scispace - formally typeset
Search or ask a question
Journal Article•DOI•

Prevention of Recurrent Depression With Cognitive Behavioral Therapy: Preliminary Findings

Giovanni A. Fava1, Chiara Rafanelli, Silvana Grandi, Sandra Conti, Piera Belluardo •
University at Buffalo1
01 Sep 1998-Archives of General Psychiatry (American Medical Association)-Vol. 55, Iss: 9, pp 816-820
TL;DR: The results challenge the assumption that long-term drug treatment is the only tool to prevent relapse in patients with recurrent depression and suggest CBT offers a viable alternative for other patients.
Abstract: Background Cognitive behavioral treatment (CBT) of residual symptoms after successful pharmacotherapy yielded a substantially lower relapse rate than did clinical management in patients with primary major depressive disorders. The aim of this study was to test the effectiveness of this approach in patients with recurrent depression (≥3 episodes of depression). Methods Forty patients with recurrent major depression who had been successfully treated with antidepressant drugs were randomly assigned to either CBT of residual symptoms (supplemented by lifestyle modification and well-being therapy) or clinical management. In both groups, during the 20-week experiment, antidepressant drug administration was tapered and discontinued. Residual symptoms were measured with a modified version of the Paykel Clinical Interview for Depression. Two-year follow-up was undertaken, during which no antidepressant drugs were used unless a relapse ensued. Results The CBT group had a significantly lower level of residual symptoms after discontinuation of drug therapy compared with the clinical management group. At 2-year follow-up, CBT also resulted in a lower relapse rate (25%) than did clinical management (80%). This difference attained statistical significance by survival analysis. Conclusions These results challenge the assumption that long-term drug treatment is the only tool to prevent relapse in patients with recurrent depression. Although maintenance pharmacotherapy seems to be necessary in some patients, CBT offers a viable alternative for other patients. Amelioration of residual symptoms may reduce the risk of relapse in depressed patients by affecting the progression of residual symptoms to prodromes of relapse.
Citations
More filters
Journal Article•DOI•
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.

[...]

John D. Teasdale1, Zindel V. Segal, Jeffrey Williams, V A Ridgeway, J M Soulsby, M A Lau •
Cognition and Brain Sciences Unit1
01 Aug 2000-Journal of Consulting and Clinical Psychology
TL;DR: In this article, the authors evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence.
Abstract: This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients (n = 145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.

2,942 citations

Cites background or result from "Prevention of Recurrent Depression ..."

  • ...For example, Fava et al. (1998) described the results of a trial comparing the long-term outcome of 40 patients with recurrent major depression (three or more episodes) successfully treated with antidepressant medication and then randomized to clinical management or a combination of (a) CBT for residual symptoms, (b) lifestyle modification, and (c) well-being therapy, while antidepressant medication was withdrawn....

    [...]

  • ...In contrast to Fava et al. (1998) , we (a) focused on a group intervention rather than an individual intervention, (b) studied more than a single therapist, (c) used a larger sample size, and (d) administered the psychological intervention at least 3 months after, rather than during, withdrawal of antidepressant medication....

    [...]

  • ...The present findings add to a growing body of evidence ( Fava et al., 1996, 1998; Frank, Kupfer, et al., 1991) that psychological interventions administered after recovery from the acute symptoms of a depressive episode can substantially alter the future course of MDD....

    [...]

  • ...A cutoff between those with only two episodes and those with more than two episodes meant that those in the latter stratum were broadly comparable with patient samples studied in other trials of psychological treatments for recurrent depression (e.g., Fava et al., 1998; Frank et al., 1990)....

    [...]

  • ...Fava and colleagues (e.g., Fava, Grandi, Zielezny, Canestrari, & Morphy, 1994; Fava, Grandi, Zielezny, Rafanelli, & Canestrari, 1996; Fava, Rafanelli, Grandi, Conti, & Belluardo, 1998 ) have reported successful use of such an approach, combining treatment of the acute episode by antidepressant medication with provision of CBT, following recovery, while antidepressant medication is gradually withdrawn....

    [...]

Journal Article•DOI•
Psychological well-being revisited: advances in the science and practice of eudaimonia.

[...]

