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Cognitive change in cognitive-behavioural therapy v. pharmacotherapy for adult depression: a longitudinal mediation analysis

Published online by Cambridge University Press:  18 December 2018

Leanne Quigley ,
David J. A. Dozois ,
R. Michael Bagby ,
Daniela S. S. Lobo ,
Lakshmi Ravindran  and
Lena C. Quilty
Leanne Quigley
Affiliation:
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, USA
David J. A. Dozois
Affiliation:
Department of Psychology, Western University, London, Canada
R. Michael Bagby
Affiliation:
Centre for Addiction and Mental Health, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
Daniela S. S. Lobo
Affiliation:
Centre for Addiction and Mental Health, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
Lakshmi Ravindran
Affiliation:
Centre for Addiction and Mental Health, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
Lena C. Quilty*
Affiliation:
Centre for Addiction and Mental Health, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
*
Author for correspondence: Lena C. Quilty, E-mail: lena.quilty@camh.ca
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Abstract

Background

Although cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model.

Methods

The present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT (n = 54) or ADM (n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models.

Results

Both CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant.

Conclusions

The results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change.

Keywords

Antidepressant medicationautomatic thoughtscognitive-behavioural therapycognitive distortionsdepressiondysfunctional attitudesmediationpharmacotherapytreatment mechanismtreatment outcome
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 15 , November 2019 , pp. 2626 - 2634
Copyright
Copyright © Cambridge University Press 2018 

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