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Depression: HELP
Articles by Robert J. DeRubeis
Based on 50 articles published since 2008
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Between 2008 and 2019, R. DeRubeis wrote the following 50 articles about Depression.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. 2014

Andersen, Barbara L / DeRubeis, Robert J / Berman, Barry S / Gruman, Jessie / Champion, Victoria L / Massie, Mary Jane / Holland, Jimmie C / Partridge, Ann H / Bak, Kate / Somerfield, Mark R / Rowland, Julia H / Anonymous2830791. ·Barbara L. Andersen, The Ohio State University, Columbus, OH · Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA · Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL · Jessie Gruman, Center for Advancing Health, Washington, DC · Victoria L. Champion, Indiana University, Indianapolis, IN · Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY · Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA · Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA · Julia H. Rowland, National Cancer Institute, Bethesda, MD. ·J Clin Oncol · Pubmed #24733793.

ABSTRACT: PURPOSE: A Pan-Canadian Practice Guideline on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults With Cancer was identified for adaptation. METHODS: American Society of Clinical Oncology (ASCO) has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The guideline was reviewed for developmental rigor and content applicability. RESULTS: On the basis of content review of the pan-Canadian guideline, the ASCO panel agreed that, in general, the recommendations were clear, thorough, based on the most relevant scientific evidence, and presented options that will be acceptable to patients. However, for some topics addressed in the pan-Canadian guideline, the ASCO panel formulated a set of adapted recommendations based on local context and practice beliefs of the ad hoc panel members. It is recommended that all patients with cancer be evaluated for symptoms of depression and anxiety at periodic times across the trajectory of care. Assessment should be performed using validated, published measures and procedures. Depending on levels of symptoms and supplementary information, differing treatment pathways are recommended. Failure to identify and treat anxiety and depression increases the risk for poor quality of life and potential disease-related morbidity and mortality. This guideline adaptation is part of a larger survivorship guideline series. CONCLUSION: Although clinicians may not be able to prevent some of the chronic or late medical effects of cancer, they have a vital role in mitigating the negative emotional and behavioral sequelae. Recognizing and treating effectively those who manifest symptoms of anxiety or depression will reduce the human cost of cancer.

2 Review Initial severity of depression and efficacy of cognitive-behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials. 2017

Furukawa, Toshi A / Weitz, Erica S / Tanaka, Shiro / Hollon, Steven D / Hofmann, Stefan G / Andersson, Gerhard / Twisk, Jos / DeRubeis, Robert J / Dimidjian, Sona / Hegerl, Ulrich / Mergl, Roland / Jarrett, Robin B / Vittengl, Jeffrey R / Watanabe, Norio / Cuijpers, Pim. ·Toshi A. Furukawa, MD, PhD, Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Erica S. Weitz, MA, Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands; Shiro Tanaka, PhD, Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA; Stefan G. Hofmann, PhD, Department of Psychological and Brain Science, Boston University, Massachusetts, USA; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden and Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stokholm, Sweden; Jos Twisk, PhD, Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Sona Dimidjian, PhD, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA; Ulrich Hegerl, MD, PhD, Roland Mergl, PhD, Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany; Robin B. Jarrett, PhD, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Jeffrey R. Vittengl, PhD, Department of Psychology, Truman State University, Kirksville, Missouri, USA; Norio Watanabe, MD, PhD, Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Pim Cuijpers, PhD, Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands furukawa@kuhp.kyoto-u.ac.jp. · Toshi A. Furukawa, MD, PhD, Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Erica S. Weitz, MA, Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands; Shiro Tanaka, PhD, Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA; Stefan G. Hofmann, PhD, Department of Psychological and Brain Science, Boston University, Massachusetts, USA; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden and Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stokholm, Sweden; Jos Twisk, PhD, Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Sona Dimidjian, PhD, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA; Ulrich Hegerl, MD, PhD, Roland Mergl, PhD, Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany; Robin B. Jarrett, PhD, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Jeffrey R. Vittengl, PhD, Department of Psychology, Truman State University, Kirksville, Missouri, USA; Norio Watanabe, MD, PhD, Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Pim Cuijpers, PhD, Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands. ·Br J Psychiatry · Pubmed #28104735.

ABSTRACT:

3 Review Cognitive-Behavioral Therapy: Nature and Relation to Non-Cognitive Behavioral Therapy. 2016

Lorenzo-Luaces, Lorenzo / Keefe, John R / DeRubeis, Robert J. ·University of Pennsylvania. Electronic address: lorenzl@sas.upenn.edu. · University of Pennsylvania. ·Behav Ther · Pubmed #27993333.

ABSTRACT: Since the introduction of Beck's cognitive theory of emotional disorders, and their treatment with psychotherapy, cognitive-behavioral approaches have become the most extensively researched psychological treatment for a wide variety of disorders. Despite this, the relative contribution of cognitive to behavioral approaches to treatment are poorly understood and the mechanistic role of cognitive change in therapy is widely debated. We critically review this literature, focusing on the mechanistic role of cognitive change across cognitive and behavioral therapies for depressive and anxiety disorders.

4 Review It's complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. 2015

Lorenzo-Luaces, Lorenzo / German, Ramaris E / DeRubeis, Robert J. ·Department of Psychology, University of Pennsylvania, United States. · Department of Psychology, University of Pennsylvania, United States. Electronic address: derubeis@psych.upenn.edu. ·Clin Psychol Rev · Pubmed #25595660.

