Biomedical subjects

R B Jarrett

Publications and source records attributed to R B Jarrett.

At least 19 recordsLinked to original sources

PubMed2004

Improvement in social-interpersonal functioning after cognitive therapy for recurrent depression.

BACKGROUND: Cognitive therapy reduces depressive symptoms of major depressive disorder, but little is known about concomitant reduction in social-interpersonal dysfunction. METHOD: We evaluated social-interpersonal functioning (self-reported social adjustment, interpersonal problems and dyadic adjustment) and depressive symptoms (two self-report and two clinician scales) in adult outpatients (n=156) with recurrent major depressive disorder at several points during a 20-session course of acute phase cognitive therapy. Consenting acute phase responders (n=84) entered a 2-year follow-up phase, which included an 8-month experimental trial comparing continuation phase cognitive therapy to assessment-only control. RESULTS: Social-interpersonal functioning improved after acute phase cognitive therapy (dyadic adjustment d=0.47; interpersonal problems d=0.91; social adjustment d=1.19), but less so than depressive symptoms (d=1.55). Improvement in depressive symptoms and social-interpersonal functioning were moderately to highly correlated (r=0.39-0.72). Improvement in depressive symptoms was partly independent of social-interpersonal functioning (r=0.55-0.81), but improvement in social-interpersonal functioning independent of change in depressive symptoms was not significant (r=0.01-0.06). In acute phase responders, continuation phase therapy did not further enhance social-interpersonal functioning, but improvements in social-interpersonal functioning were maintained through the follow-up. CONCLUSIONS: Social-interpersonal functioning is improved after acute phase cognitive therapy and maintained in responders over 2 years. Improvement in social-interpersonal functioning is largely accounted for by decreases in depressive symptoms.

Adult↗

PubMed2001

Preventing recurrent depression using cognitive therapy with and without a continuation phase: a randomized clinical trial.

BACKGROUND: Cognitive therapy (CT) may reduce depressive relapse and recurrence when patients learn and use the associated skills. Reported relapse and recurrence rates after CT discontinuation vary widely. The factors that determine when CT is preventive remain unidentified. We developed continuation-phase CT (C-CT) to teach responders skills to prevent relapse. This is the first randomized trial comparing CT with and without a continuation phase in responders to CT who were vulnerable, given their history of recurrent unipolar depression. METHODS: Patients aged 18 to 65 years (n = 156) with recurrent DSM-IV major depressive disorder (MDD) entered 20 sessions of acute-phase CT (A-CT). Unmedicated responders (ie, no MDD and 17-item Hamilton Rating Scale for Depression score < or =9; n = 84) were randomized to either 8 months (10 sessions) of C-CT or control (evaluation without CT). Follow-up lasted an additional 16 months. A clinician blind to assignment evaluated relapse and recurrence (ie, DSM-IV MDD). RESULTS: Over an 8-month period, C-CT significantly reduced relapse estimates more than control (10% vs 31%). Over 24 months, including the CT-free follow-up, age of onset and quality of remission during the late phase of A-CT each interacted with condition assignment to influence durability of effects. In patients with early-onset MDD, C-CT significantly reduced relapse and recurrence estimates (16% vs 67% in control). When patients had unstable remission during late A-CT, C-CT significantly reduced relapse and recurrence estimates to 37% (vs 62% in control). CONCLUSIONS: Findings suggest that 8 months of C-CT significantly reduces relapse and recurrence in the highest-risk patients with recurrent MDD. Risk factors influenced the necessity for C-CT.

Adaptation, Psychological↗

PubMed1999

Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial.

BACKGROUND: Patients with atypical depression are more likely to respond to monoamine oxidase inhibitors than to tricyclic antidepressants. They are frequently offered psychotherapy in the absence of controlled tests. There are no prospective, randomized, controlled trials, to our knowledge, of psychotherapy for atypical depression or of cognitive therapy compared with a monoamine oxidase inhibitor. Since there is only 1 placebo-controlled trial of cognitive therapy, this trial fills a gap in the literature on psychotherapy for depression. METHODS: Outpatients with DSM-III-R major depressive disorder and atypical features (N = 108) were treated in a 10-week, double-blind, randomized, controlled trial comparing acute-phase cognitive therapy or clinical management plus either phenelzine sulfate or placebo. Atypical features were defined as reactive mood plus at least 2 additional symptoms: hypersomnia, hyperphagia, leaden paralysis, or lifetime sensitivity to rejection. RESULTS: With the use of an intention-to-treat strategy, the response rates (21-item Hamilton Rating Scale for Depression score, < or =9) were significantly greater after cognitive therapy (58%) and phenelzine (58%) than after pill placebo (28%). Phenelzine and cognitive therapy also reduced symptoms significantly more than placebo according to contrasts after a repeated-measures analysis of covariance and random regression with the use of the blind evaluator's final Hamilton Rating Scale for Depression score. The scores between cognitive therapy and phenelzine did not differ significantly. Supplemental analyses of other symptom severity measures confirm the finding. CONCLUSIONS: Cognitive therapy may offer an effective alternative to standard acute-phase treatment with a monoamine oxidase inhibitor for outpatients with major depressive disorder and atypical features.

