Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-26T03:38:04.488Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th Edn. Washington, DC: American Psychiatric Association.Google Scholar
Baron, RM and Kenny, DA (1986) The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182.Google Scholar
Beck, AT, Rush, AJ, Shaw, BF and Emery, G (1979) Cognitive Therapy of Depression. New York: Guilford.Google Scholar
Beck, AT, Steer, RA and Brown, GK (1996) Manual for the Beck Depression Inventory – II. San Antonio, TX: Psychological Corporation.Google Scholar
Burns, DD (1980) Feeling Good: The New Mood Therapy. New York, NY: Signet.Google Scholar
Burns, DD and Spangler, DL (2001) Do changes in dysfunctional attitudes mediate changes in depression and anxiety in cognitive behavioral therapy? Behavior Therapy 32, 337–369.Google Scholar
Castonguay, LG, Goldfried, MR, Wiser, S, Raue, PJ and Hayes, AM (1996) Predicting the effect of cognitive therapy for depression: a study of unique and common factors. Journal of Consulting and Clinical Psychology 64, 497–504.Google Scholar
Clark, DA, Beck, AT and Alford, BA (1999) Scientific Foundations of Cognitive Theory and Therapy of Depression. New York: Wiley.Google Scholar
Cole, DA and Maxwell, SE (2003) Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology 112, 558–577.Google Scholar
Covin, R, Dozois, DJ, Ogniewicz, A and Seeds, PM (2011) Measuring cognitive errors: initial development of the Cognitive Distortions Scale (CDS). International Journal of Cognitive Therapy 4, 297–322.Google Scholar
Cuijpers, P, Berking, M, Andersson, G, Quigley, L, Kleiboer, A and Dobson, KS (2013) A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry 58, 376–385.Google Scholar
DeRubeis, RJ, Evans, MD, Hollon, SD, Garvey, MJ, Grove, WM and Tuason, VB (1990) How does cognitive therapy work? Cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology 58, 862–869.Google Scholar
DeRubeis, RJ, Brotman, MA and Gibbons, CJ (2005 a) A conceptual and methodological analysis of the nonspecifics argument. Clinical Psychology: Science and Practice 12, 174–183.Google Scholar
DeRubeis, RJ, Hollon, SD, Amsterdam, JD, Shelton, RC, Young, PR, Salomon, RM, O'Reardon, JP, Lovett, ML, Gladis, MM, Brown, LL and Gallop, R (2005 b) Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry 62, 409–416.Google Scholar
Dimidjian, S, Hollon, SD, Dobson, KS, Schmaling, KB, Kohlenberg, RJ, Addis, ME, Gallop, R, McGlinchey, JB, Markley, DK, Gollan, JK and Atkins, DC (2006) Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology 74, 658–670.Google Scholar
Dozois, DJ, Bieling, PJ, Patelis-Siotis, I, Hoar, L, Chudzik, S, McCabe, K and Westra, HA (2009) Changes in self-schema structure in cognitive therapy for major depressive disorder: a randomized clinical trial. Journal of Consulting and Clinical Psychology 77, 1078–1088.Google Scholar
First, MB, Spitzer, RL, Gibbon, M and Williams, JBW (1995) Structured Clinical Interview for DSM-IV Axis I Disorders – Patient edition (SCID – IV), version 2. Biometric Research Department, New York State Psychiatric Institute: New York.Google Scholar
Fournier, JC, DeRubeis, RJ, Hollon, SD, Gallop, R, Shelton, RC and Amsterdam, JD (2013) Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy. Behaviour Research and Therapy 51, 392–398.Google Scholar
Fresco, DM, Heimberg, RG, Abramowitz, A and Bertram, TL (2006) The effect of a negative mood priming challenge on dysfunctional attitudes, explanatory style, and explanatory flexibility. British Journal of Clinical Psychology 45, 167–183.Google Scholar
Fresco, DM, Segal, ZV, Buis, T and Kennedy, S (2007) Relationship of posttreatment decentering and cognitive reactivity to relapse in major depression. Journal of Consulting and Clinical Psychology 75, 447–455.Google Scholar
Garratt, G, Ingram, RE, Rand, KL and Sawalani, G (2007) Cognitive processes in cognitive therapy: evaluation of the mechanisms of change in the treatment of depression. Clinical Psychology: Science and Practice 14, 224–239.Google Scholar
Goldsmith, KA, Chalder, T, White, PD, Sharpe, M and Pickles, A (2018) Measurement error, time lag, unmeasured confounding: considerations for longitudinal estimation of the effect of a mediator in randomised clinical trials. Statistical Methods in Medical Research 27, 1615–1633.Google Scholar
Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.Google Scholar
Hollon, SD and Kendall, PC (1980) Cognitive self-statements in depression: development of an automatic thoughts questionnaire. Cognitive Therapy and Research 4, 383–395.Google Scholar
Kraemer, HC, Wilson, T, Fairburn, CG and Agras, WS (2002) Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry 59, 877–883.Google Scholar
Lam, RW, Kennedy, SH, Grigoriadis, S, McIntyre, RS, Milev, R, Ramasubbu, R, Parikh, SV, Patten, SB and Ravindran, AV (2009) Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults: III. Pharmacotherapy. Journal of Affective Disorders 117, S26–S43.Google Scholar
Leichsenring, F (2001) Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach. Clinical Psychology Review 21, 401–419.Google Scholar
Lemmens, LH, Müller, VN, Arntz, A and Huibers, MJ (2016) Mechanisms of change in psychotherapy for depression: an empirical update and evaluation of research aimed at identifying psychological mediators. Clinical Psychology Review 50, 95–107.Google Scholar
Lemmens, LH, Galindo-Garre, F, Arntz, A, Peeters, F, Hollon, SD, DeRubeis, RJ and Huibers, MJ (2017) Exploring mechanisms of change in cognitive therapy and interpersonal psychotherapy for adult depression. Behaviour Research and Therapy 94, 81–92.Google Scholar
Lorenzo-Luaces, L, German, RE and DeRubeis, RJ (2015) It's complicated: the relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clinical Psychology Review 41, 3–15.Google Scholar
Ma, SH and Teasdale, JD (2004) Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology 72, 31–40.Google Scholar
MacKinnon, DP (2008) Introduction to Statistical Mediation Analysis. New York, NY: Erlbaum.Google Scholar
MacKinnon, DP, Fairchild, AJ and Fritz, MS (2007) Mediation analysis. Annual Review of Psychology 58, 593–614.Google Scholar
Maxwell, SE and Cole, DA (2007) Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods 12, 23–44.Google Scholar
Miranda, J and Persons, JB (1988) Dysfunctional attitudes are mood-state dependent. Journal of Abnormal Psychology 97, 76–79.Google Scholar
Muthén, LK and Muthén, BO (1998–2017). Mplus User's Guide, 8th Edn. Los Angeles, CA: Muthén & Muthén.Google Scholar
Oei, TPS and Free, ML (1995) Do cognitive behaviour therapies validate cognitive models of mood disorders? A review of the empirical evidence. International Journal of Psychology 30, 145–180.Google Scholar
Quilty, LC, McBride, C and Bagby, RM (2008) Evidence for the cognitive mediational model of cognitive behavioural therapy for depression. Psychological Medicine 38, 1531–1541.Google Scholar
Quilty, LC, Dozois, DJ, Lobo, DS, Ravindran, LN and Bagby, RM (2014) Cognitive structure and processing during cognitive behavioral therapy vs. pharmacotherapy for depression. International Journal of Cognitive Therapy 7, 235–250.Google Scholar
Rosenzweig, S (1936) Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry 6, 412–415.Google Scholar
Segal, ZV, Gemar, M and Williams, S (1999) Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression. Journal of Abnormal Psychology 108, 3–10.Google Scholar
Segal, ZV, 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.Google Scholar
Vittengl, JR, Clark, LA, Thase, ME and Jarrett, RB (2014) Are improvements in cognitive content and depressive symptoms correlates or mediators during acute-phase cognitive therapy for recurrent major depressive disorder? International Journal of Cognitive Therapy 7, 251–271.Google Scholar
Warmerdam, L, van Straten, A, Jongsma, J, Twisk, J and Cuijpers, P (2010) Online cognitive behavioral therapy and problem-solving therapy for depressive symptoms: exploring mechanisms of change. Journal of Behavior Therapy and Experimental Psychiatry 41, 64–70.Google Scholar
Weissman, AN and Beck, AT (1978) Developmental validation of the Dysfunctional Attitude Scale. Paper presented at the Annual Meeting of the Association of Advancement of Behavioral Therapy, Chicago.Google Scholar
Whisman, MA (1993) Mediators and moderators of change in cognitive therapy of depression. Psychological Bulletin 114, 248–265.Google Scholar
Supplementary material: File

Quigley et al. supplementary material

Quigley et al. supplementary material 1

Download Quigley et al. supplementary material(File)
File 16.2 KB