ABSTRACT: Many attempts have been made to discover and characterize the mechanisms of change in psychotherapies for depression, yet no clear, evidence-based account of the relationship between therapeutic procedures, psychological mechanisms, and symptom improvement has emerged. Negatively-biased thinking plays an important role in the phenomenology of depression, and most theorists acknowledge that cognitive changes occur during successful treatments. However, the causal role of cognitive change procedures in promoting cognitive change and alleviating depressive symptoms has been questioned. We describe the methodological and inferential limitations of the relevant empirical investigations and provide recommendations for addressing them. We then develop a framework within which the possible links between cognitive procedures, cognitive change, and symptom change can be considered. We conclude that cognitive procedures are effective in alleviating symptoms of depression and that cognitive change, regardless of how it is achieved, contributes to symptom change, a pattern of findings that lends support to the cognitive theory of depression.

5 Review Processes of change in CBT of adolescent depression: review and recommendations. 2012

Webb, Christian A / Auerbach, Randy P / Derubeis, Robert J. ·Department of Psychology, University of Pennsylvania, 3815 Walnut Street, Philadelphia, PA 19104-1696, USA. webb@sas.upenn.edu ·J Clin Child Adolesc Psychol · Pubmed #22867130.

ABSTRACT: A growing body of research supports the efficacy of cognitive-behavioral therapy (CBT) for adolescent depression. The mechanisms through which CBT exerts its beneficial effects on adolescent patients suffering from depression, however, remain unclear. The current article reviews the CBT for adolescent depression process literature. Our review focuses on several process variables: the therapeutic alliance, patient cognitive change, and therapist adherence to, and competence in, the theory-specified techniques of therapy. Given that the vast majority of CBT process research has been conducted in the context of adult psychotherapy, we also review relevant adult research as a framework for understanding adolescent process research and to inform future investigations. Methodological issues are addressed and recommendations for future process research are raised.

6 Review Antidepressant drug effects and depression severity: a patient-level meta-analysis. 2010

Fournier, Jay C / DeRubeis, Robert J / Hollon, Steven D / Dimidjian, Sona / Amsterdam, Jay D / Shelton, Richard C / Fawcett, Jan. ·Department of Psychology, University of Pennsylvania, 3720 Walnut St, Philadelphia, PA 19104, USA. jcf@sas.upenn.edu ·JAMA · Pubmed #20051569.

ABSTRACT: CONTEXT: Antidepressant medications represent the best established treatment for major depressive disorder, but there is little evidence that they have a specific pharmacological effect relative to pill placebo for patients with less severe depression. OBJECTIVE: To estimate the relative benefit of medication vs placebo across a wide range of initial symptom severity in patients diagnosed with depression. DATA SOURCES: PubMed, PsycINFO, and the Cochrane Library databases were searched from January 1980 through March 2009, along with references from meta-analyses and reviews. STUDY SELECTION: Randomized placebo-controlled trials of antidepressants approved by the Food and Drug Administration in the treatment of major or minor depressive disorder were selected. Studies were included if their authors provided the requisite original data, they comprised adult outpatients, they included a medication vs placebo comparison for at least 6 weeks, they did not exclude patients on the basis of a placebo washout period, and they used the Hamilton Depression Rating Scale (HDRS). Data from 6 studies (718 patients) were included. DATA EXTRACTION: Individual patient-level data were obtained from study authors. RESULTS: Medication vs placebo differences varied substantially as a function of baseline severity. Among patients with HDRS scores below 23, Cohen d effect sizes for the difference between medication and placebo were estimated to be less than 0.20 (a standard definition of a small effect). Estimates of the magnitude of the superiority of medication over placebo increased with increases in baseline depression severity and crossed the threshold defined by the National Institute for Clinical Excellence for a clinically significant difference at a baseline HDRS score of 25. CONCLUSIONS: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

7 Review Mediating the effects of cognitive therapy for depression. 2009

Hollon, Steven D / DeRubeis, Robert J. ·Department of Psychology, Vanderbilt University, Nashville, Tennessee 37240, USA. steven.d.hollon@vanderbilt.edu ·Cogn Behav Ther · Pubmed #19675962.

ABSTRACT: Cognitive theory holds that inaccurate beliefs and maladaptive information processing play a role in the cause and maintenance of depression, and a cognitive theory of change posits that correcting those errors in thinking will ameliorate existing distress and reduce subsequent risk. Cognitive therapy has been shown to be efficacious in the treatment of depression and prevention of subsequent relapse, but evidence for mediation has been difficult to detect. The authors review efforts to test for mediation in cognitive therapy and describe the epistemological issues that complicate the process. Cognitive mediation of acute response likely will be hard to detect, whereas there already is good evidence that cognitive processes play a role in the mediation of enduring effects.

8 Review Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. 2008

DeRubeis, Robert J / Siegle, Greg J / Hollon, Steven D. ·University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. derubeis@psych.upenn.edu ·Nat Rev Neurosci · Pubmed #18784657.

ABSTRACT: Depression is one of the most prevalent and debilitating of the psychiatric disorders. Studies have shown that cognitive therapy is as efficacious as antidepressant medication at treating depression, and it seems to reduce the risk of relapse even after its discontinuation. Cognitive therapy and antidepressant medication probably engage some similar neural mechanisms, as well as mechanisms that are distinctive to each. A precise specification of these mechanisms might one day be used to guide treatment selection and improve outcomes.

