Differential response following Tx of Depression with CT or meds predicts relapse

Many individuals experience recurrent episodes of depression, even after successful treatment. Therefore, considerable effort has been made to understand and prevent relapse following the treatment of depression. Cognitive models of depression have postulated that dysfunctional beliefs/attitudes/schemas both contribute to the development of depression and predispose individuals to relapse unless they are successfully modified. This view implies that treatment approaches which modify dysfunctional beliefs/attitudes/schemas should have a lower relapse rate than treatments which do not do this.

In theory, the dysfunctional beliefs/attitudes/schemas are dormant until they are activated by a specific life stress. For vulnerable persons, the life event precipitates a pattern of negatively biased, self-referent information processing which initiates the first cycle of a downward spiral into depression. Nonvulnerable persons react with an appropriate level of distress to the event but do not spiral into depression.

Early attempts to determine whether this is indeed the case were largely equivocal or negative. However, more recent research which explicitly assure that the cognitions being assessed are activated has produced more encouraging results. In a new study by Segal, Gemar, and Williams (1999), formerly depressed patients who had been successfully treated through CT (n=25) or antidepressant medication (n=29) completed ratings of dysfunctional attitudes before and after a negative mood induction procedure. Follow-up analyses reassessed 30 patients several years after initial testing.

The two groups did not differ in their level of endorsement of dysfunctional attitudes before the mood induction procedure. However, previously depressed individuals who had been successfully treated with antidepressant medication showed a strong increase in their endorsement of dysfunctional attitudes following induction of a sad mood compared with individuals successfully treated with CT.

To determine whether this differential response to mood induction had any bearing on risk of relapse, subjects were recontacted an average of 31.7 months following their initial assessment (range, 13 to 48 months) and their experiences with depression during the intervening period were assessed. A regression equation including the extent to which subjects endorsed dysfunctional attitudes following the mood induction successfully predicted outcome for 75% of the patients who did not relapse and 64% of the patients who did relapse.

These findings suggest that successful CT produces lasting changes in individuals' response to life events which produce a sad mood and thereby reduce the likelihood of depressive relapse. (Of course, more research is needed but this is pretty encouraging.)

• Segal, Z. V., Gemar, M. & 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.

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