Anne D. Simons

Therapist skill and patient variables in homework compliance : Controlling an uncontrolled variable in cognitive therapy outcome research

Prior research suggests therapists assignmentof homework, and patients compliance with it, enhancesthe efficacy of cognitive therapy (CT). However, factorscontributing to homework compliance have received scant empirical attention. This study examinedspecific demographic and clinical patient variables(age, education, number of previous depressive episodes,depression severity, and learned resourcefulness) and a variety of therapist skills (general,CT-specific, and homework-focused) as they predictedhomework compliance among 26 patients in a 20-session CTprotocol for major depression. Patients who were more compliant with homework exhibitedsignificantly greater treatment response on onedepression measure but not another. Homework compliancewas most strongly predicted by therapists reviewinghomework assigned previously, and by general therapeuticskills. Patients age, education, depression severity,and learned resourcefulness were unrelated tocompliance; however, number of previous episodes was negatively related to compliance.

Sleep, gender, and depression: An analysis of gender effects on the electroencephalographic sleep of 302 depressed outpatients

Gender-related differences in electroencephalographic (EEG) sleep were examined in 151 pairs of men and women with major depression, all outpatients, matched for age and severity of depression. Across five decades (age 21-69), depressed men had less slow-wave sleep than did depressed women. Gender differences were small with respect to visually scored measures of slow-wave sleep time and percent, but moderate for gender differences in automated measures of slow-wave density. The time constant of the polygraph preamplifier significantly affected both visually scored and automatically scored slow-wave sleep. Other measures such as REM sleep latency, first REM period duration, sleep efficiency, and early morning awakening, showed robust age effects, but no main effects for gender or gender-by-age interactions. Gender effects on slow-wave sleep and delta-wave counts in depression parallel gender effects seen in healthy aging. The possibility of occult alcohol use by depressed male outpatients cannot be definitely excluded as a partial explanation of the current findings. However, covarying for past alcohol abuse did not negate the statistical significance of the observed gender effects on slow-wave sleep and delta-wave density. The possibility of gender differences in slow-wave regulatory mechanisms is suggested, but similarity in temporal distribution of delta-wave density between the first and second non-rapid-eye-movement (NREM) periods does not support gender differences in slow-wave sleep regulation.

The generation of life events in recurrent and non-recurrent depression

BACKGROUNDnThe stress generation hypothesis proposed by Hammen (1991) holds that depressed individuals generate stressful conditions for themselves, which lead to recurrence. The original test of this hypothesis compared dependent life events in women with recurrent depression to medical and normal controls. Two further research questions emerged from this work: (a) do individuals with a history of many depressive episodes generate more dependent life events than depressives with fewer episodes?; and (b) what is the aetiological relevance of any stress that may be generated?nnnMETHODSnThe present research tested differences in dependent and independent events between depressed individuals who had experienced: (a) no previous major depressive episodes; (b) one previous episode; and (c) two or more previous episodes. We predicted that, based on the stress generation hypothesis, recurrent depressives would show more dependent events than people without a depression history, and that these generated stressors would be of aetiological importance for precipitating recurrence (i.e. severe events in the 3 months preceding recurrence).nnnRESULTSnRecurrent depressives experienced significantly more total dependent events than first-onset depressives in the 12 months, but not the 3 months, preceding their episode.nnnCONCLUSIONSnAlthough the findings supported the general premise of stress generation, the aetiological relevance of the generated stress for recurrence requires further study.

Exercise as a treatment for depression: An update☆

Abstract The traditional treatments for nonbipolar affective disorders have been pharmacological. Recently, a number of well-designed studies have demonstrated the efficacy of different nonpharmacological treatments for depression. Exercise has been among the more novel approaches to the treatment of depression, and the antidepressant effects of exercise have received considerable popular attention. The early research reports on the effects of exercise on depression suffer from conceptual confusion and methodological problems. An appraisal of recent research, however, provides grounds for cautious optimism regarding the potential therapeutic effects of exercise.