9 Article Dysfunctional attitudes or extreme response style as predictors of depressive relapse and recurrence after mobile cognitive therapy for recurrent depression. 2019

Brouwer, Marlies E / Williams, Alishia D / Forand, Nicholas R / DeRubeis, Robert J / Bockting, Claudi L H. ·Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht 3584 CS, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands. · Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht 3584 CS, The Netherlands. · Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 110042, USA. · University of Pennsylvania, Department of Psychology, Stephen A. Levin Building, 425 S. University Ave, Philadelphia, PA 19104-6018, United States. · Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands; Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2-1, Groningen 9712 TS, The Netherlands. Electronic address: c.l.bockting@amc.uva.nl. ·J Affect Disord · Pubmed #30223139.

ABSTRACT: BACKGROUND: According to previous research, dysfunctional attitudes and/or scoring extreme on the end-point anchors of questionnaires of dysfunctional thinking predict depressive relapse/recurrence. Evidence that these two methods represent a risk for depressive relapse/recurrence is however mixed, due to differential or poorly defined concepts. The current study aimed to test the two methods. METHODS: Remitted recurrently depressed patients with low residual depressive symptoms (N = 264) were recruited as part of a randomized controlled trial of the effectiveness of mobile Cognitive Therapy for recurrent depression versus treatment as usual. In the current secondary analysis, Cox regression models were conducted to test dysfunctional attitudes and extreme responding variables (assessed on the Dysfunctional Attitudes Scale [DAS]) as predictors of depressive relapse/recurrence within two years after randomization. RESULTS: Data from 255 participants were analyzed. Results showed that DAS total scores at baseline significantly predicted depressive relapse/recurrence (Hazard Ratio [HR] = 1.01, p = .042). An index that reflects endorsement of habitual relative to functional responses was a significant predictor of depressive relapse/recurrence (HR = 2.11, p = .029). LIMITATIONS: The current study employed a single measure to identify extreme responses and dysfunctional attitudes. Secondly, various statistical analyses were performed without correcting for multiple testing, which in turn increased the likelihood to finding significant results. CONCLUSIONS: Current study confirmed both methods: People who scored higher on the DAS or had relatively more habitual than functional responses on the extreme positive ends of the DAS had a decreased time to depressive relapse/recurrence.

10 Article Cross-sectional networks of depressive symptoms before and after antidepressant medication treatment. 2018

Bos, Fionneke M / Fried, Eiko I / Hollon, Steven D / Bringmann, Laura F / Dimidjian, Sona / DeRubeis, Robert J / Bockting, Claudi L H. ·Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. f.m.bos01@umcg.nl. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. f.m.bos01@umcg.nl. · Department Quantitative Psychology and Individual Differences, University of Leuven, Leuven, Belgium. · Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands. · Department of Psychology, Vanderbilt University, Nashville, TN, USA. · Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. · Department of Psychiatry, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands. ·Soc Psychiatry Psychiatr Epidemiol · Pubmed #29627898.

ABSTRACT: PURPOSE: Recent reviews have questioned the efficacy of selective serotonin reuptake inhibitors (SSRIs) above placebo response, and their working mechanisms remain unclear. New approaches to understanding the effects of SSRIs are necessary to enhance their efficacy. The aim of this study was to explore the possibilities of using cross-sectional network analysis to increase our understanding of symptom connectivity before and after SSRI treatment. METHODS: In two randomized controlled trials (total N = 178), we estimated Gaussian graphical models among 20 symptoms of the Beck Depression Inventory-II before and after 8 weeks of treatment with the SSRI paroxetine. Networks were compared on connectivity, community structure, predictability (proportion explained variance), and strength centrality (i.e., connectedness to other symptoms in the network). RESULTS: Symptom severity for all individual BDI-II symptoms significantly decreased over 8 weeks of SSRI treatment, whereas interconnectivity and predictability of the symptoms significantly increased. At baseline, three communities were detected; five communities were detected at week 8. CONCLUSIONS: Findings suggest the effects of SSRIs can be studied using the network approach. The increased connectivity, predictability, and communities at week 8 may be explained by the decrease in depressive symptoms rather than specific effects of SSRIs. Future studies with larger samples and placebo controls are needed to offer insight into the effects of SSRIs. TRIAL REGISTRATION: The trials described in this manuscript were funded by the NIMH. Pennsylvania/Vanderbilt study: 5 R10 MH55877 ( https://projectreporter.nih.gov/project_info_description.cfm?aid=6186633&icde=28344168&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC&MMOpt= ). Washington study: R01 MH55502 ( https://projectreporter.nih.gov/project_info_description.cfm?aid=2034618&icde=28344217&ddparam=&ddvalue=&ddsub=&cr=5&csb=default&cs=ASC ).

11 Article Exploring mechanisms of change in schema therapy for chronic depression. 2018

Renner, Fritz / DeRubeis, Robert / Arntz, Arnoud / Peeters, Frenk / Lobbestael, Jill / Huibers, Marcus J H. ·MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; Department of Clinical Psychological Science, Maastricht University, The Netherlands. Electronic address: Fritz.Renner@mrc-cbu.cam.ac.uk. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States. · Department of Clinical Psychology, University of Amsterdam, The Netherlands. · Department of Psychiatry and Neuropsychology, University Hospital Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. · Department of Clinical Psychological Science, Maastricht University, The Netherlands. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States; Department of Clinical Psychology, VU University Amsterdam, The Netherlands. ·J Behav Ther Exp Psychiatry · Pubmed #29035800.

