Eric Gortner

A Component Analysis of Cognitive-Behavioral Treatment for Depression

The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.

Cognitive-behavioral treatment for depression : Relapse prevention

This study presents 2-year follow-up data of a comparison between complete cognitive-behavioral therapy for depression (CT) and its 2 major components: behavioral activation and behavioral activation with automatic thought modification. Data are reported on 137 participants who were randomly assigned to 1 of these 3 treatments for up to 20 sessions with experienced cognitive-behavioral therapists. Long-term effects of the therapy were evaluated through relapse rates, number of asymptomatic or minimally symptomatic weeks, and survival times at 6-, 12-, 18-, and 24-month follow-ups. CT was no more effective than its components in preventing relapse. Both clinical and theoretical implications of these findings are discussed.

Psychological Factors in the Longitudinal Course of Battering: When Do the Couples Split Up? When Does the Abuse Decrease?

The longitudinal course of battering was investigated over a 2-year time span. Forty-five batterers and their spouses were assessed with self-report, psychophysiological, and marital interaction measures. Both the stability of the relationship and of the battering were assessed. At the two-year follow-up, 62% of the couples were still married and living together, while 38% had separated or divorced. A combination of six variables, reflecting severity of husband emotional abuse, wife dissatisfaction, husband physiological arousal, and wife defending herself assertively, was 90.2% accurate in predicting separation or divorce 2 years later. Of the couples still living together at follow-up, 46% of the batterers did not reduce their levels of severe violence, while 54% did significantly decrease levels of violence. Husbands who continued to be severely violent at 2-year follow-up were more domineering, globally negative and emotionally abusive toward their wives at Time 1 than husbands who reduced their levels of violence. Even though 54% of the batterers decreased the frequency of violent acts over the 2-year period, only 7% achieved complete desistance. Moreover, husband emotional abuse did not decrease over the 2-year period, even when physical abuse did.

PSYCHOLOGICAL ASPECTS OF PERPETRATORS OF DOMESTIC VIOLENCE AND THEIR RELATIONSHIPS WITH THE VICTIMS

Domestic violence is a serious public health concern in the United States. Despite the serious and often tragically fatal consequences of spousal abuse, we have very little understanding about the root causes of domestic violence. We know even less about providing effective treatments and prevention. In this article, we have discussed some of the more promising individual difference variables that discriminate between violent and nonviolent men. We also have addressed some of the growing research on how violent couples are different from nonviolent ones. Unfortunately, methodologic limitations hamper us from being able to discuss definitive risk factors or predictive variables, but we can speak of factors associated with domestic violence. We also have discussed the importance of attending to important differences among violent men and violent couples. The complexity of battering behavior and battering relationships necessarily points researchers and clinicians toward multifaceted research designs and treatment models. The tragedy of domestic violence demands that science continues to address these crucial unanswered questions.

Predictors of depressive relapse during a two year prospective follow-up after cognitive and behavioral therapies

Patient characteristics may partly explain individual differences in long-term maintenance of treatment gains in response to cognitive and behavioral therapies (CBT). This study evaluated the relative contribution of negative cognitive style, behavioral activation, and personality patterns, measured at the end of treatment among treatment responders, towards the risk of relapse of major depressive disorder over a 2-year prospective follow-up. The sample included depressed adults who were randomized and received an adequate dose of one of three forms of CBT, who then fully responded and completed a 2-year prospective follow-up ( N = 93) (Jacobson et al., 1996; Gortner, Gollan, Dobson and Jacobson, 1998). Cox regression analyses revealed that for treatment responders, self-devaluative depressogenic cognitive style did not predict relapse during the 2-year follow-up. Separate cox regression analyses indicated that without considering the contribution of personality patterns, it was important to distinguish the level of behavioral activation (e.g. frequency of pleasant events) from its associated pleasure in predicting relapse. With the introduction of personality patterns; however, an integrated model revealed that only dependent personality pattern was associated with hazard of relapse during the 2-year prospective follow-up. Dependent personality pattern may increase relapse through behavioral passivity.

Biosocial Risk Factors for Domestic Violence

Domestic violence occupies an unusual position in psychological research. While being one of the most widespread and devastating of societal problems, domestic violence is also one of the areas with the least amount of quality empirical work. We need to look no further than the historical and cultural context of wife assault to recognize that violence against women has not only been largely ignored and minimized across time, but has also been sanctioned by our patriarchal culture (Bograd, 1988; Dobash & Dobash, 1979). Part of this apparent lack of research enthusiasm may be explained by the delicate ethical issues that are raised when science attempts to intervene in such a politically perilous area (Jacobson, 1994). The accurate dissemination of results from this type of research is particularly difficult given the propensity of the mass media to confuse and misinterpret issues of correlation, causality, and responsibility. Another possible deterrent to would-be researchers is that domestic violence is not part of any mainstream, but rather overlaps with many different disciplines, including psychology, public health, law, and social work domains.