Carol D. Ryff1•
University of Wisconsin-Madison1
01 Jan 2014-Psychotherapy and Psychosomatics
TL;DR: Research and interventions that have grown up around a model of psychological well-being generated more than two decades ago to address neglected aspects of positive functioning such as purposeful engagement in life, realization of personal talents and capacities, and enlightened self-knowledge are reviewed.
Abstract: This article reviews research and interventions that have grown up around a model of psychological well-being generated more than two decades ago to address neglected aspects of positive functioning such as purposeful engagement in life, realization of personal talents and capacities, and enlightened self-knowledge. The conceptual origins of this formulation are revisited and scientific products emerging from 6 thematic areas are examined: (1) how well-being changes across adult development and later life; (2) what are the personality correlates of well-being; (3) how well-being is linked with experiences in family life; (4) how well-being relates to work and other community activities; (5) what are the connections between well-being and health, including biological risk factors, and (6) via clinical and intervention studies, how psychological well-being can be promoted for ever-greater segments of society. Together, these topics illustrate flourishing interest across diverse scientific disciplines in understanding adults as striving, meaning-making, proactive organisms who are actively negotiating the challenges of life. A take-home message is that increasing evidence supports the health protective features of psychological well-being in reducing risk for disease and promoting length of life. A recurrent and increasingly important theme is resilience - the capacity to maintain or regain well-being in the face of adversity. Implications for future research and practice are considered.

1,573 citations

Journal Article•DOI•
Metacognitive awareness and prevention of relapse in depression: Empirical evidence

[...]

John D. Teasdale1, Richard G. Moore, Hazel Hayhurst, Marie Pope, Susan Williams2, Zindel V. Segal2 •
Cognition and Brain Sciences Unit1, University of Toronto2
01 Apr 2002-Journal of Consulting and Clinical Psychology
TL;DR: This article found that reduced metacognitive awareness is associated with vulnerability to depression and cognitive therapy (CT) and mindfulness-based CT (MBCT) would reduce depressive relapse by increasing metACognitive awareness.
Abstract: Metacognitive awareness is a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self. The authors hypothesized that (a) reduced metacognitive awareness would be associated with vulnerability to depression and (b) cognitive therapy (CT) and mindfulness-based CT (MBCT) would reduce depressive relapse by increasing metacognitive awareness. They found (a) accessibility of metacognitive sets to depressive cues was less in a vulnerable group (residually depressed patients) than in nondepressed controls; (b) accessibility of metacognitive sets predicted relapse in residually depressed patients; (c) where CT reduced relapse in residually depressed patients, it increased accessibility of metacognitive sets; and (d) where MBCT reduced relapse in recovered depressed patients, it increased accessibility of metacognitive sets. CT and MBCT may reduce relapse by changing relationships to negative thoughts rather than by changing belief in thought content.

1,053 citations

Journal Article•DOI•
Sequenced treatment alternatives to relieve depression (STAR * D): rationale and design

[...]

A. John Rush1, Maurizio Fava2, Stephen R. Wisniewski3, Philip W. Lavori4, Madhukar H. Trivedi1, Harold A. Sackeim5, Michael E. Thase3, Andrew A. Nierenberg2, Frederic M. Quitkin3, T. Michael Kashner1, David J. Kupfer3, Jerrold F. Rosenbaum2, Jonathan E. Alpert2, Jonathan W. Stewart5, Patrick J. McGrath5, Melanie M. Biggs1, Kathy Shores-Wilson1, Barry D. Lebowitz6, Louise Ritz6, George Niederehe6 •
University of Texas Southwestern Medical Center1, Harvard University2, University of Pittsburgh3, United States Department of Veterans Affairs4, Columbia University5, National Institutes of Health6
01 Feb 2004-Controlled Clinical Trials
TL;DR: STAR*D as discussed by the authors is a multisite, prospective, randomized, multistep clinical trial of outpatients with nonpsychotic major depressive disorder, which compared various treatment options for those who do not attain a satisfactory response with citalopram, a selective serotonin reuptake inhibitor antidepressant.

987 citations

Journal Article•DOI•
Psychological Well-Being and Ill-Being: Do They Have Distinct or Mirrored Biological Correlates?

[...]

Carol D. Ryff1, Gayle D. Love1, Heather L. Urry1, Daniel Muller1, Melissa A. Rosenkranz1, Elliot M. Friedman1, Richard J. Davidson1, Burton H. Singer2 •
University of Wisconsin-Madison1, Princeton University2
01 Jan 2006-Psychotherapy and Psychosomatics
TL;DR: Measures of psychological well-being and ill-being were significantly linked with numerous biomarkers, with some associations being more strongly evident for respondents aged 75+.
Abstract: Background: Increasingly, researchers attend to both positive and negative aspects of mental health. Such distinctions call for clarifi cation of whether psychological well-being and ill-being comprise opposite ends of a bipolar continuum, or are best construed as separate, independent dimensions of mental health. Biology can help resolve this query – bipolarity predicts ‘mirrored’ biological correlates (i.e. well-being and ill-being correlate similarly with biomarkers, but show opposite directional signs), whereas independence predicts ‘distinct’ biological correlates (i.e. well-being and ill-being have different biological signatures). Methods: Multiple aspects of psychological well-being (eudaimonic, hedonic) and ill-being (depression, anxiety, anger) were assessed in a sample of aging women (n = 135, mean age = 74) on whom diverse neuroendocrine (salivary cortisol, epinephrine, norepinephrine, DHEA-S) and cardiovascular factors (weight, waist-hip ratio, systolic and diastolic blood pressure, HDL cholesterol, total/HDL cholesterol, glycosylated hemoglobin) were also measured. Results:

566 citations

References
More filters
Book•
Cognitive Therapy of Depression

[...]

