Cognitive therapy to prevent depressive relapse in adults
Introduction
Major depressive disorder (MDD) is a common illness with a large public health cost (e.g., [58]). A curative treatment for MDD would eliminate underlying pathology, relieve all patients’ depressive symptoms rapidly, restore psychosocial functioning fully, and prevent depressive relapses and recurrences entirely. Current treatments are far from these ideals. However, cognitive and cognitive-behavioral therapy (CT) for MDD reduces depressive symptoms, improves psychosocial functioning, and lowers the probability future depression in many patients. Here we review some of the most important and most recent research on CT for adults with MDD to inform prevention of relapse and recurrence.
Section snippets
What is major depressive disorder?
The experience of at least one major depressive episode (MDE) defines MDD [1]. MDEs reflect disturbances in mood (e.g., subjectively depressed and/or loss of pleasure in life's activates) with attendant changes in behavior (e.g., increased or decreased sleep, eating, activity level) and cognition (e.g., reduced concentration, increased guilt, suicidality), last at least two weeks, and produce significant life interference (e.g., as a student, worker, parent, friend, romantic partner; [2]).
What is cognitive behavioral therapy?
Cognitive behavioral therapies for depression share efforts to change patients’ distress-related cognition as a means to improve mood and functioning. Beck et al.’s [13] individual, in-person CT is prototypical. During a limited period (e.g., 16–20 one-hour sessions over 3–4 months), Beck's CT aims to increase patients’ engagement with sources of reinforcement and adaptive functioning (‘behavioral activation’) and then to assess and restructure depressive cognition, including negative automatic
Acute phase CT
Roughly 60–70% of patients no longer meet criteria for MDD after completing acute phase CT ([24, 1]), and average symptom levels are comparable after acute phase CT versus pharmacotherapy [25]. Although CT and pharmacotherapy produce similar short-term outcomes, CT's preventive effects exceed pharmacotherapy after either acute phase treatment ends.
In an earlier meta-analysis of studies reporting follow-up data after response then discontinuation of acute phase treatment, relapse/recurrence
Conclusions and future directions
Major depressive disorder is often recurrent and treatment with CT increases patients’ periods of relative wellness, with important clinical trials ongoing (e.g., [52, 53•]). Research shows that acute, continuation, and maintenance CTs have preventive effects against relapse and/or recurrence, although none is fully efficacious. Refined treatments and treatment-application protocols may profitably focus on maximizing individual-level and population-level benefits of CT and on identifying
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
•• of outstanding interest
Acknowledgements
This report was supported by Grants Number K24 MH001571, R01 MH58397, R01 MH69619 to Robin B. Jarrett, PhD, from the National Institute of Mental Health (NIMH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health.
Dr. Vittengl has no financial interest or conflict of interest in the research. Dr. Jarrett's medical center collects the payments from the cognitive therapy she provides to
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Meta-Analysis: Relapse Prevention Strategies for Depression and Anxiety in Remitted Adolescents and Young Adults
2023, Journal of the American Academy of Child and Adolescent PsychiatryCitation Excerpt :Relapse rates ranged from 29% over 14 months to 60% over 6 years and up to 87% over 10 years follow-up.18 Next to improved relapse rates, we found that CBT-based strategies (combined with ADMc) are associated with increased time to relapse, which is closely comparable to findings in previous meta-analyses in adults (eg, see 6,17-21). There was a small difference between CBT-based strategies and CAU control conditions on mean depressive symptoms at last follow-up, which was not found in the previous meta-analysis in youth.8
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