Adult↗

PubMed1998

Is there a role for continuation phase cognitive therapy for depressed outpatients?

Two pilot studies evaluated the rate of relapse or recurrence (i.e., major depressive disorder) after cognitive therapy (CT). Two sequential cohorts included outpatients who responded to acute phase CT (A-CT) and who agreed to monthly, treatment-free follow-up. In Study 1, the Kaplan-Meier technique estimated relapse and recurrence rates of 40% at 6 months, 45% at 8 months, 50% at 12 months, 67% at 18 months, and 74% at 24 months. In Study 2, responders to A-CT received 8 months (10 sessions) of continuation phase CT (C-CT). In Study 2, relapse or recurrence was 20% at 6 and 8 months, 27% at 12 months, and 36% at 18 and 24 months after A-CT. An exploratory log-rank test showed that relapse or recurrence-free survival was greater in Study 2 than in Study 1. If replicated, this result suggests that C-CT can reduce depressive relapse or recurrence. Alternative explanations are presented.

Adult↗

PubMed1996

The Inventory of Depressive Symptomatology (IDS): psychometric properties.

The psychometric properties of the 28- and 30-item versions of the Inventory of Depressive Symptomatology, Clinician-Rated (IDS-C) and Self-Report (IDS-SR) are reported in a total of 434 (28-item) and 337 (30-item) adult out-patients with current major depressive disorder and 118 adult euthymic subjects (15 remitted depressed and 103 normal controls). Cronbach's alpha ranged from 0.92 to 0.94 for the total sample and from 0.76 to 0.82 for those with current depression. Item total correlations, as well as several tests of concurrent and discriminant validity are reported. Factor analysis revealed three dimensions (cognitive/mood, anxiety/arousal and vegetative) for each scale. Analysis of sensitivity to change in symptom severity in an open-label trial of fluoxetine (N = 58) showed that the IDS-C and IDS-SR were highly related to the 17-item Hamilton Rating Scale for Depression. Given the more complete item coverage, satisfactory psychometric properties, and high correlations with the above standard ratings, the 30-item IDS-C and IDS-SR can be used to evaluate depressive symptom severity. The availability of similar item content for clinician-rated and self-reported versions allows more direct evaluations of these two perspectives.

Adult↗

PubMed1995

Clinical characteristics of outpatients with chronic major depression.

A cross-sectional evaluation of 243 unipolar, nonpsychotic outpatients with major depression was conducted. All subjects were diagnosed by RDC with SADS-L structured interviews. Diagnoses included RDC primary/secondary, RDC endogenous/nonendogenous and Winokur's family-history subtypes. Symptom severity was assessed by the 17-item Hamilton Rating Scale for Depression. Chronic depression was defined as the current episode of major depression lasting at least 2 years, corresponding to DSM-III-R and -IV criteria. Patients with chronic depression (n = 64) were compared with those with nonchronic depression (n = 179). Chronicity was not related to gender, symptom severity, prior length of illness, age at onset of illness, RDC endogenous/nonendogenous, RDC primary/secondary or Winokur's family-history subtypes. Those with chronic depression were older and had fewer major depressive episodes than the nonchronic group. That the chronic group had fewer total episodes of depression than the nonchronic group, but a similar age at onset, is consistent with the notion that patients in a current chronic episode have characteristically longer depressive episodes throughout the course of their illness. Those with chronic episodes may be subject to psychological, biological and/or sociocultural factors that preclude an earlier episode remission for these individuals.

Adult↗

PubMed1994

Short-term psychotherapy of depressive disorders: current status and future directions.