ABSTRACT: BACKGROUND AND OBJECTIVES: The underlying mechanisms of symptom change in schema therapy (ST) for chronic major depressive disorder (cMDD) have not been studied. The aim of this study was to explore the impact of two potentially important mechanisms of symptom change, maladaptive schemas (proxied by negative idiosyncratic core-beliefs) and the therapeutic alliance. METHODS: We drew data from a single-case series of ST for cMDD. Patients with cMDD (N = 20) received on average 78 repeated weekly assessments over a course of up to 65 individual sessions of ST. Focusing on repeated assessments within-individuals, we used mixed regression to test whether change in core-beliefs and therapeutic alliance preceded, followed, or occurred concurrently with change in depressive symptoms. RESULTS: Changes in core-beliefs did not precede but were concurrently related to changes in symptoms. Repeated goal and task agreement ratings (specific aspects of alliance) of the same session, completed on separate days, were at least in part associated with concurrent changes in symptoms. LIMITATIONS: By design this study had a small sample-size and no control group. CONCLUSIONS: Contrary to what would be expected based on theory, our findings suggest that change in core-beliefs does not precede change in symptoms. Instead, change in these variables occurs concurrently. Moreover, alliance ratings seem to be at least in part colored by changes in current mood state.

12 Article Moderation of the Alliance-Outcome Association by Prior Depressive Episodes: Differential Effects in Cognitive-Behavioral Therapy and Short-Term Psychodynamic Supportive Psychotherapy. 2017

Lorenzo-Luaces, Lorenzo / Driessen, Ellen / DeRubeis, Robert J / Van, Henricus L / Keefe, John R / Hendriksen, Mariëlle / Dekker, Jack. ·University of Pennsylvania, Brown University. Electronic address: lorenzl@sas.upenn.edu. · VU University Amsterdam. · University of Pennsylvania. · Arkin Mental Health Care, Amsterdam. · VU University Amsterdam, Arkin Mental Health Care, Amsterdam. ·Behav Ther · Pubmed #28711109.

ABSTRACT: Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were administered the Helping Alliance Questionnaire (N=282) at Week 5 of treatment. Overall, the alliance was a predictor of symptom change (d=0.33). In SPSP, the alliance was a modest but robust predictor of change, irrespective of prior episodes (d=0.25-0.33). By contrast, in CBT, the effects of the alliance on symptom change were large for patients with 0 prior episodes (d=0.86), moderate for those with 1 prior episode (d=0.49), and small for those with 2+ prior episodes (d=0.12). These findings suggest a complex interaction between patient features and common vs. specific therapy processes. In CBT, the alliance relates to change for patients with less recurrent depression whereas other CBT-specific processes may account for change for patients with more recurrent depression.

13 Article Exploring mechanisms of change in cognitive therapy and interpersonal psychotherapy for adult depression. 2017

Lemmens, Lotte H J M / Galindo-Garre, Francisca / Arntz, Arnoud / Peeters, Frenk / Hollon, Steven D / DeRubeis, Robert J / Huibers, Marcus J H. ·Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: Lotte.Lemmens@Maastrichtuniversity.nl. · EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. · Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Psychology, University of Amsterdam, PO Box 19268, 1000 GG Amsterdam, The Netherlands. · Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. · Department of Psychology, Vanderbilt University, 306 Wilson Hall, Nashville, TN, USA. · Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104-6241, USA. · Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. ·Behav Res Ther · Pubmed #28544896.

ABSTRACT: The present study explored the temporal relationships between change in five candidate causal mechanisms and change in depressive symptoms in a randomized comparison of individual Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for adult depression. Furthermore, hypotheses concerning the mediation of change in these treatments were tested. Patients were 151 depressed adult outpatients treated with either CT (n = 76) or IPT (n = 75). Depression severity was assessed with the BDI-II. Candidate mediators included both therapy-specific as well as common factors. Measures were taken multiple times over the course of treatment (baseline, mid-, and post-treatment). Pearson's correlations and Latent-Difference-Score models were used to examine the direct and indirect relationships between (change in) the candidate mediators and (subsequent) (change in) depression. Patients showed improvement on all measures. No differential effects in pre- to post-treatment changes were observed between the two conditions. However, change in interpersonal functioning occurred more rapidly in IPT. Only little empirical support for the respective theoretical models of change in CT and IPT was found. Future studies should pay special attention to the timing of assessments and within-patient variance.

14 Article Psychometric Properties of the Reconstructed Hamilton Depression and Anxiety Scales. 2017

Porter, Eliora / Chambless, Dianne L / McCarthy, Kevin S / DeRubeis, Robert J / Sharpless, Brian A / Barrett, Marna S / Milrod, Barbara / Hollon, Steven D / Barber, Jacques P. ·*Department of Psychology, University of Pennsylvania; †Department of Psychology, Chestnut Hill College, Philadelphia, PA; ‡American School of Professional Psychology, Argosy University, Arlington, VA; §Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; ∥Department of Psychiatry, Weill Cornell Medical College, New York, NY; ¶Department of Psychology, Vanderbilt University, Nashville, TN; and #Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY. ·J Nerv Ment Dis · Pubmed #28225509.

ABSTRACT: Although widely used, the Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Rating Scale (HARS) discriminate poorly between depression and anxiety. To address this problem, Riskind, Beck, Brown, and Steer (J Nerv Ment Dis. 175:474-479, 1987) created the Reconstructed Hamilton Scales by reconfiguring HRSD and HARS items into modified scales. To further analyze the reconstructed scales, we examined their factor structure and criterion-related validity in a sample of patients with major depressive disorder and no comorbid anxiety disorders (n = 215) or with panic disorder and no comorbid mood disorders (n = 149). Factor analysis results were largely consistent with those of Riskind et al. The correlation between the new reconstructed scales was small. Compared with the original scales, the new reconstructed scales correlated more strongly with diagnosis in the expected direction. The findings recommend the use of the reconstructed HRSD over the original HRSD but highlight problems with the criterion-related validity of the original and reconstructed HARS.

