Adele M. Hayes

Predicting the Effect of Cognitive Therapy for Depression: A Study of Unique and Common Factors

The ability of several process variables to predict therapy outcome was tested with 30 depressed clients who received cognitive therapy with or without medication. Two types of process variables were studied: 1 variable that is unique to cognitive therapy and 2 variables that this approach is assumed to share with other forms of treatment. The clients improvement was found to be predicted by the 2 common factors measured: the therapeutic alliance and the clients emotional involvement (experiencing). The results also indicated, however, that a unique aspect of cognitive therapy (i.e., therapists focus on the impact of distorted cognitions on depressive symptoms) correlated negatively with outcome at the end of treatment. Descriptive analyses that were conducted to understand this negative correlation suggest that therapists sometimes increased their adherence to cognitive rationales and techniques to correct problems in the therapeutic alliance. Such increased focus, however, seems to worsen alliance strains, thereby interfering with therapeutic change.

Modeling General and Specific Variance in Multifaceted Constructs: A Comparison of the Bifactor Model to Other Approaches

This article recommends an alternative method for testing multifaceted constructs. Researchers often have to choose between two problematic approaches for analyzing multifaceted constructs: the total score approach and the individual score approach. Both approaches can result in conceptual ambiguity. The proposed bifactor model assesses simultaneously the general construct shared by the facets and the specific facets, over and above the general construct. We illustrate the bifactor model by examining the construct of Extraversion as measured by the Revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992), with two college samples (N = 383 and 378). The analysis reveals that the facets of the NEO-PI-R Extraversion correlate with criteria in opposite directions after partialling out the general construct. The direction of gender differences also varies by facets. Bifactor models combine the advantages but avoid the drawbacks of the 2 existing methods and can lead to greater conceptual clarity.

Discontinuities and Cognitive Changes in an Exposure-Based Cognitive Therapy for Depression

Significant shifts or discontinuities in symptom course can mark points of transition and reveal important change processes. The authors investigated 2 patterns of change in depression-the rapid early response and a transient period of apparent worsening that the authors call a depression spike. Participants were 29 patients diagnosed with major depressive disorder who enrolled in an open trial of an exposure-based cognitive therapy. Hierarchical linear modeling revealed an overall cubic shape of symptom change and that both the rapid response and spike patterns predicted lower posttreatment depression. Patients wrote weekly narratives about their depression. Early narratives of rapid responders were coded as having more hope than those of nonrapid responders. The narratives of patients with a depression spike had more cognitive-emotional processing during this period of arousal than those without a spike. Findings are discussed in the context of cognitive-emotional processing theories in depression and anxiety disorders.

Changes in Mindfulness and Emotion Regulation in an Exposure-Based Cognitive Therapy for Depression

With the mounting evidence for mindfulness training as a promising strategy for distress reduction across clinical and nonclinical populations, it is important to learn more about the kinds of changes associated with this training. In an exposure-based cognitive therapy for depression that includes mindfulness training, participants reported significant increases in mindfulness over the course of therapy. Hierarchical linear modeling revealed that change in mindfulness was associated with a linear decrease in depression on self-report and clinical interview measures over the course of therapy. Increases in mindfulness were significantly correlated with reductions in avoidance and rumination, two emotion regulation strategies that are conceptual opposites of mindfulness.

Stress, Coping and Depression

Contents: Preface. Part I: Child Development. T.M. Field, Infants of Depressed Mothers. E.Z. Tronick, M.K. Weinberg, Gender Differences and Their Relation to Maternal Depression. P.J. Marshall, N.A. Fox, Emotion Regulation, Depression, and Hemispheric Asymmetry. S.L. Johnson, T. Jacob, Moderators of Child Outcome in Families With Depressed Mothers and Fathers. Part II: Basic Adult Psychopathology. C. Hammen, Interpersonal Factors in an Emerging Developmental Model of Depression. P.H. Blaney, Stress and Depression: A Personality-Situation Interaction Approach. I.H. Gotlib, D.L. Neubauer, Information-Processing Approaches to the Study of Cognitive Biases in Depression. W.D. Scott, R.W. Winters, C.G. Beevers, Affective Distress as a Central and Organizing Symptom in Depression: Psychological Mechanisms. R.W. Winters, W.D. Scott, C.G. Beevers, Affective Distress as a Central and Organizing Symptom in Depression: Neurobiological Mechanisms. Part III: Treatment. R.J. DeRubeis, T.Z. Tang, L.A. Gelfand, M. Feeley, Recent Findings Concerning the Processes and Outcomes of Cognitive Therapy for Depression. M.H. Antoni, Effects of Cognitive Behavioral Stress Management Intervention on Depressed Mood, Distress Levels, and Immune Status in HIV Infection. K. Kilbourn, P. Saab, N. Schneiderman, Depression and Negative Affect in Post-Myocardial Infarction Patients: Assessment and Treatment Implications. A.M. Hayes, M.S. Harris, The Development of an Integrative Therapy for Depression. E.L. George, J.C. Friedman, D.J. Miklowitz, Integrated Family and Individual Therapy for Bipolar Disorder.

