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Early Intervention for Adults at High Risk of Recurrent/Chronic Depression: Cognitive Model and Clinical Case Series

Published online by Cambridge University Press:  06 June 2008

Stephen Barton ,
Peter Armstrong ,
Mark Freeston  and
Vivien Twaddle
Stephen Barton*
Affiliation:
Newcastle University and Newcastle Centre for Cognitive and Behavioural Therapies, UK
Peter Armstrong
Affiliation:
Newcastle Centre for Cognitive and Behavioural Therapies, UK
Mark Freeston
Affiliation:
Newcastle University and Newcastle Centre for Cognitive and Behavioural Therapies, UK
Vivien Twaddle
Affiliation:
Newcastle Centre for Cognitive and Behavioural Therapies, UK
*
Reprint requests to Stephen Barton, Consultant Clinical Psychologist, Transitions Service, Chester le Street Health Centre, Newcastle Road, Chester le Street, Co Durham DH3 3UR, UK. E-mail: s.b.barton@newcastle.ac.uk
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Abstract

This paper describes a cognitive model for first/second onset depression that has been precipitated by major life stress, entrenched for several months and is unresponsive to pharmacotherapy. These conditions create high risks for recurrent/chronic depression and early intervention is proposed to identify, treat and protect against relapse/recurrence. Severe life stress interacts with an individual's core self-representations and personal values, identity is disrupted and depression is maintained by dysfunctional goal engagement and disengagement. Treatment aims to restore functional self-regulation by increasing self-diversification and creating balanced goal investments. Outcome and follow-up data are reported in a case series of five consecutive patients. There was good therapist adherence to the prescribed targets and pre-post effect sizes were comparable or larger than published outcome studies. At the 12 month follow-up, three of the four treatment completers (75%) had made reliable and clinically significant changes and were in full remission. This provides encouraging preliminary evidence for the model's validity and the therapy's efficacy.

Keywords

Depressionearly interventionrecurrencepersonal identitygoal investments
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 36 , Issue 3 , May 2008 , pp. 263 - 282
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

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References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, DC: APA.Google Scholar
Barton, S. B. (2000). New possibilities in cognitive therapy for depression. Behavioural and Cognitive Psychotherapy, 28, 1–4.CrossRefGoogle Scholar
Barton, S. B. and Morley, S. J. (1999). Specificity of reference patterns in depressive thinking: agency and object roles in self-representation. Journal of Abnormal Psychology, 108, 655–661.CrossRefGoogle ScholarPubMed
Barton, S. B., Morley, S. J., Bloxham, G., Kitson, C. and Platts, S. (2005). Sentence completion test for depression (SCD): an idiographic measure of depressive thinking. British Journal of Clinical Psychology, 44, 29–46.CrossRefGoogle ScholarPubMed
Bebbington, P. E., Brugha, T., MacCarthy, B., Potter, J., Sturt, E., Wykes, T., Katz, R. and McGuffin, P. (1988). The Camberwell collaborative depression study. 1. Depressed probands: adversity and the form of depression. British Journal of Psychiatry, 152, 754–765.CrossRefGoogle Scholar
Beck, A. T., Rush, A. J., Shaw, B. F. and Emery, G. (1979). Cognitive Therapy of Depression: a treatment manual. New York: Guilford Press.Google Scholar
Beck, A. T. and Steer, R. A. (1991). Manual for the Beck Depression Inventory. San Antonio, TX: The Psychological Corp.Google Scholar
Beck, A. T., Steer, R. A. and Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100.CrossRefGoogle Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E. and Erbaugh, J. K. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Beck, A. T., Weissman, A., Lester, D. and Trexler, I. (1974). The measurement of pessimism: the hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861–865.CrossRefGoogle ScholarPubMed