15 Article A prognostic index (PI) as a moderator of outcomes in the treatment of depression: A proof of concept combining multiple variables to inform risk-stratified stepped care models. 2017

Lorenzo-Luaces, Lorenzo / DeRubeis, Robert J / van Straten, Annemieke / Tiemens, Bea. ·Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: lorenzl@sas.upenn.edu. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. · Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands. · Department of Clinical Psychology, Radboud University, Nijmegen, The Netherlands; Pro Persona Research, Renkum, The Netherlands. ·J Affect Disord · Pubmed #28199892.

ABSTRACT: BACKGROUND: Prognostic indices (PIs) combining variables to predict future depression risk may help guide the selection of treatments that differ in intensity. We develop a PI and show its promise in guiding treatment decisions between treatment as usual (TAU), treatment starting with a low-intensity treatment (brief therapy (BT)), or treatment starting with a high-intensity treatment intervention (cognitive-behavioral therapy (CBT)). METHODS: We utilized data from depressed patients (N=622) who participated in a randomized comparison of TAU, BT, and CBT in which no statistically significant differences in the primary outcomes emerged between the three treatments. We developed a PI by predicting depression risk at follow-up using a LASSO-style bootstrap variable selection procedure. We then examined between-treatment differences in outcome as a function of the PI. RESULTS: Unemployment, depression severity, hostility, sleep problems, and lower positive emotionality at baseline predicted a lower likelihood of recovery across treatments. The PI incorporating these variables produced a fair classification accuracy (c=0.73). Among patients with a high PI (75% percent of the sample), recovery rates were high and did not differ between treatments (79-86%). Among the patients with the poorest prognosis, recovery rates were substantially higher in the CBT condition (60%) than in TAU (39%) or BT (44%). LIMITATIONS: No information on additional treatment sought. Prospective tests needed. CONCLUSION: Replicable PIs may aid treatment selection and help streamline stepped models of care. Differences between treatments for depression that differ in intensity may only emerge for patients with the poorest prognosis.

16 Article Prognosis moderates the engagement-outcome relationship in unguided cCBT for depression: A proof of concept for the prognosis moderation hypothesis. 2017

Forand, Nicholas R / Huibers, Marcus J H / DeRubeis, Robert J. ·Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center. · Department of Clinical Psychology, VU University Amsterdam. · Department of Psychology, University of Pennsylvania. ·J Consult Clin Psychol · Pubmed #28150952.

ABSTRACT: OBJECTIVE: Understanding how treatments work is a goal of psychotherapy research, however the strength of relationships between therapy processes and outcomes is inconsistent. DeRubeis, Cohen, et al. (2014) proposed that process-outcome relationships are moderated by patient characteristics. These "patient response patterns" (PRPs) indicate individuals' responsiveness to the active ingredients of treatment. Given the same quality of therapy, one individual may receive more benefit than another depending on their PRP. The "prognosis moderation hypothesis" states that PRPs can be defined by pretreatment prognostic indicators. Medium prognosis groups ("pliant-like") will have stronger process-outcome relationships than good ("easy-like") or poor ("challenging-like") groups. METHOD: N = 190 individuals received unguided computerized CBT. They were 58% women, aged 44.7 years. Engagement with the cCBT program was the process variable. PRPs were defined by predicted scores from a prognostic regression model. Outcomes were BDI scores at 3, 6, and 12 months. "Easy-like," "pliant-like" and "challenging-like" groups were created and the engagement-outcome relationship was assessed as a function of group. RESULTS: Engagement-outcome correlations by PRP were: easy-like, r = -.27 (p < .05); pliant-like, r = -.36 (p < .01); and challenging-like, r = .05 (p = .70). The pliant-like group was found to be the only moderator of the engagement-outcome relationship. Results were similar at 6 months but faded at 12. CONCLUSIONS: The engagement-outcome relationship varied as a function of prognosis, providing support for the prognosis moderation hypothesis. The "pliant-like" group appeared most sensitive to treatment procedures. Future research is needed to refine the methods for identifying PRPs. (PsycINFO Database Record

17 Article Melancholic and atypical depression as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression. 2017

Cuijpers, Pim / Weitz, Erica / Lamers, Femke / Penninx, Brenda W / Twisk, Jos / DeRubeis, Robert J / Dimidjian, Sona / Dunlop, Boadie W / Jarrett, Robin B / Segal, Zindel V / Hollon, Steven D. ·Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands. · EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands. · Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. · Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA. · Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA. · Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. · Department of Psychology, University of Toronto-Scarborough, Toronto, Canada. · Department of Psychology, Vanderbilt University, Nashville, TN, USA. ·Depress Anxiety · Pubmed #27921338.

