David D. Burns

Integrative Cognitive Therapy for Depression: A Preliminary Investigation

This study is a preliminary investigation of an integrative treatment aimed atimproving the efficacy of cognitive therapy (CT) for depression. The devel-opment of the treatment protocol was based on process findings, whichsuggested that strategies used in CT to resolve alliance ruptures may actuallyexacerbate problems in the therapeutic relationship. The protocol integrates,within the traditional CT treatment manual, procedures to repair allianceruptures that are derived from or consistent with humanistic and interper-sonal therapies. Although conducted by inexperienced therapists, the inte-grative treatment led to greater improvement than a waiting-list condition.The results also compare favorably to previous findings for CT.

Do changes in dysfunctional attitudes mediate changes in depression and anxiety in cognitive behavioral therapy

Using structural equation modeling (SEM), four hypotheses about the causal linkages between dysfunctional attitudes (DAs), anxiety, and depression were tested in a group of 521 outpatients treated with cognitive behavioral therapy (CBT) over a 12-week period. The four hypotheses were as follows: (1) changes in DAs lead to changes in depression and anxiety during treatment (the cognitive mediation hypothesis); (2) changes in depression and/or anxiety lead to changes in DAs (the mood activation hypothesis); (3) DAs and negative emotions have reciprocal causal effects on each other (the circular causality hypothesis); and (4) there are no causal links between DAs and emotions—instead, a third variable simultaneously activates DAs, depression and anxiety (the “common cause” hypothesis). Consistent with previous reports, DAs were significantly correlated with levels of depression and anxiety at intake and at 12 weeks; in addition, changes in DAs were significantly correlated with changes in depression and anxiety during treatment. However, the results were inconsistent with the first three hypotheses. There did not appear to be any causal effects linking the DAs with depression or anxiety at intake or at 12 weeks. Instead, the analyses suggested the existence of an unknown variable with simultaneous causal effects on dysfunctional attitudes, depression, and anxiety. This common cause accounted for all the correlations between the attitude and mood variables, and also appeared to mediate the effects of psychotherapy and medication on dysfunctional attitudes, depression, and anxiety.

Rumination and Distraction Among Chronic Depressives in Treatment: A Structural Equation Analysis

Response Styles Theory hypothesizes that rumination about ones symptoms amplifies and prolongs depressed mood, whereas distraction has the opposite effect. Response styles are also hypothesized to be trait-like dispositions. The generalizability of Response Styles Theory, as well as the linkages that may account for correlations between rumination, distraction, and depression, were explored with structural equation modeling in a sample of chronically depressed individuals undergoing treatment with psychotherapy, medication, or combination treatment. Results were not consistent with the hypotheses that rumination or distraction have causal effects on recovery from depression or that depression causes rumination or distraction. Rather a common cause or causes appeared to account for the correlations between these variables. Stability of rumination and distraction was low over a 12-week period. Implications of the findings are discussed.

Is it true that men are from Mars and women are from Venus? A test of gender differences in dependency and perfectionism.

Several theorists have proposed that dependency and perfectionism differentially characterize depression in women and men. Structural equation modeling was conducted on a sample of 427 patients with mood disorders to test the hypotheses that: (1) depressed women exhibit greater dependency than depressed men, (2) depressed men exhibit greater perfectionism than depressed women, (3) dependency is more related to depression in women, (4) perfectionism is more related to depression in men, (5) reductions in dependency during treatment are more associated with recovery in women, and (6) reductions in perfectionism during treatment are more associated with recovery in men. No support was found for any of the hypothesized gender differences. Women and men did not differ in the level of dependency or perfectionism, or in the correlation between these variables and depression. In addition, changes in dependency and perfectionism during treatment were not differentially associated with changes in depression in women and men.

Are dysfunctional attitudes and attributional style the same or different

Dysfunctional attitudes and attributional style have both been hypothesized to be cognitive vulnerabilities to depression. However, it is unclear whether they are the same or distinct constructs, and whether they are associated with the same or unique portions of depression variance. Structural equation modeling was conducted on a sample of depressed outpatients to test the hypotheses that dysfunctional attitudes and attributional style are distinct factors, and that each has a unique relationship with depression. Dysfunctional attitudes and attributional style were found to comprise correlated but distinct factors, as predicted. However, the attributional style factor was not correlated with depression when controlling for its correlation with dysfunctional attitudes. In contrast, the dysfunctional attitude factor was positively and strongly correlated with depression when controlling for attributional style.

Perspective for special Gurdon issue for differentiation: can cell fusion inform nuclear reprogramming?

Nuclear reprogramming was first shown to be possible by Sir John Gurdon over a half century ago. The process has been revolutionized by the production of induced pluripotent cells by overexpression of the four transcription factors discovered by Shinya Yamanaka, which now enables mammalian applications. Yet, reprogramming by a few transcription factors remains incomplete and inefficient, whether to pluripotent or differentiated cells. We propose that a better understanding of mechanistic insights based on developmental principles gained from heterokaryon studies may inform the process of directing cell fate, fundamentally and clinically.