Brewin, C. R. (2006). Understanding cognitive behaviour therapy: a retrieval competition account. Behaviour Research and Therapy, 44, 765–784.CrossRefGoogle ScholarPubMed
Brown, G. W. and Harris, T. (1978). Social Origins of Depression: a study of psychiatric disorder in women. London: Tavistock Publications.Google Scholar
Brown, G. W., Harris, T. and Hepworth, C. (1994). Life events and endogenous depression: a puzzle re-examined. Archives of General Psychiatry, 51, 525–534.CrossRefGoogle Scholar
Cahill, J., Barkham, M., Hardy, G., Rees, A., Shapiro, D. A., Stiles, W. B. and Macaskill, N. (2003). Outcomes of patients completing and not completing cognitive therapy for depression. British Journal of Clinical Psychology, 42, 133–143.CrossRefGoogle Scholar
Carver, C. S. and Scheier, M. F. (1998). On the Self-Regulation of Behavior. New York: Cambridge University Press.CrossRefGoogle Scholar
Carver, C. S. and White, T. L. (1994). Behavioural inhibition, behavioural activation, and affective responses to impending reward and punishment: the BIS/BAS scales. Journal of Personality and Social Psychology, 67, 319–333.CrossRefGoogle Scholar
Champion, L. A. and Power, M. J. (1995). Social and cognitive approaches to depression: towards a new synthesis. British Journal of Clinical Psychology, 34, 485–503.CrossRefGoogle ScholarPubMed
Chisholm, D., Sanderson, K., Ayusi-Mateos, J. L. and Saxena, S. (2004). Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions. British Journal of Psychiatry, 184, 393–403.CrossRefGoogle ScholarPubMed
Clark, D. M. (2004). Developing new treatments: on the interplay between theories, experimental science and clinical innovation. Behaviour, Research and Therapy, 42, 1089–1104.CrossRefGoogle ScholarPubMed
DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., O'Reardon, J. P., Lovett, M. L., Gladis, M. M., Brown, L. L. and Gallop, R. (2005). Cognitive therapy versus medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409–416.CrossRefGoogle Scholar
Dobson, K. (1989). A meta-analysis of the efficacy of cognitive therapy of depression. Journal of Consulting and Clinical Psychology, 57, 414–419.CrossRefGoogle Scholar
Dolan, R. J., Calloway, S. P., Fonagy, P., De Souza, F. V. A. and Wakeling, A. (1985). Life events, depression and the hypothalamic-pituitary-adrenal axis function. British Journal of Psychiatry, 147, 429–433.CrossRefGoogle ScholarPubMed
Dozois, D. J. A. and Dobson, K. S. (2001). Information processing and cognitive organisation in unipolar depression: specificity and comorbidity issues. Journal of Abnormal Psychology, 110, 236–246.CrossRefGoogle ScholarPubMed
Dozois, D. J. A. and Dobson, K. S. (2003). The structure of the self-schema in clinical depression: differences related to episode recurrence. Cognition and Emotion, 17, 933–941.Google Scholar
Ezquiga, T. E., Ayuso Gutierrez, J. L. and Garcia Lopez, A. (1987). Psychosocial factors and episode number in depression. Journal of Affective Disorders, 11, 135–138.CrossRefGoogle Scholar
Fava, G. A., Rafanelli, C., Grandi, S., Conti, S. and Belluardo, P. (1998). Prevention of recurrent depression with cognitive behavioural therapy: preliminary findings. Archives of General Psychiatry, 55, 816–820.CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I disorders – Patient Edition (SCID I/P, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Friedman, M. A., Detweiler-Bedell, J. B., Leventhal, H. E., Horne, R., Keitner, G. I. and Miller, I. W. (2004). Combined psychotherapy and pharmacotherapy for the treatment of major depressive disorder. Clinical Psychology: Science and Practice, 11, 47–68.Google Scholar
Gilbert, P., Gilbert, J. and Irons, C. (2004). Life events, entrapments and arrested anger in depression. Journal of Affective Disorders, 79, 149–160.CrossRefGoogle ScholarPubMed
Gloaguen, V., Cottreaux, J., Cucherat, M. and Blackburn, I.-M. (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders, 49, 59–72.CrossRefGoogle ScholarPubMed
Hamilton, M. A. (1960). A rating scale for depression. Journal of Neurological and Neurosurgical Psychiatry, 23, 59–61.CrossRefGoogle ScholarPubMed
Hammen, C. (1991). Generation of stress in the course of unipolar depression. Journal of Abnormal Psychology, 100, 555–561.CrossRefGoogle ScholarPubMed