ABSTRACT: BACKGROUND: Melancholic and atypical depression are widely thought to moderate or predict outcome of pharmacological and psychological treatments of adult depression, but that has not yet been established. This study uses the data from four earlier trials comparing cognitive behavior therapy (CBT) versus antidepressant medications (ADMs; and pill placebo when available) to examine the extent to which melancholic and atypical depression moderate or predict outcome in an "individual patient data" meta-analysis. METHODS: We conducted a systematic search for studies directly comparing CBT versus ADM, contacted the researchers, integrated the resulting datasets from these studies into one big dataset, and selected the studies that included melancholic or atypical depressive subtyping according to DSM-IV criteria at baseline (n = 4, with 805 patients). After multiple imputation of missing data at posttest, mixed models were used to conduct the main analyses. RESULTS: In none of the analyses was melancholic or atypical depression found to significantly moderate outcome (indicating a better or worse outcome of these patients in CBT compared to ADM; i.e., an interaction), predict outcome independent of treatment group (i.e., a main effect), or predict outcome within a given modality. The outcome differences between patients with melancholia or atypical depression versus those without were consistently very small (all effect sizes g < 0.10). CONCLUSIONS: We found no indication that melancholic or atypical depressions are significant or relevant moderators or predictors of outcome of CBT and ADM.

18 Article Specific Pharmacological Effects of Paroxetine Comprise Psychological but Not Somatic Symptoms of Depression. 2016

Schalet, Benjamin D / Tang, Tony Z / DeRubeis, Robert J / Hollon, Steven D / Amsterdam, Jay D / Shelton, Richard C. ·Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. · Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States of America. · Department of Psychology, Vanderbilt University, Nashville, TN, United States of America. · Depression Research Unit, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America. · Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, United States of America. ·PLoS One · Pubmed #27438078.

ABSTRACT: BACKGROUND: Meta-analyses of placebo-controlled trials of SSRIs suggest that only a small portion of the observable change in depression may be attributed to "true" pharmacological effects. But depression is a multidimensional construct, so treatment effects may differ by symptom cluster. We tested the hypothesis that SSRIs uniquely alter psychological rather than somatic symptoms of depression and anxiety. METHOD: Outpatients with moderate to severe MDD were randomly assigned to receive paroxetine (n = 120) or placebo (n = 60). RESULTS: Paroxetine significantly outperformed placebo on all psychological subscales of the syndrome measures, but not on any of the somatic subscales. The difference in score reduction between paroxetine and placebo was more than twice as great for the psychological symptoms compared to the somatic symptoms. CONCLUSIONS: Paroxetine appears to have a "true" pharmacological effect on the psychological but not on the somatic symptoms of depression and anxiety. Paroxetine's influence on somatic symptoms appears to be mostly duplicated by placebo.

19 Article Positive extreme responding after cognitive therapy for depression: Correlates and potential mechanisms. 2016

Forand, Nicholas R / Strunk, Daniel R / DeRubeis, Robert J. ·The Ohio State University Wexner Medical Center, Department of Psychiatry and Behavioral Health, 1670 Upham Drive, Columbus, OH 43210, United States. Electronic address: nforand@gmail.com. · The Ohio State University, Department of Psychology, 1835 Neil Avenue, Columbus, OH 43210, United States. Electronic address: strunk.20@osu.edu. · University of Pennsylvania, Department of Psychology, 3720 Walnut Street, Solomon Lab Bldg, Philadelphia, PA 19104-624, United States. Electronic address: derubeis@psych.upenn.edu. ·Behav Res Ther · Pubmed #27236074.

ABSTRACT: "Extreme responding" is the tendency to endorse extreme responses on self-report measures (e.g., 1s and 7s on a 7-point scale). It has been linked to depressive relapse after cognitive therapy (CT), but the mechanisms are unknown. Moreover, findings of positive extreme responding (PER) predicting depressive relapse do not support the original hypothesis of "extreme" negative thinking leading to extreme negative emotional reactions. We assessed the relationships between post-treatment PER on the Dysfunctional Attitudes Scale (DAS) and Attributional Style Questionnaire (ASQ) and these constructs: coping skills, in-session performance of cognitive therapy skills, age, and estimated IQ. Significant correlates were entered into a model predicting rate of relapse to determine whether these constructs explained the relationship between PER and relapse. The sample consisted of 60 individuals who participated in CT for moderate to severe depression. Results indicated the following relationships: a negative correlation between ASQ PER and IQ, negative correlations between DAS PER and performance of CT skills and planning coping, and a positive correlation between DAS PER and behavioral disengagement coping. IQ scores fully accounted for the relationship between ASQ PER and relapse. These results suggest two potential mechanisms linking PER to relapse: cognitive limitations and coping deficits/cognitive avoidance.

20 Article Divergent Outcomes in Cognitive-Behavioral Therapy and Pharmacotherapy for Adult Depression. 2016

Vittengl, Jeffrey R / Jarrett, Robin B / Weitz, Erica / Hollon, Steven D / Twisk, Jos / Cristea, Ioana / David, Daniel / DeRubeis, Robert J / Dimidjian, Sona / Dunlop, Boadie W / Faramarzi, Mahbobeh / Hegerl, Ulrich / Kennedy, Sidney H / Kheirkhah, Farzan / Mergl, Roland / Miranda, Jeanne / Mohr, David C / Rush, A John / Segal, Zindel V / Siddique, Juned / Simons, Anne D / Cuijpers, Pim. ·From the Department of Psychology, Truman State University, Kirksville, Mo.; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University Amsterdam, the Netherlands; the Department of Psychology, Vanderbilt University, Nashville, Tenn.; the Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj, Romania; the Department of Psychology, University of Pennsylvania, Philadelphia; the Department of Psychology and Neuroscience, University of Colorado, Boulder; the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; the Fatemeh Zahra Infertility and Reproductive Health Research Center and the Department of Psychiatry, Babol University of Medical Sciences, Babol, Iran; the Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany; the Department of Psychiatry, Faculty of Medicine, University of Toronto; the Department of Psychology, University of Toronto-Scarborough; the Health Services Research Center, Neuropsychiatric Institute, University of California, Los Angeles; the Department of Preventive Medicine and the Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago; the Duke-National University of Singapore Graduate Medical School, Singapore; and the Department of Psychology, University of Notre Dame, Notre Dame, Ind. ·Am J Psychiatry · Pubmed #26869246.