Steven D. Hollon1, Aaron T. Beck2•
Vanderbilt University1, University of Pennsylvania2
04 Dec 1979
TL;DR: Hollon and Shaw as discussed by the authors discuss the role of emotions in Cognitive Therapy and discuss the integration of homework into Cognitive Therapy, and discuss problems related to Termination and Relapse.
Abstract: 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

9,970 citations

Journal Article•DOI•
A Diagnostic Interview: The Schedule for Affective Disorders and Schizophrenia

[...]

Jean Endicott, Robert L. Spitzer
01 Jul 1978-Archives of General Psychiatry
TL;DR: Initial scale development and reliability studies of the items and the scale scores are reported on.
Abstract: • The Schedule for Affective Disorders and Schizophrenia (SADS) was developed to reduce information variance in both the descriptive and diagnostic evaluation of a subject. The SADS is unique among rating scales in that it provides for (1) a detailed description of the features of the current episode of illness when they were at their most severe; (2) a description of the level of severity of manifestations of major dimensions of psychopathology during the week preceding the evaluation, which can then be used as a measure of change; (3) a progression of questions and criteria, which provides information for making diagnoses; and (4) a detailed description of past psychopathology and functioning relevant to an evaluation of diagnosis, prognosis, and overall severity of disturbance. This article reports on initial scale development and reliability studies of the items and the scale scores.

5,623 citations

"Prevention of Recurrent Depression ..." refers methods in this paper

  • ...The patients’ diagnoses were established by the consensus of a psychiatrist (G.A.F.) and a clinical psychologist (C.R.) independently using the Schedule for Affective Disorders and Schizophrenia.13 Patients had to meet the following criteria: (1) a current diagnosis of major depressive disorder according to the Research Diagnostic Criteria for a Selected Group of Functional Disorders14; (2) 3 or more episodes of depression, with the immediately preceding episode being no more than 21⁄2 years before the onset of the present episode5; (3) a minimum 10-week remission according to Research Diagnostic Criteria (#2 symptoms present to no more than a mild degree with absence of functional impairment) between the index episode and the immediately preceding episode5; (4) a minimum global severity score of 7 for the current episode of depression15; (5) no history of manic, hypomanic, or cyclothymic features; (6) no history of active drug or alcohol abuse or dependence or of personality disorder according to DSM-IV criteria16; (7) no history of antecedent dysthymia; (8) no active medical illness; and (9) successful response to antidepressant drugs administered by 2 psychiatrists (S.G. and S.C.) according to a standardized protocol.17 The latter protocol involved the use of tricyclic antidepressant drugs, with gradual increases in dosages....

    [...]

  • ...) independently using the Schedule for Affective Disorders and Schizophrenia.(13) Patients had to meet the following criteria: (1) a current diagnosis of major depressive disorder according to the Research Diagnostic Criteria for a Selected Group of Functional Disorders(14); (2) 3 or more episodes of depression, with the immediately preceding episode being no more than 21⁄2 years before the onset of the present episode(5); (3) a minimum 10-week remission according to Research Diagnostic Criteria (#2 symptoms present to no more than a mild degree with absence of functional impairment) between the index episode and the immediately preceding episode(5); (4) a minimum global severity score of 7 for the current episode of depression(15); (5) no history of manic, hypomanic, or cyclothymic features; (6) no history of active drug or alcohol abuse or dependence or of personality disorder according to DSM-IV criteria(16); (7) no history of antecedent dysthymia; (8) no active medical illness; and (9) successful response to antidepressant drugs administered by 2 psychiatrists (S....

    [...]

Journal Article•DOI•
Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)

[...]

George Mendelson
06 Jul 2009-Australian and New Zealand Journal of Psychiatry

3,512 citations

Journal Article•DOI•
Stress and the Individual: Mechanisms Leading to Disease

[...]

