TY - JOUR
T1 - Do Cognitive Therapy Skills Neutralize Lifetime Stress to Improve Treatment Outcomes in Recurrent Depression?
AU - Vittengl, Jeffrey R.
AU - Stutzman, Sonja
AU - Atluru, Aparna
AU - Jarrett, Robin B.
N1 - Funding Information:
This report was supported by Grants Number K24 MH001571, R01 MH58397, R01 MH69619 (Robin B. Jarrett, Ph.D.) and R01 MH58356 from the National Institute of Mental Health (NIMH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH.We appreciate the careful review by the trial's Data Safety and Monitoring Board. We are indebted to our patients, research teams, and our colleagues at The University of Texas Southwestern Medical Center. We appreciate the participation of colleagues, previously named, and study participants. We appreciate the careful coding of stressful life events from Nancy Cravens, LVN, and data management by Abu Minhajuddin, Ph.D. We are grateful to Carol Tamminga, M.D., Lou and Ellen McGinley Distinguished Chair in Psychiatric Research and Communities Foundation of Texas Chair in Brain Sciences and the University of Texas Southwestern Medical Center Department of Psychiatry for support of research.Dr. Vittengl and Dr. Jarrett are paid reviewers for UpToDate. Dr. Jarrett is a paid consultant to the National Institutes of Health. Dr. Jarrett's medical center collects the payments from the cognitive therapy she provides to patients. Dr. Atluru and Dr. Stutzman have no financial conflicts of interests to disclose.
Publisher Copyright:
© 2019
PY - 2020/9
Y1 - 2020/9
N2 - Cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but not all patients respond. Past research suggests that stressful life events (SLE; e.g., childhood maltreatment, emotional and physical abuse, relationship discord, physical illness) sometimes reduce the efficacy of depression treatment, whereas greater acquisition and use of CT skills may improve patient outcomes. In a sample of 276 outpatient participants with recurrent MDD, we tested the hypothesis that patients with more SLE benefit more from CT skills in attaining response and remaining free of relapse/recurrence. Patients with more pretreatment SLE did not develop weaker CT skills, on average, but were significantly less likely to respond to CT. However, SLE predicted non-response only for patients with relatively weak skills, and not for those with stronger CT skills. Similarly, among acute-phase responders, SLE increased risk for MDD relapse/recurrence among patients with weaker CT skills. Thus, the combination of more SLE and weaker CT skills forecasted negative outcomes. These novel findings are discussed in the context of improving CT for depression among patients with greater lifetime history of SLE and require replication before clinical application.
AB - Cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but not all patients respond. Past research suggests that stressful life events (SLE; e.g., childhood maltreatment, emotional and physical abuse, relationship discord, physical illness) sometimes reduce the efficacy of depression treatment, whereas greater acquisition and use of CT skills may improve patient outcomes. In a sample of 276 outpatient participants with recurrent MDD, we tested the hypothesis that patients with more SLE benefit more from CT skills in attaining response and remaining free of relapse/recurrence. Patients with more pretreatment SLE did not develop weaker CT skills, on average, but were significantly less likely to respond to CT. However, SLE predicted non-response only for patients with relatively weak skills, and not for those with stronger CT skills. Similarly, among acute-phase responders, SLE increased risk for MDD relapse/recurrence among patients with weaker CT skills. Thus, the combination of more SLE and weaker CT skills forecasted negative outcomes. These novel findings are discussed in the context of improving CT for depression among patients with greater lifetime history of SLE and require replication before clinical application.
KW - cognitive therapy
KW - depression
KW - relapse
KW - skills
KW - stressful life events
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U2 - 10.1016/j.beth.2019.10.008
DO - 10.1016/j.beth.2019.10.008
M3 - Article
C2 - 32800302
AN - SCOPUS:85078032852
SN - 0005-7894
VL - 51
SP - 739
EP - 752
JO - Behavior Therapy
JF - Behavior Therapy
IS - 5
ER -