ABSTRACT: OBJECTIVE: Although the average depressed patient benefits moderately from cognitive-behavioral therapy (CBT) or pharmacotherapy, some experience divergent outcomes. The authors tested frequencies, predictors, and moderators of negative and unusually positive outcomes. METHOD: Sixteen randomized clinical trials comparing CBT and pharmacotherapy for unipolar depression in 1,700 patients provided individual pre- and posttreatment scores on the Hamilton Depression Rating Scale (HAM-D) and/or Beck Depression Inventory (BDI). The authors examined demographic and clinical predictors and treatment moderators of any deterioration (increase ≥1 HAM-D or BDI point), reliable deterioration (increase ≥8 HAM-D or ≥9 BDI points), extreme nonresponse (posttreatment HAM-D score ≥21 or BDI score ≥31), superior improvement (HAM-D or BDI decrease ≥95%), and superior response (posttreatment HAM-D or BDI score of 0) using multilevel models. RESULTS: About 5%-7% of patients showed any deterioration, 1% reliable deterioration, 4%-5% extreme nonresponse, 6%-10% superior improvement, and 4%-5% superior response. Superior improvement on the HAM-D only (odds ratio=1.67) and attrition (odds ratio=1.67) were more frequent in pharmacotherapy than in CBT. Patients with deterioration or superior response had lower pretreatment symptom levels, whereas patients with extreme nonresponse or superior improvement had higher levels. CONCLUSIONS: Deterioration and extreme nonresponse and, similarly, superior improvement and superior response, both occur infrequently in randomized clinical trials comparing CBT and pharmacotherapy for depression. Pretreatment symptom levels help forecast negative and unusually positive outcomes but do not guide selection of CBT versus pharmacotherapy. Pharmacotherapy may produce clinician-rated superior improvement and attrition more frequently than does CBT.

21 Article Sudden gains in Cognitive Therapy and Interpersonal Psychotherapy for adult depression. 2016

Lemmens, Lotte H J M / DeRubeis, Robert J / Arntz, Arnoud / Peeters, Frenk P M L / Huibers, Marcus J H. ·Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: Lotte.Lemmens@Maastrichtuniversity.nl. · Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104-6241, USA. · Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Psychology, University of Amsterdam, P.O. Box 19268, 1000 GG Amsterdam, The Netherlands. · Department of Psychiatry and Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. · Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104-6241, USA; Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. ·Behav Res Ther · Pubmed #26803276.

ABSTRACT: OBJECTIVE: We examined the rates, baseline predictors and clinical impact of sudden gains in a randomized comparison of individual Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for adult depression. METHOD: 117 depressed outpatients received 16-20 sessions of either CT or IPT. Session-by-session symptom severity was assessed using the BDI-II. Sudden gains were examined using the original criteria as defined by Tang and DeRubeis (1999b). Furthermore, we examined whether the duration of the between-session interval at which sudden gains were recorded affected the results. RESULTS: There were significantly more patients with sudden gains in CT (42.2%) as compared to IPT (24.5%). The difference appeared to be driven by the criterion representing the stability of the gain. No between-group differences were found with regard to the magnitude, timing and predictors of the gains. Those with sudden gains were less depressed at post-treatment and follow-up. After controlling for the duration of the between-session interval, the difference in rates between the two conditions became a non-significant trend. Other sudden gains characteristics were similar to those observed when allowing for longer intervals as well. CONCLUSIONS: The current study indicates differences in occurrence of sudden gains in two treatment modalities that overall showed similar results, which might reflect different mechanisms of change.

22 Article In cognitive therapy for depression, early focus on maladaptive beliefs may be especially efficacious for patients with personality disorders. 2016

Keefe, John R / Webb, Christian A / DeRubeis, Robert J. ·Department of Psychology, University of Pennsylvania. · Department of Psychiatry, McLean Hospital, Harvard Medical School. ·J Consult Clin Psychol · Pubmed #26727410.

ABSTRACT: OBJECTIVE: Patients with major depressive disorder (MDD) and a comorbid personality disorder (PD) have been found to exhibit relatively poor outcomes in cognitive therapy (CT) and other treatments. Adaptations of CT focusing heavily on patients' core beliefs have yielded promising findings in the treatment of PD. However, there have been no investigations that have specifically tested whether increased focus on maladaptive beliefs contributes to CT's efficacy for these patients. METHOD: CT technique use from an early CT session was assessed for 59 patients (33 without PD, 26 with PD-predominantly Cluster C) who participated in a randomized controlled trial for moderate to severe MDD. Scores were calculated for directive CT techniques (CT-Concrete) and a set of belief-focused items (CT-Belief) as rated by the Collaborative Study Process Rating Scale. Robust regressions were conducted to estimate relations between scores on each of these measures and change in depressive and PD symptoms. A PD status by CT-Belief use interaction tested the hypothesis that therapist use of CT-Belief techniques would exhibit a stronger association with symptom change in the PD group relative to the non-PD group. RESULTS: As hypothesized, a significant interaction between PD status and use of CT-Belief techniques emerged in the prediction of depressive and PD symptom change. Among PD patients, higher early CT-Belief interventions were found to predict significantly greater improvement. CT-Belief use did not predict greater symptom change among those without PD. CONCLUSIONS: Early focus on CT-Belief interventions may facilitate changes in depression and PD symptoms for patients with MDD-PD comorbidity.