Bruce S. McEwen1, Eliot Stellar•
Yale University1
27 Sep 1993-JAMA Internal Medicine
TL;DR: A new formulation of the relationship between stress and the processes leading to disease is presented, emphasizing the cascading relationships between environmental factors and genetic predispositions that lead to large individual differences in susceptibility to stress and, in some cases, to disease.
Abstract: Objective: This article presents a new formulation of the relationship between stress and the processes leading to disease. It emphasizes the hidden cost of chronic stress to the body over long time periods, which act as a predisposing factor for the effects of acute, stressful life events. It also presents a model showing how individual differences in the susceptibility to stress are tied to individual behavioral responses to environmental challenges that are coupled to physiologic and pathophysiologic responses. Data Sources: Published original articles from human and animal studies and selected reviews. Literature was surveyed using MEDLINE. Data Extraction: Independent extraction and cross-referencing by us. Data Synthesis: Stress is frequently seen as a significant contributor to disease, and clinical evidence is mounting for specific effects of stress on immune and cardiovascular systems. Yet, until recently, aspects of stress that precipitate disease have been obscure. The concept of homeostasis has failed to help us understand the hidden toll of chronic stress on the body. Rather than maintaining constancy, the physiologic systems within the body fluctuate to meet demands from external forces, a state termed allostasis . In this article, we extend the concept of allostasis over the dimension of time and we define allostatic load as the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine response resulting from repeated or chronic environmental challenge that an individual reacts to as being particularly stressful. Conclusions: This new formulation emphasizes the cascading relationships, beginning early in life, between environmental factors and genetic predispositions that lead to large individual differences in susceptibility to stress and, in some cases, to disease. There are now empirical studies based on this formulation, as well as new insights into mechanisms involving specific changes in neural, neuroendocrine, and immune systems. The practical implications of this formulation for clinical practice and further research are discussed. (Arch Intern Med. 1993;153:2093-2101)

3,308 citations

Book•
Statistical Methods for Survival Data Analysis

[...]

Elisa T. Lee
01 Jan 1980
TL;DR: The Fourth Edition of Statistical Methods for Survival Data Analysis is an ideal text for upper-undergraduate and graduate-level courses on survival data analysis and is an excellent resource for biomedical investigators, statisticians, and epidemiologists, as well as researchers in every field in which the analysis of survival data plays a role.
Abstract: Praise for the Third Edition. . . an easy-to read introduction to survival analysis which covers the major concepts and techniques of the subject. Statistics in Medical ResearchUpdated and expanded to reflect the latest developments, Statistical Methods for Survival Data Analysis, Fourth Edition continues to deliver a comprehensive introduction to the most commonly-used methods for analyzing survival data. Authored by a uniquely well-qualified author team, the Fourth Edition is a critically acclaimed guide to statistical methods with applications in clinical trials, epidemiology, areas of business, and the social sciences. The book features many real-world examples to illustrate applications within these various fields, although special consideration is given to the study of survival data in biomedical sciences.Emphasizing the latest research and providing the most up-to-date information regarding software applications in the field, Statistical Methods for Survival Data Analysis, Fourth Edition also includes:Marginal and random effect models for analyzing correlated censored or uncensored dataMultiple types of two-sample and K-sample comparison analysisUpdated treatment of parametric methods for regression model fitting with a new focus on accelerated failure time modelsExpanded coverage of the Cox proportional hazards modelExercises at the end of each chapter to deepen knowledge of the presented materialStatistical Methods for Survival Data Analysis is an ideal text for upper-undergraduate and graduate-level courses on survival data analysis. The book is also an excellent resource for biomedical investigators, statisticians, and epidemiologists, as well as researchers in every field in which the analysis of survival data plays a role.

3,307 citations

Related Papers (5)
Prevention of relapse in residual depression by cognitive therapy: a controlled trial.

[...]

01 Sep 1999-Archives of General Psychiatry
Eugene S. Paykel, Jan Scott, John D. Teasdale, Anthony L. Johnson, Anne Garland, Richard G. Moore, Alison Jenaway, Peter L. Cornwall, Hazel Hayhurst, Rosemary Abbott, Marie Pope 
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.

[...]

01 Aug 2000-Journal of Consulting and Clinical Psychology
John D. Teasdale, Zindel V. Segal, Jeffrey Williams, V A Ridgeway, J M Soulsby, M A Lau 
Cognitive Therapy of Depression

[...]

04 Dec 1979
Steven D. Hollon, Aaron T. Beck
Five-Year Outcome for Maintenance Therapies in Recurrent Depression

[...]

01 Dec 1990-Archives of General Psychiatry
David J. Kupfer, Ellen Frank, James M. Perel, Cleon Cornes, Alan G. Mallinger, Michael E. Thase, Ann B. McEachran, Victoria J. Grochocinski 
Conceptualization and Rationale for Consensus Definitions of Terms in Major Depressive Disorder: Remission, Recovery, Relapse, and Recurrence

[...]

01 Sep 1991-Archives of General Psychiatry
Ellen Frank, Robert F. Prien, Robin B. Jarrett, Martin B. Keller, David J. Kupfer, Philip W. Lavori, A. John Rush, Myrna M. Weissman