Denise D. Davis

Cognitive therapy for depression: conceptual issues and clinical efficacy.

Cognitive therapy has emerged as 1 of the most promising psychosocial interventions for the treatment of depression. It appears to be at least the equal of alternative interventions (including pharmacotherapy) with respect to acute treatment. In addition, there are indications that it may reduce risk of symptom return after treatment termination. Nonetheless, design limitations reduce the certainty with which such conclusions can be drawn. Furthermore, tests of its efficacy have largely been limited to nonbipolar outpatient (or subclinical) samples. At this time, cognitive therapy is best considered a promising, but as yet not adequately tested, intervention for the treatment of depression.

Biological stress responses in high and low trait anxious students

In an investigation of biological indicators of stress in normal humans, undergraduate psychology students were differentiated on trait anxiety and assessed under baseline, preexam (stress), and postexam conditions. Assessment at each condition involved drawing 20 ml of blood, followed by self-reporting for selected questionnaires. Self-reports included state anxiety, general psychological symptomatology, dysfunctional attitudes, academic confidence, sleep patterns, and intake of drugs, including alcohol and caffeine. Blood was analyzed for whole blood serotonin content, plasma MHPG, and platelet imipramine binding. Baseline differences between high and low trait anxious students on biological measures were significant only for whole blood serotonin content. Variation across situational conditions was significant for whole blood serotonin, with an increase under the stressful condition for both anxiety groups. Thus, serotonin is highlighted as an important factor in the human response to stress, whereas expected differences in MHPG were not observed. The serotonergic response to stress was not explained by changes in psychological or physical state variables. Changes in serotonin content were positively correlated with changes in platelet imipramine binding.

Enhancing Cognitive Therapy with Women

In considering the array of therapeutic approaches available today, cognitive therapy offers some special advantages for women. The theory and practice of cognitive therapy appear to be especially harmonious with the feminist philosophy of advancing the rights and status of women (Farrell & Davis, 1986). Dealing with women clients does not mean that the fundamentals of cognitive therapy need to be substantially revised. However, cognitive therapists attempting to understand their clients’ idiosyncratic, internal reality may enhance this understanding by considering the context of gender. Just as it is clearly a mistake to overgeneralize research findings based only on a male sample, so it is a mistake in clinical practice to assume male and female experiences and beliefs are identical. Therapists are becoming more sophisticated in applying cognitive therapy with special populations, as demonstrated by this volume. Recognizing women as a population in cognitive therapy involves consideration of the importance of gender and a willingness to explore the ways in which a woman’s thoughts are influenced by her social realities.

Cognitive Therapy of Depression

There are many psychological explanations for the development of depressive patterns of response. Generally, psychoanalytic formulations regarding introjected anger have not stood the test of time or research (Beck, Rush, Shaw, & Emery, 1979). Behavioral formulations, by contrast, have focused on well-established principles of learning in trying to understand the establishment, maintenance, and treatment of the depressive process. Boyd and Levis (1980) have identified four conceptual approaches for understanding depression from a behavioral perspective: S-R nonmotivational, S-R motivational, S-S nonmotivational, and S-S motivational.

Serotonin, Imipramine Binding, Cortisol and Anxiety in Humans Under Stress

Although noradrenergic and serotonergic neurotransmitter systems have been implicated in stress among animals and humans [1,4] specific biological indicators of human stress have produced inconsistent results [3].