Teasdale et al. (2001). How does cognitive therapy prevent relapse in residual depression? Evidence from a controlled trial. Journal of Consulting and Clinical Psychology, 69, 347-357.

This article is based on research suggesting that cognitive therapy (CT) is more successful in preventing post-treatment relapse in depression than other forms of treatment. The question addressed is, “What is the presumed mechanism that prevents relapse?” One would think that it might be a change in the content of clients’ cognitions that might be protective, but research to date has not supported this.

158 patients with recent major depression, partially remitted with treatment by antidepressant medication, were randomized to either (a) a continued drug/treatment plus clinical management (drug-cm =control) for 20 weeks or drug-cm plus CT (16 sessions) for 20 weeks. Then over a 48 week follow-up, all patients in were kept on continuation and maintenance drugs, and the drug-cm plus CT group received 2 booster CT sessions.

Outcome analysis: at 68 weeks, relapse rates for the CT group were significantly lower (29%) than for the control group (47%). However, there was no sig. difference between the groups on post-treatment BDI scores.

Process analyses: None of the cognitive variables measured at sessions 0 and 8 (Attribution Style Questionnaire, Dysfunctional Attitude scale [need for approval subscale], Perceived Uncontrollability, Blame, or Meta-cognitive Awareness) significantly predicted relapse. That is the endorsement of CONTENT on these scales was not related to recurrent depression.

However, a measure of the FORM of responses indicated that endorsement of extreme response categories (i.e., totally agree or totally disagree) to items such as “Cause of bad outcomes”… (a)”is totally due to me”… (b)”will never again be present” …”(c) influences all situations in my life” was predictive of relapse. Note that extreme undepressotypic responding predicted early relapse as much, or more than extreme depressotypic responding.

These were not a priori hypotheses and need to be replicated. They do suggest that beneficial effects of CT regarding relapse may rest more in changes in the mode of how one thinks about depressotypic beliefs than in changes in the content of those beliefs.