Hammen, C. (2003). Interpersonal stress and depression in women. Journal of Affective Disorders, 74, 49–57.CrossRefGoogle ScholarPubMed
Harkness, K. L., Monroe, S. M., Simons, A. D. and Thase, M. (1999). The generation of life events in recurrent and non-recurrent depression. Psychological Medicine, 29, 135–144.CrossRefGoogle ScholarPubMed
Hirschfield, R. M., Montgomery, S. A., Aguglia, E., Amore, M., Delgado, P. L., Gastpar, M., Hawley, C., Kasper, S., Linden, M., Massana, J., Mendlewicz, J., Moller, H. J., Nemeroff, C. B., Saiz, J., Such, P., Torta, R. and Versiani, M. (2002). Partial response and nonresponse to anti-depressant therapy: current approaches and treatment options. Journal of Clinical Psychiatry, 63, 826–837.CrossRefGoogle Scholar
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O'Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Freeman, B. B. and Gallop, R. (2005). Prevention of relapse following cognitive therapy versus medications in moderate to severe depression. Archives of General Psychiatry, 62, 417–422.CrossRefGoogle Scholar
Hollon, S. D., Jarrett, R. J., Nierenberg, A. A., Thase, M. E., Trivedi, M. and Rush, A. J. (2005). Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment? Journal of Clinical Psychiatry, 66, 455–468.CrossRefGoogle ScholarPubMed
Hollon, S. D. and Kendall, P. C. (1980). Cognitive self-statements in depression: development of an automatic thoughts questionnaire. Cognitive Therapy and Research, 4, 383–395.CrossRefGoogle Scholar
Jacobsen, N. S., Roberts, L. J., Berns, S. B. and McGlinchey, J. B. (1999). Methods for defining and determining the clinical significance of treatment effects: description, application and alternatives. Journal of Consulting and Clinical Psychology, 67, 300–307.CrossRefGoogle Scholar
Jacobsen, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefGoogle Scholar
Jarrett, R. B., Kraft, D., Doyle, J., Foster, B. M., Eaves, G. G. and Silver, P. C. (2001). Preventing recurrent depression using cognitive therapy with and without a continuation phase. Archives of General Psychiatry, 58, 381–388.CrossRefGoogle ScholarPubMed
Johnson-Laird, P. N. (1983). Mental Models: towards a cognitive science of language, inference and consciousness. Cambridge: Cambridge University Press.Google Scholar
Joiner, T. E. (2000). Depression's vicious scree: self-propagating and erosive processes in depression chronicity. Clinical Psychology: Science and Practice, 7, 203–218.Google Scholar
Judd, L. L., Paulus, M. J., Scheffler, P. J., Akiskal, H. S., Endicott, J., Leon, A. C., Maser, J. D., Mueller, T., Solomon, D. A. and Keller, M. B. (2000). Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? American Journal of Psychiatry, 157, 1501–1504.CrossRefGoogle Scholar
Lam, D. H., Green, B. and Power, M. J. (1994). The impact of social cognitive variables on the initial level of depression and recovery. Journal of Affective Disorders, 32, 75–83.CrossRefGoogle ScholarPubMed
Lam, D. H., Green, B., Power, M. J. and Checkley, S. (1996). Dependency, matching adversity and relapse in major depression. Journal of Affective Disorders, 37, 81–90.CrossRefGoogle ScholarPubMed
Lewinsohn, P. M., Allen, N. B., Seeley, J. R. and Gotlib, I. H. (1999). First onset versus recurrence of depression: differential processes of psychosocial risk. Journal of Abnormal Psychology, 108, 483–489.CrossRefGoogle ScholarPubMed
Lewinsohn, P. M., Zeiss, A. M. and Duncan, E. M. (1989). Probability of relapse after recovery from an episode of depression. Journal of Abnormal Psychology, 98, 107–116.CrossRefGoogle ScholarPubMed
Ma, S. H. and Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31–40.CrossRefGoogle ScholarPubMed
McGlinchey, J. B. and Dobson, K. S. (2003). Treatment integrity concerns in cognitive therapy for depression. Journal of Cognitive Psychotherapy: An International Quarterly, 17, 299–317.CrossRefGoogle Scholar
Mitchell, P. B., Parker, G. B., Gladstone, G. L., Wilhelm, K. and Austin, M-P. V. (2003). Severity of stressful life events in first and subsequent episodes of depression: the relevance of depressive subtype. Journal of Affective Disorders, 73, 245–252.CrossRefGoogle ScholarPubMed