23 Article The therapeutic alliance and therapist adherence as predictors of dropout from cognitive therapy for depression when combined with antidepressant medication. 2016

Cooper, Andrew A / Strunk, Daniel R / Ryan, Elizabeth T / DeRubeis, Robert J / Hollon, Steven D / Gallop, Robert. ·The Ohio State University, USA. · The Ohio State University, USA. Electronic address: strunk.20@osu.edu. · University of Pennsylvania, USA. · Vanderbilt University, USA. · West Chester University, USA. ·J Behav Ther Exp Psychiatry · Pubmed #26164110.

ABSTRACT: BACKGROUND: Previous psychotherapy research has examined the therapeutic alliance and therapist adherence as correlates or predictors of symptom change. While some initial evidence suggests the alliance is associated with risk of dropout in cognitive behavioral treatment for depression, evidence of such relations has been limited to date. We examined the relation of these psychotherapy process variables and dropout in the context of cognitive therapy for depression when provided in combination with pharmacotherapy. METHODS: Patients were randomized to the CT plus pharmacotherapy condition of a clinical trial for chronic or recurrent depression. Consistent with the spirit of personalized medicine, patients were treated until they met remission and recovery criteria (or reached the maximum allowable time in the study). In a sample of 176 patients, we examined observer-rated alliance and therapist adherence in the first three CT sessions as potential predictors of treatment dropout. RESULTS: The therapeutic alliance and one facet of therapist adherence (i.e., Behavioral Methods/Homework) predicted reduced odds of dropout. Therapist use of Negotiating/Structuring predicted greater likelihood of dropout, but only when other variables were included in the model. LIMITATIONS: Process ratings were not available for concurrent pharmacotherapy sessions. A minority of patients did not have session recordings available. CONCLUSIONS: Results are consistent with the possibility that the therapeutic alliance and therapists' focus on homework and behavioral methods promote treatment retention in combined treatment for depression.

24 Article A re-examination of process-outcome relations in cognitive therapy for depression: Disaggregating within-patient and between-patient effects. 2016

Sasso, Katherine E / Strunk, Daniel R / Braun, Justin D / DeRubeis, Robert J / Brotman, Melissa A. ·a Department of Psychology , The Ohio State University , Columbus , OH , USA. · b Department of Psychology , University of Pennsylvania , Philadelphia , PA , USA. · c Mood and Anxiety Disorders Program, National Institute of Mental Health , Bethesda , MD , USA. ·Psychother Res · Pubmed #25876795.

ABSTRACT: OBJECTIVE: We previously examined alliance and therapist adherence as predictors of symptom change. Applying a new analytic strategy, we can ensure that any relations identified were not attributable to stable patient characteristics. METHOD: Participants were 57 depressed cognitive therapy patients. We disaggregated within- and between-patient variation in process measures. RESULTS: Between-patients, variability in adherence to Cognitive Methods and Negotiating/Structuring predicted patients' symptom change. Within-patients, only variability in ratings of adherence to Cognitive Methods predicted next-session symptom change. CONCLUSIONS: Relations involving between-patient process variables are potentially attributable to stable patient characteristics. However, the relation of within-patient Cognitive Methods and session-to-session symptom change cannot be attributed to stable characteristics and is consistent with a causal relationship.

25 Article Primary Care Physicians' Selection of Low-Intensity Treatments for Patients With Depression. 2015

Lorenzo-Luaces, Lorenzo / DeRubeis, Robert J / Bennett, Ian M. ·Department of Psychology, School of Arts and Sciences, University of Pennsylvania. ·Fam Med · Pubmed #26562637.

ABSTRACT: BACKGROUND AND OBJECTIVES: Most outpatient treatment for depression is delivered by primary care physicians (PCPs), yet little is known about which patient variables affect PCPs' selection of high-intensity interventions, namely antidepressant medications or psychotherapy, as opposed to less-intensive treatment regimens (eg, watchful waiting, exercise). Our objective was to ascertain whether the patient's symptom severity, presenting psychosocial stress, and lifestyle habits influenced treatment recommendations. METHODS: Forty-two PCPs from six Northeastern US primary care practices provided recommendations in response to vignettes depicting patients with major depressive disorder who varied in symptom severity, psychosocial stressors, and lifestyle habits. RESULTS: Low-intensity-only interventions were recommended less than 25% of the time. Lower symptom severity and higher psychosocial stressors were associated with a greater likelihood of "low-intensity interventions only" recommendations. Less-intensive treatments were rarely recommended without more intensive treatments when the vignettes featured severe depression, whereas they were recommended 39% of the time with vignettes featuring mild/moderate symptoms. In response to the mild/moderate vignettes, the presence of psychosocial stressors led to a decreased likelihood of low-intensity-only recommendations. CONCLUSIONS: Although vignettes depicting depressed patients with mild/moderate symptoms were more likely to elicit low-intensity treatment recommendations, the frequency was still low. Given the evidence that antidepressants and psychotherapy for mild/moderate depression may be no more effective, and likely less cost-effective, than low-intensity treatments, the findings suggest a need to disseminate knowledge of less intensive treatment options to primary care physicians.

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