Reductions in herpes simplex virus type 2 antibody titers after cognitive behavioral stress management and relationships with neuroendocrine function, relaxation skills, and social support in HIV-positive men

Objective Coinfection with herpes simplex virus type 2 (HSV-2) is common in individuals infected with human immunodeficiency virus (HIV) and may have health implications. This study examined the effect of a 10-week cognitive behavioral stress management (CBSM) intervention on immunoglobulin G (IgG) antibody titers to HSV-2 in a group of mildly symptomatic HIV-infected gay men and the degree to which these effects were mediated by psychosocial and endocrine changes during the 10-week period. Methods Sixty-two HIV+ gay men were randomly assigned to either a 10-week CBSM intervention (N = 41) or a wait-list control condition (N = 21). Anxious mood, social support, cortisol/dehydroepiandrosterone sulfate (DHEA-S) ratio levels, and HSV-2 IgG antibody titers were assessed at baseline and after the 10-week period. CBSM participants also recorded their stress levels before and after at-home relaxation practice. Results HSV-2 IgG titers were significantly reduced in the CBSM participants but remained unchanged in the control group after the 10-week intervention period. Increases in one type of social support, perceived receipt of guidance, during the 10 weeks was associated with and partially mediated the effect of the intervention on HSV-2 IgG. Similarly, decreases in cortisol/DHEA-S ratio levels were associated with decreases in HSV-2 IgG, and lower mean stress levels achieved after home relaxation practice were associated with greater decreases in HSV-2 IgG among CBSM participants. Conclusions These findings suggest that behavioral and psychosocial changes occurring during CBSM interventions, including relaxation, enhanced social support, and adrenal hormone reductions, may help to explain the effects of this form of stress management on immune indices such as HSV-2 antibody titers.

Dynamic systems theory as a paradigm for the study of change in psychotherapy: An application to cognitive therapy for depression.

Dynamic systems theory provides a conceptual framework for the study of change in psychotherapy that is consistent with that used in other sciences. A dynamic systems model of change was proposed and evaluated in the context of cognitive therapy for depression. Consistent with this model, less client protection and more destabilization of depressive patterns predicted more improvement at the end of treatment. Less protection was associated with more therapist support/stabilization. More destabilization was associated with more affective intensity in the session and with more of a therapist focus on the historical antecedents of current problems, exposure to multiple sources of corrective information, and repeated practice of new skills. Although preliminary, this pattern of findings is consistent with the model proposed and with principles of dynamic systems from other sciences.

Effectiveness of targeting the vulnerability factors of depression in cognitive therapy.

I. H. Gotlib and C.L. Hammens (1992) psychopathology model of depression was used as a conceptual framework for studying the process of change in an effective course of cognitive therapy (CT) for depression. Archived CT transcripts from 30 depressed outpatients in the Cognitive-Pharmaco-therapy Treatment project (S. D. Hollon et al., 1992) were studied. An observational coding system was used to assess whether therapists focused on the cognitive, interpersonal, and developmental vulnerabilities of depression and whether these interventions were associated with symptom reduction. Therapists maintained a primarily cognitive focus, but it was interventions that addressed the interpersonal and developmental domains that were associated with improvement. A developmental focus also predicted a longer time of recovery and better global functioning over the 24-month followup period. These findings are consistent with recent theoretical developments in cognitive therapy and with the psychopathology research on depression.

Changes in mood and depressive symptoms and related change processes during cognitive-behavioral stress management in HIV-infected men

This study examined the effects of a cognitive–behavioral stress management (CBSM) intervention vs. a no-treatment control group in 100 HIV-infected gay men. CBSM participants showed significant decreases in mood disturbance and depressive symptoms as well as changes in coping, perceptions of social support, self-efficacy, and dysfunctional attitudes. Stepwise regression analyses were conducted to determine which of these changes were most important for reductions in mood disturbance and depressive symptoms. Although increases in self-efficacy emerged as a significant predictor of reduction in both mood disturbance and depressive symptoms, improvements in behavioral coping strategies were most closely tied to lowered overall mood disturbance whereas improvements in cognitive coping strategies and reduction in dysfunctional attitudes were more closely associated with decreases in depressive symptoms. These results support the use of multimodal CBSM interventions for HIV-infected men as a way to modify many different types of processes independently associated with different indicators of psychological adjustment.

Predictors of self-esteem variability

Self-esteem (SE) variability has been shown to prospectively predict symptoms of depression. We examined four potential contributors to SE variability (limited sources of self-esteem, defectiveness, negative generalization, and adverse events). College students with and without a history of depression symptoms completed ratings of current self-esteem and adverse events for 14 days. Adverse interpersonal events predicted SE variability, as did their interaction with defectiveness and with generalization. Generalization also contributed uniquely to the prediction of SE variability. More severe symptoms of past depression were associated with more defectiveness, negative generalization, adverse events, and SE variability. Results support J. E. Roberts and S. M. Monroes (1994) theoretical model of vulnerable self-esteem and depression and help to elucidate the process by which SE variability occurs.