Biomedical subjects
Publications and source records attributed to S D Hollon.
Thirty depressed patients collected 24-h urine samples for a 3-methoxy-4-hydroxyphenylglycol (MHPG) determination prior to imipramine treatment. Patients responding to treatment had lower levels of MHPG than did non-responders.
The effects of changes in depression-relevant cognition were examined in relation to subsequent change in depressive symptoms for outpatients with major depressive disorder randomly assigned to cognitive therapy (CT; n = 32) versus those assigned to pharmacotherapy only (NoCT; n = 32). Depression severity scores were obtained at the beginning, middle, and end of the 12-week treatment period, as were scores on 4 measures of cognition: Attributional Styles Questionnaire (ASQ), Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS), and the Hopelessness Scale (HS). Change from pretreatment to midtreatment on the ASQ, DAS, and HS predicted change in depression from midtreatment to posttreatment in the CT group, but not in the NoCT group. It is concluded that cognitive phenomena play mediational roles in cognitive therapy. However, data do not support their status as sufficient mediators.
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Thirty-three outpatients with primary nonbipolar depression received individual treatment with either cognitive therapy alone (n = 18) or cognitive therapy plus amitriptyline hydrochloride pharmacotherapy (n = 15). All patients were treated according to a protocol specifying a maximum of 20 sessions during a 12-week period. Both groups showed statistically significant and clinically meaningful decreases in depressive symptoms. No differences emerged between the two groups in terms of the magnitude of the decrease in depressive symptoms. The addition of tricyclic antidepressant medication did not improve the response obtained by cognitive therapy alone, during the short-term treatment phase. Although there was a nonsignificant trend suggesting greater stability of gains for the combined treatment at a one-year follow-up, the patients had more therapy during the follow-up period. There was no evidence of any negative interaction between cognitive therapy and pharmacotherapy, although evidence for any positive additive or interactive effect was meager.
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The authors examined the effects of cognitive therapy and imipramine on hopelessness and self-concept in 35 unipolar nonpsychotic depressed outpatients who were treated with either modality over approximately 11 weeks. Compared with imipramine, cognitive therapy resulted in significantly greater improvements in hopelessness and more generalized gains in self-concept. Thus, cognitive therapy may offer a particular advantage in reducing hopelessness and improving low self-concept in depression.
Using a controlled, clinical-trial format, 44 nonpsychotic, nonbipolar, depressed outpatients were treated with cognitive therapy or imipramine hydrochloride over a 12-week period. Although both interventions were associated with significant reductions in levels of depression, the cognitive-therapy patients showed greater symptomatic improvement and a higher treatment-completion rate. A one-year naturalistic follow-up of the 35 subjects who completed the protocol revealed that although many of the patients had a variable clinical course, both original treatment groups remained generally well. Self-rated depressive symptomatology was significantly lower for those who, one year earlier, had completed cognitive therapy than for those who had been in the clinical trial's pharmacotherapy cell. While there were several other interesting trends in favor of the cognitive-therapy patients, none of the between-group differences were significant. The pragmatic and clinical implications of the followup results are discussed.
Patterns of symptoms change were examined in 35 unipolar depressed outpatients treated with either cognitive therapy or pharmacotherapy (imipramine HCl). Cross-lagged panel analyses were used to evaluate the temporal relationships among changes in views of the self, hopelessness, mood, motivation and vegetative symptoms during treatment weeks 1-4. During cognitive therapy improvements in hopelessness, views of the self and mood generally preceded changes in vegetative and motivational symptoms. On the other hand, no consistent pattern of change was associated with pharmacotherapy. While these results are compatible with the notion that cognitive therapy initially alters negative thinking and mood, which secondarily leads to improvements in vegetative and motivational symptoms, further studies with a placebo or wait-list group are needed to determine if this is a unique effect of cognitive therapy.
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