Cognitive Therapy for Chronic and Persistent Depression

Cognitive Therapy for Chronic and Persistent Depression

Cognitive Therapy for Chronic and Persistent Depression

Cognitive Therapy for Chronic and Persistent Depression


'This volume provides the most comprehensive presentation to date of the phenomenology, clinical aspects and cognitive therapy of persistent depression. The text is highly readable, replete with illustrative case material, and highlighted by concise summaries at the end of each chapter. The treatment approach, already validated in the famed Cambridge-Newcastle clinical trial, is an invaluable contribution.'

Aaron T. Beck, M. D.

Drawing on extensive clinical experience, Richard G. Moore and Anne Garland present a cognitive model of persistent depression that places particular importance on the role of thinking styles, underlying beliefs, subtle forms of avoidance and environmental factors.

For the practitioner, this book offers guidance on how to address particular issues that commonly arise at each stage of therapy, such as:

  • the patient is reluctant to engage in therapy
  • the patient's negative thinking does not respond to standard therapeutic techniques
  • the patient's negative beliefs have much basis in their experience
  • the therapist becomes demoralised by the apparent lack of progress in therapy

Through extensive clinical material, Cognitive Therapy for Chronic and Persistent Depression demonstrates how entrenched negative thinking patterns and ongoing avoidance can be addressed to achieve significant change in many people's lives.

This book is essential reading for any therapist working with these hard to help patients, such as clinical psychologists, psychiatric nurses, psychiatrists, social workers and counsellors.


When we set out to write this book, we wanted to write a definitive work on the treatment of persistent depression with cognitive therapy. For some disorders, the development of cognitive therapy based on the cognitive model seems to have 'sewn up' treatment of the disorder in many cases. For example, for many patients with panic disorder, addressing the factors described in the cognitive model using the techniques recommended results in remediation of the problem with minimal risk of relapse. Such an approach to persistent depression would be welcome indeed. With this possibility in mind, we made heavy weather of describing cognitive therapy for persistent depression. It seemed that perhaps we were doing exactly what many patients with persistent depression do: having set our sights on an impossible ideal, we were thrown back by the disappointment of failing to live up to it. A different approach was needed. Therefore, the book does not present 'the answer to chronic depression'. Rather, it describes some of the ideas and experiences that were successful in endeavouring to develop and apply the therapy with many patients over the years…and some of our interventions that did not result in the desired or anticipated outcome.

We believe our difficulty highlights something important about the nature of persistent depression. For more acute disorders, acquiring clinical experience enables the clinician to home in on the one or two factors that are most important in addressing the patient's problems. Working with persistent depression, increasing experience seems to have the reverse effect. As the clinician sees more patients or gets to know each individual better, they become more and more aware of an increasing number of factors, all of which seem to be contributing to the problems. These include not only intrapersonal, cognitive, behavioural and emotional factors, but also interpersonal, relational, environmental, biological, historical and cultural factors. If this impression is correct, we will have to accept that no single approach to the treatment of persistent depressionis likely to be universally successful. In presenting a cognitive approach to treatment, we have tried to balance focusing on cognition with acknowledging the role of many other factors. Therefore, we aim to consider the role of cognition among the plethora of factors contributing to the persistence of depression, to describe how to minimise the ways that all these factors may undermine . . .

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