Academic journal article Journal of Cognitive Psychotherapy

Examining Specific Cognitive Change in Cognitive Therapy for Depression: A Controlled Case Experiment

Academic journal article Journal of Cognitive Psychotherapy

Examining Specific Cognitive Change in Cognitive Therapy for Depression: A Controlled Case Experiment

Article excerpt

Cognitive therapy (CT) is purported to ease depression primarily by weakening the influence of certain depressive beliefs. Customarily, this claim is supported by a reduced score on one or more of the standardized measures of dysfunctional thinking, and not by measuring beliefs specific to the individual; nor is it usual practice to monitor dysfunctional beliefs regularly before and throughout CT. The present single-case study describes a new approach for studying specific cognitive change by obtaining ongoing data on process and outcome. Multiple-baseline methodology was used to measure the impact of CT on four depressive beliefs identified during a pre-baseline assessment stage. The patient, a man in his late 30s, was diagnosed according to Research Diagnostic Criteria (RDC: Spitzer, Endicott, & Robins, 1978) as having a primary depressive disorder which showed as moderate to severe on the Beck Depression Inventory (BDI: Beck & Steer, 1987). A number of measures of change were used, including weekly ratings of the degree of conviction with which the four beliefs were held, and the BDI was given at regular intervals. By the close of therapy, all beliefs were rejected and the BDI scores indicated that the client was asymptomatic. Validation of change was provided by an independent clinician who conducted pre- and post-assessment interviews, and via the Dysfunctional Attitudes Scale (DAS: Weissman & Beck, 1978); while this increased confidence that the reported changes were genuine, the limitations of the study are acknowledged. Maintenance over the six-month follow-up period was good. The study thus offers provisional evidence of specific cognitive change in CT, and describes a new methodology that could be used on a wider scale to reveal if cognitive change has primacy over symptom relief.

Cognitive therapy for depression (CT: Beck, Rush, Shaw, & Emery, 1979) is a widely used treatment for unipolar, nonpsychotic depression. Research has borne out its early promise, although its comparative efficacy is still uncertain. In a comprehensive review of the outcome literature, Hollon, Shelton, and Loosen (1991) conclude on the basis of current evidence that it is too soon to assert that CT is a match for tricy clic pharmacotherapy in the treatment of acute depression, although the evidence is pointing this way. These authors cautiously propose that CT during an acute episode may reduce the risk of relapse, although they detail methodological shortcomings in outcome studies which preclude this becoming a firm conclusion.

As these comments attest, CThas come a long way in a short time. The underlying theory is that for many people, depression is a consequence of erroneous beliefs and maladaptive information processing. Therapy is intended to correct these beliefs and biases and thereby to ease the depression. In other words, the '"primary premise" of CTis that cognitive change effects symptom remission (Beckham, 1990). For this to be confirmed, CT would have to be shown to produce predictable cognitive changes, and these changes would need to precede symptom relief. Using measures of general cognitions such as the DAS, the Attributional Style Questionnaire (Seligman, Abramson, Semmel, & von Baeyer, 1979), and the Automatic Thoughts Questionnaire (Hollon & Kendall, 1980), a number of studies have established that CT for depression produces predictable cognitive change (see DeRubeis et al., 1990). However, few studies have shown that CT produces changes in beliefs that are specific to the person, as well as in more general ones.

One impediment is a lack of individualized psychometric approaches to the assessment of core beliefs (Safran, Vallis, Segal, & Shaw, 1986). As far as we are aware, Personal Questionnaire (PQ) methodology (Phillips, 1977) has yet to be used to measure depressive beliefs. In the study of delusions it has proved to be sensitive to changes in several aspects of delusional thinking that occur spontaneously (Garety, 1985) and following disputation (Chadwick & Lowe, 1990; Lowe & Chadwick, 1990). …

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