Depressive disorders can affect all aspects of a person's functioning and are often associated with significant psychosocial impairment. Such psychosocial problems promote studies of the efficacy of short-term psychotherapy for depressive disorders. This report summarizes the literature on acute-phase, short-term psychotherapy for adult outpatients with major depressive disorder and is an updated component of a larger review commissioned by the United States Public Health Services Agency for Health Care Policy and Research (AHCPR review on "Short-term Psychotherapy for Depression," Jarrett and Maguire [1991]; Jarrett and Down [in press] during the preparation of the Clinical Practice Guidelines in primary care (Depression Guideline Panel 1993). The short-term psychotherapies reviewed here and studied most often include behavior therapy, cognitive therapy, interpersonal psychotherapy, and brief dynamic psychotherapy, which all aim to reduce depressive symptoms. We comment on the state of the literature and raise some of the questions which await data.

Behavior Therapy↗

PubMed1993

Prospective assessment of electroencephalographic sleep in remitted major depression.

We studied 29 patients with major depression before treatment and then followed these patients prospectively with monthly electroencephalographic (EEG) sleep assessments after successful treatment. Most EEG sleep measures demonstrated no change from the episode throughout a prolonged period of clinical remission. When there was evidence of a change in EEG sleep measures, the effect was modest and due to only a small subset of patients. These findings contribute to the accumulating evidence that selected EEG sleep measures appear to be trait-like and may be useful in identifying individuals at risk for major depression.

Adult↗

PubMed1991

Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence.

In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery, relapse, and recurrence. In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments.

Depressive Disorder↗

PubMed1991

Does learned resourcefulness predict response to cognitive therapy in depressed outpatients?

Thirty-seven unipolar, nonpsychotic, outpatients with major depression were treated with cognitive therapy in an ongoing study designed to identify which depressions respond to cognitive therapy. Pretreatment levels of learned resourcefulness, assessed by Rosenbaum's (1980) Self Control Schedule (SCS), were used to predict response to cognitive therapy (according to the 17-item Hamilton Rating Scale for Depression and the 21-item Beck Depression Inventory). Pretreatment SCS scores did not predict response to cognitive therapy according to either measure.

Adaptation, Psychological↗

PubMed1991

Clinical, cognitive, and demographic predictors of response to cognitive therapy for depression: a preliminary report.

This preliminary study evaluated prognostic indicators or predictors of response to cognitive therapy. The sample included 37 unipolar outpatients with moderate to severe major nonpsychotic depressive disorder, according to Research Diagnostic Criteria. Demographic characteristics (sex, age, marital status, and education), pretreatment severity measures (Hamilton Rating Scale for Depression [HRSD] and Beck Depression Inventory [BDI]), pretreatment cognitive measures (Dysfunctional Attitudes Scale [DAS] and Attributional Style Questionnaire Failure Composite [ASQ-F]), and historical features (length of illness, length of current episode, number of episodes, and age of onset) were used in multiple regression models to predict response. In accord with previous findings, patients who had higher (rather than lower) pretreatment HRSD, BDI, or DAS scores and were single (rather than married) showed a poorer response to cognitive therapy, according to the HRSD. Furthermore, married outpatients with high DAS scores or single patients with low DAS scores showed an intermediate response to cognitive therapy, while single patients with high DAS scores responded the least. Generally, effects were stronger when response was assessed according to clinician-rated severity measures rather than patient self-reports.

Adult↗

PubMed1990

Does the pretreatment polysomnogram predict response to cognitive therapy in depressed outpatients? A preliminary report.

Although several studies reveal that cognitive therapy effectively remediates depressive symptoms in many unipolar nonpsychotic depressed outpatients, the question as to which depressions respond to cognitive therapy remains unanswered. We hypothesized that patients with reduced rapid eye movement (REM) latency (less than or equal to 65.0 min) before treatment would be less likely than those with nonreduced REM latency (greater than 65.0 min) to respond to cognitive therapy. The rationale for this prediction was that endogenous depressions are more likely to exhibit this abnormality and also tend to respond to tricyclic antidepressant medication. Thus, we queried whether these depressions might also respond less to a psychosocial intervention. To date, 39 outpatients with nonpsychotic, unipolar major depression (by the Schedule for Affective Disorders and Schizophrenia-Lifetime Version and Research Diagnostic Criteria) who score at least 14 on the 17-item Hamilton Rating Scale for Depression have completed this project, which is still in process. Preliminary findings do not suggest a systematic relationship between pretreatment REM latency and response to cognitive therapy. Further, these results suggest that at least some patients with biological dysregulation, as indicated by reduced REM latency, show a favorable response to an acute trial of cognitive therapy. Study limitations include a small sample of patients who exhibit extremely reduced REM latencies (less than or equal to 51.0 min) and a small number of endogenous depressions. Data collection continues.

