1. An Overview 2. The Role of Emotions in Cognitive Therapy 3. The Therapeutic Relationship: Application to Cognitive Therapy 4. Structure of the Therapeutic Interview 5. The Initial Interview 6. Session by Session Treatment: A Typical Course of Therapy 7. Application of Behavioral Techniques 8. Cognitive Techniques 9. Focus on Target Symptoms 10. Specific Techniques for the Suicidal Patient 11. Interview with a Depressed Suicidal Patient 12. Depressogenic Assumptions 13. Integration of Homework into Therapy 14. Technical Problems 15. Problems Related to Termination and Relapse 16. Group Cognitive Therapy for Depressed Patients Steven D. Hollon and Brian F. Shaw 17. Cognitive Therapy and Antidepressant Medications 18. Outcome Studies of Cognitive Therapy Appendix: Materials *The Beck Inventory *Scale for Suicide Ideation *Daily Record of Dysfunctional Thoughts *Competency Checklist for Cognitive Therapists *Possible Reasons for Not Doing Self-Help Assignments *Research Protocol for Outcome Study at Center for Cognitive Therapy *Further Materials and Technical Aids

Cognitive Therapy of Depression

The electrodermal system

Three potential sources of error in retrospective reports of childhood experiences are documented: low reliability and validity of autobiographical memory in general, the presence of general memory impairment associated with psychopathology, and the presence of specific mood-congruent memory biases associated with psychopathology. The evidence reviewed suggests that claims concerning the general unreliability of retrospective reports are exaggerated and that there is little reason to link psychiatric status with less reliable or less valid recall of early experiences. Nevertheless, it is clear that steps must be taken to overcome the limitations of retrospective reports and enhance their reliability.

https://psycnet.apa.org/journals/bul/113/1/82.pdf

Psychopathology and early experience: a reappraisal of retrospective reports.

The development of cognitive therapy, one of the most promising interventions for the treatment of depression and other nonpsychotic disorders, has been strongly influenced by basic research in social and cognitive psychology. The approach is predicated on a two-factor cognitive theory of emotion and accords a central role to the operation of schematic knowledge structures and information-processing heuristics. Procedures designed to produce change in existing depresotypic beliefs are grounded in principles emerging from that basic literature, and strategies derived from attribution theory appear to contribute to the apparent capacity of cognitive therapy to prevent the emergence of future depressive episodes. Clearly, the development and articulation of cognitive therapy have benefited greatly from basic research in experimental social and cognitive psychology.

Cognitive Therapy for Depression A Social Cognitive Perspective

Anxiety as an Emotional State

We tested the role of guaranteed delivery of medication in the prevention of relapse and the enhancement of adjustment in the community in patients with schizophrenia. Two hundred and ninety newly hospitalized patients at four hospitals were randomly assigned to groups receiving either long-acting injectable fluphenazine decanoate or short-acting oral fluphenazine hydrochloride. After discharge and stabilization, patients were treated in the community for up to one year. By the end of the year, 28% of all the patients had relapsed. Contrary to hypothesis, differences between the two treatment groups in relapse percentages were not significant. Furthermore, there were no differences between the treatment groups as to development of affective symptomatology or social adjustment. Patients who rated themselves as having more symptom distress at the start of the community-maintenance phase of the study relapsed much earlier while receiving fluphenazine decanoate rather than fluphenazine hydrochloride. The results suggest that compliance is not an important determinant of relapse among newly discharged schizophrenic patients.

Prevention of relapse in schizophrenia: An evaluation of fluphenazine decanoate.

With recent developments in community psychiatric services, concern with prevention has become an urgent social, as well as medical challenge. Comprehensive investigation into causation must therefore be given systematic emphasis. This paper is an effort toward clarification of etiology, specifically of the depressive disorder, in terms of early childhood experiences. The work is based on social and psychiatric history data collected by experienced psychiatric social workers on two groups of subjects from the National Institute of Mental Health (NIMH) Collaborative Depression Studies under the direction of Allen Raskin, Ph.D, of the NIMH Psychology Research Branch, and a third group of subjects from Boston State Hospital. The hypothesis that childhood deprivation, defined as "the lack, loss or absence of an emotionally sustaining relationship prior to adolescence", has a meaningful association with the occurrence of adult depression was tested in a sample of 347 depressed inpatient women and 114 outpatient women in comparison to 198 normal women used as a control or reference population. The subjects were all Caucasian. Events occurring during childhood that could be considered within the definition of deprivation were documented. Further, subjects were assessed as to depriving childrearing experiences. The findings revealed no association of adult depression with overt childhood loss events, but did provide evidence to support an association of depriving childrearing processes with adult depression. The findings also revealed evidence of a relationship between the degree of the depriving childrearing experience with the severity of the adult illness as measured by hospital status. The results are discussed in relation to findings from other studies of childhood deprivation and psychiatric disorder.