Monroe, S. M. and Harkness, K. L. (2005). Life stress, the “kindling” hypothesis, and the recurrence of depression: considerations from a life stress perspective. Psychological Review, 112, 417–445.CrossRefGoogle ScholarPubMed
Monroe, S. M. and Simons, A. D. (1991). Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychological Bulletin, 110, 406–425.CrossRefGoogle ScholarPubMed
Moore, R. G. and Blackburn, I. M. (1997). Cognitive therapy in the treatment of non-responders to antidepressant medication: a controlled pilot study. Behavioural and Cognitive Psychotherapy, 25, 251–259.CrossRefGoogle Scholar
Murray, C. J. L. and Lopez, A. D. (1997). Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet, 349, 1436–1442.CrossRefGoogle ScholarPubMed
Nietzel, M. T., Russel, R. L., Hemmings, K. A. and Gretter, M. L. (1987). Clinical significance of psychotherapy for unipolar depression: a meta-analytic approach to social comparison. Journal of Consulting and Clinical Psychology, 55, 156–161.CrossRefGoogle ScholarPubMed
Oatley, K. and Johnson-Laird, P. N. (1987). Towards a cognitive theory of emotions. Cognition and Emotion, 1, 29–50.CrossRefGoogle Scholar
Papakostas, G. I., Petersen, T., Pava, J., Masson, E., Worthington, J. J., Alpert, J. E., Fava, M. and Nierenberg, A. A. (2003). Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: prevalence and impact on treatment outcome. Journal of Nervous and Mental Disease, 191, 444–449.CrossRefGoogle ScholarPubMed
Segal, Z. V., Kennedy, S., Gemar, M., Hood, K., Pedersen, R. and Buis, T. (2006) Cognitive reactivity to sad mood provocation and the prediction of depressive relapse. Archives of General Psychiatry, 63, 749–755.CrossRefGoogle ScholarPubMed
Solomon, D. A., Keller, M. B., Leon, A. C., Mueller, T. I., Shea, M. T., Warshaw, M., Maser, J. D., Coryell, W. and Endicott, J. (1997). Recovery from major depression: a 10-year prospective follow-up across multiple episodes. Archives of General Psychiatry, 54, 1001–1006.CrossRefGoogle ScholarPubMed
Spijker, J., de Graaf, R., Bijl, R. V., Beekman, A. T. F., Ormel, J. and Nolen, W. A. (2002). Duration of major depressive episodes in the general population: results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS). British Journal of Psychiatry, 181, 208–213.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Williams, J. B. W., Gibbon, M. and First, M. B. (1992). The Structured Clinical Interview for DSM-III-R (SCID): 1. history, rational, and description. Archives of General Psychiatry, 49, 624–629.CrossRefGoogle Scholar
Taylor, J. L., Morley, S. and Barton, S. B. in press. Self-organization in bipolar disorder: compartmentalization and self-complexity. Cognitive Therapy and Research.Google Scholar
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M. and Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.CrossRefGoogle ScholarPubMed
Thase, M. E. (2004). Therapeutic alternatives for difficult-to-treat depression: a narrative review of the state of the evidence. CNS Spectrums, 9, 808–821.CrossRefGoogle ScholarPubMed
Vallacher, R. R. and Wegner, D. M. (1989). Levels of personal agency: individual variation in action identification. Journal of Personality and Social Psychology, 57, 660–671.CrossRefGoogle Scholar
Waltz, J., Addis, M. E., Koerner, K. and Jacobson, N. S. (1993). Testing the integrity of a psychotherapy protocol: assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61, 620–630.CrossRefGoogle ScholarPubMed
World Health Organization (2002). The World Health Report 2002: reducing risks, promoting healthy life. Geneva: WHO.Google Scholar
Wrosch, C., Scheier, M. F., Carver, C. S. and Schultz, R. (2003). The importance of goal disengagement in adaptive self-regulation: when giving up is beneficial. Self and Identity, 2, 1–20.CrossRefGoogle Scholar
Wrosch, C., Scheier, M. F., Miller, G. E., Schultz, R. and Carver, C. S. (2003). Adaptive self-regulation of unattainable goals: goal disengagement, goal reengagement, and subjective well-being. Personality and Social Psychology Bulletin, 29, 1494–1508.CrossRefGoogle ScholarPubMed
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