Are personality assessments valid in acute major depression

A number of recent studies indicate that identification of Axis II comorbidity in depressed patients may influence both the initial treatment plan and subsequent prognosis. Nevertheless, the validity of personality disorder diagnoses may be compromised by the effects of the patients depression on historical recall, which distort presentation of their premorbid strengths and liabilities. These problems are illustrated in this study of 53 acutely depressed unipolar outpatients, with (N = 14) or without (N = 39) personality disorder diagnoses as defined by the Personality Disorder Examination (PDE). We found that: 1) pretreatment PDE diagnoses had no significant associations with any measure of demography, symptomatic status, illness course, or treatment response; and 2) pretreatment PDE diagnoses typically were not confirmed when patients were reassessed following effective treatment with cognitive behavior therapy. These findings provide strong empirical support for the wisdom of deferring definitive assessment of Axis II until an acute depressive disorder has been optimally treated.

Identifying an abnormal electroencephalographic sleep profile to characterize major depressive disorder

There is little agreement as to the best definition of a categorically abnormal electroencephalographic (EEG) sleep profile to characterize major depressive disorder. Therefore, a series of classification, replication, and validation analyses were conducted to identify such a profile. The EEG sleep studies of healthy controls (n = 44), depressed inpatients (n = 44), and depressed outpatients (n = 181) were utilized, including subgroups of patients studied both before and after nonpharmacologic treatment with either cognitive behavior therapy (CBT) or interpersonal psychotherapy (IPT). A discriminant index score (based on reduced REM latency, increased REM density, and decreased sleep efficiency) was found to: 1) reliably discriminate between depressed inpatients, depressed outpatients, and controls; 2) show good test-retest reliability; and 3) identify a subset of depressed outpatients who were older, manifested a broader array of EEG sleep disturbances, and were less responsive to CBT or IPT. Posttreatment studies of patients indicated that normal sleep profiles were relatively stable, whereas abnormal profiles tended to normalize. These findings provide an empirically validated method that may improve the applicability, efficiency, and prognostic utility of EEG sleep studies of depressed patients.

Life stress and the symptoms of major depression.

Life stress has been found to be associated with onset of depression and with greater severity of depressive symptoms. It is unclear, though, if life stress is related to particular classes or specific symptoms in depression. The association between severe life events and depressive symptoms was tested in 59 individuals diagnosed by Research Diagnostic Criteria with endogenous primary nonpsychotic major depression. As predicted, life stress was associated principally with cognitive-affective symptoms, not somatic symptoms. There also was a consistent association across different assessment methods between severe events and suicidal ideation. Finally, associations held specifically for severe events occurring before onset, not for severe events occurring after onset. Symptom variation in major depression is related specifically to severe stressors before onset and includes primarily cognitive-affective types of symptoms. There is an especially pronounced association of prior severe stress with suicidal ideation. The implications of stress-symptom associations are addressed for enlarging understanding of symptom heterogeneity and subtype distinctions in major depression.

The Circular Mood Scale: A new technique of measuring ambulatory mood

This article presents a new method of assessing and quantifying qualitatively different mood states, the Circular Mood Scale. The method is suitable for self-monitoring of mood. It involves two parallel assessments, each based on one of two models of mood: the circumplex model and the prototypical model. In the main assessment, subjects record their mood states on a circular visual analogue scale, which can be scored for both quality and intensity of mood. The recordings on this circular scale are supplemented by an additional assessment in which subjects monitor a limited number of mood prototypes. We tested the Circular Mood Scale on four classes of mood stimuli: verbal mood descriptors, music, pictures of facial affects, and the subjects own mood during hourly monitoring of mood for 2 days. We determined the stability and interrater reliability of the mood ratings, as well as construct and concurrent validity. The results indicated that the Circular Mood Scale has acceptable reliability and validity. Possible applications and limitations of the instrument are discussed.

Plasma nortriptyline and clinical response in depression

Plasma levels of nortriptyline below 50 ng/ml or above 150 ng/ml have been reported to yield results inferior to intermediate levels. In the present study, patients with uncomplicated primary, nonbipolar depression were randomly assigned to 12 weeks of treatment with NT alone or with cognitive therapy. Nine of 35 patients had mean NT plasma levels less than 50 ng/ml. Five of them improved clinically to the criterion level of less than or equal to 7 on the Hamilton Rating Scale for Depression. This improvement rate was not at all different from that of patients with mean plasma levels within the presumed therapeutic window. The upper limit of 150 ng/ml was not tested. This study is presented in the hope of reviving the apparently dormant search for optimal therapeutic plasma levels of antidepressants.