Cognitive Behavioral Therapy↗

PubMed1990

Guilt in depressed outpatients.

This study was designed to determine whether normal control subjects (n = 17) and depressed outpatients (n = 72) differed with respect to the extent and conditions under which they reported dysfunctional guilt. Depressed outpatients reported significantly more guilt than normal control subjects in most types of situations. A family history of depression was related to a higher overall level of guilt in patients. Course and severity of depression and endogenous subtype did not relate to the amount of guilt reported by the patients. This study provides clinical norms on the Situational Guilt Scale (SGS) for a sample of unipolar, nonpsychotic outpatients with major depressive disorder.

Adult↗

PubMed1990

Psychosocial aspects of depression and the role of psychotherapy.

The psychosocial aspects of depression are considered with respect to psychological factors (i.e., thinking, personality, coping style) and social factors (i.e., family, relationships, employment, life events). Etiologic/mechanistic controversies are only acknowledged, as the purpose of this review is to underscore the wide variety of psychosocial complications that can occur during a depressive episode. The potential roles of psychotherapy in the treatment of mood disorders are considered. Results regarding the efficacy of behavioral therapy, cognitive therapy, and interpersonal psychotherapy in the treatment of unipolar, nonpsychotic, adult depressed outpatients are summarized.

Adaptation, Psychological↗

PubMed1989

Reduced REM latency predicts response to tricyclic medication in depressed outpatients.

Forty-two outpatients with major depressive disorder entered a double-blind, randomized trial of either desipramine or amitriptyline for a minimum of 6 weeks. Pretreatment polysomnographic and clinical measures were used to predict response. Response was defined as a 17-item Hamilton Rating Scale for Depression score less than or equal to 9 at the end of treatment. There was a 61.1% response rate for patients treated with amitriptyline and a 66.7% response rate for patients treated with desipramine. Reduced REM latency (2-night mean less than or equal to 65.0 min) predicted a positive response to these tricyclic antidepressants. REM latency did not differentiate between desipramine or amitriptyline responders. More patients with reduced REM latency (80%) responded to treatment compared with patients with nonreduced REM latency (50%). The 80% response rate in reduced REM latency depressed patients confirms our previous findings in a mixed inpatient and outpatient sample. Contrary to our hypothesis, in this sample, endogenous depression was not associated with a good response to tricyclic medication.

Adolescent↗

PubMed1989

Clinical predictors of recurrence in depression.

In a longitudinal study of 30 successfully treated unipolar depressed patients, the authors evaluated number of depressive episodes, early onset of depression, and lifetime prevalence of affective disorders other than major depression as risk factors for recurrence. Early onset of depression (before age 20) and a history of affective disorders other than major depression were each significantly associated with recurrence. Number of episodes was not as powerful in predicting recurrence as either early onset or lifetime prevalence of other affective disorders.

Actuarial Analysis↗

PubMed1987

Psychological treatments of dysmenorrhea: differential effectiveness for spasmodics and congestives.

Two studies are reported, examining the effectiveness of psychological treatments for dysmenorrhea. In Experiment 1, 33 women with spasmodic dysmenorrhea were treated with relaxation alone, or relaxation plus imagery, or assigned to a waiting-list control condition; and 29 women with congestive dysmenorrhea were treated with relaxation alone, or assigned to a waiting-list control condition. In Experiment 2, 18 additional congestives were treated with a coping skills package, or this package plus relaxation; these two groups were compared with the two congestive groups from Experiment 1. The dependent measures were reports of symptom severity, general discomfort, resting time, and medication use. Consistent with the literature, the main findings of the present studies are: (a) relaxation training (alone or with imagery) effectively reduces resting time for spasmodics; and (b) none of the treatments was shown to be effective for congestive sufferers.

Adaptation, Psychological↗

PubMed1987

Reduced rapid eye movement latency. A predictor of recurrence in depression.

In this longitudinal study of 25 successfully treated depressed patients, rapid eye movement (REM) latency during an episode of depression was evaluated as a predictor of recurrence. Patients with reduced REM latency prior to treatment were more likely to develop another episode of depression during the follow-up period.

Adult↗