theory and treatment of depression.
Thesefindings run contrary to hypotheses generated by the cognitive model of depression put forthby Beck and his associates (1979) , who proposed that direct efforts aimed at modifying11negative schema are necessary to maximize treatment outcome and prevent relapse.
Theseresults are all the more surprising, given that they run counter to the allegiance effect( Robinson, Berman, & Neimeyer, 1990 ), which is quite commonly related to outcome inpsychotherapy research.
All of the therapists expected CT to be the most effective treatment,and morale was low whenever a case was assigned to BA. Moreover, Keith S. Dobson, oneof the clinical supervisors in the TDCRP, expected CT to outperform the alternativetreatments.
raise questions about the necessary and sufficient conditions for change