Deprivation in the childhood of depressed women.

The Psychopharmacology Of Phenothiazine Compounds: A Comparative Study Of The Effects Of Chlorpromazine, Promethazine, Trifluoperazine, And Perphenazine In Normal Males. Ii

Eighty-five female depressed patients were treated for 4 weeks with amitriptyline in a flexible dose (median, 150 mg daily). Predictive analyses of outcome were carried out, using both typological and regressional models based on the same 29 predictor variables. The typological prediction utilized a previously described four-group typology derived by multivariate cluster analysis and comprising psychotic depressives, anxious depressives, hostile depressives, and young depressives with personality disorder. Patients were assigned to groups by discriminant functions on the basis of scores on the predictor variables. The four groups were found to predict outcome significantly. Psychotic depressives, initially the most severely depressed, improved the most; anxious depressives, a little less severely ill initially, showed the least improvement and the most residual illness at 4 weeks; hostile depressives and young depressives with personality disorders, initially the least severely ill, showed intermediate improvement and were least ill, by a small margin, at 4 weeks. The 29 predictor variables also predicted outcome significantly in linear multiple regression analyses. Five variables showed regression weights significantly different from zero: high initial severity predicted high improvement but more residual illness; initial insomnia, more previous depressions, longer illness, and hypochondriasis all predicted low improvement and more residual illness. Predictions by using typological and regression models were compared, and their interrelationships were examined. The regression prediction accounted for more variance in outcome measures than did the typology, but the statistical significances of the regression and typological predictions were of the same order. Two variables appeared particularly important—high initial severity of illness which characterized the psychotic depresives and increased number of previous depressions which characterized the anxious depressives. Typological prediction was not solely due to these two variables in linear regression model sicne it remained significant when the outcome measure was adjusted for both by analysis of covariance. Both typological and regressional models provide useful approaches to prediction, with only limited overlap. The typological approach, which has been relatively neglected in recent years, warents more frequent application as an alternative to multiple regression.

Clinical response to amitriptyline among depressed women.

Chiorpromazine, while a drug of proven efficacy in clinical psychiatry, does nonetheless, “backfire” on occasions. Rather than reducing a patient’s anxiety or producing a calming effect, the patients may exhibit increased agitation, paranoid reactions, or heightened anxiety after its administration. This variability of response has been attributed by both clinicians and researchers to differences in the personality structure of the drug recipient. In one of our early studies( 1), we had examined the effects of a number of drugs in normal male volunteers. Clear patterns of action emerged for each drug, but considerable variability of response to each was also noted. In a post hoc analysis of data, we found that our student volunteers could be separated into two contrasting personality types. The first group, which we called Type A’s, were extroverted athletes with a low anxiety level, while the other group, Type B’s, were introverted intellectuals with a high anxiety level. Members of each type showed a distinctly different response to reserpine, phenyltoloxamine, and a placebo. From an examination of the psychodynamics of the two personality types, we inferred that a major factor underlying the variability of response to phenyltoloxamine was the differential meaning that the subjects ascribed to its sedative-hypnotic actions. The subjects in turn reacted differently depending on the meaning of the sedative-hypnotic effects to them. Recently we investigated the psychophysiologic effects of a number of pheno-

Alberto Dimascio

Papers

Prevention of relapse in schizophrenia: An evaluation of fluphenazine decanoate.

Deprivation in the childhood of depressed women.

The Psychopharmacology Of Phenothiazine Compounds: A Comparative Study Of The Effects Of Chlorpromazine, Promethazine, Trifluoperazine, And Perphenazine In Normal Males. Ii

Clinical response to amitriptyline among depressed women.

Personality factors in variability of response to phenothiazines.