Neil S. Jacobson

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.

Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance.

The purpose of this article is to suggest some new directions for the presentation and reporting of data in psychotherapy outcome research. Statistical comparisons based on group means provide no information on the variability of treatment outcome, and statistical significance tests do not address clinical significance. Although psychotherapy research has begun to address these issues, it has done so unsystematically. New standards and conventions are needed to serve as criteria for classifying therapy subjects into categories of improved, unimproved, and deteriorated based on response to treatment. A two-fold criterion for determining improvement in a client is recommended, based on both statistical reliability and clinical significance. Statistical procedures for determining whether or not these criteria have been met are discussed.

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives.

This article summarizes and scrutinizes the growth of the development of clinically relevant and psychometrically sound approaches for determining the clinical significance of treatment effects in mental health research by tracing its evolution, by examining modifications in the method, and by discussing representative applications. Future directions for this methodology are proposed.

Testing the Integrity of a Psychotherapy Protocol: Assessment of Adherence and Competence.

Manipulation checks should be used in psychotherapy trials to confirm that therapists followed the treatment manuals and performed the therapy competently. This article is a review of some strategies that have been used to document treatment integrity; also, their limitations are discussed here. Recommendations for improving these checks are presented. Specific guidelines are offered regarding when and how to assess both therapist adherence to treatment protocols and competence.

Affect, Verbal Content, and Psychophysiology in the Arguments of Couples with a Violent Husband.

The purpose of this investigation was to study the affect, psychophysiology, and violent content of arguments in couples with a violent husband. On the basis of self-reports of violent arguments, there were no wife behaviors that successfully suppressed husband violence once it began; moreover, husband violence escalated in response to nonviolent as well as violent wife behaviors, whereas wife violence escalated only in reaction to husband violence or emotional abuse. Only wives were fearful during violent and nonviolent arguments. The observational coding of nonviolent arguments in the laboratory revealed that both battering husbands and their wives (DV) were angrier than their maritally distressed but nonviolent (DNV) counterparts. As predicted, on the more provocative anger codes, only DV men differed from their DNV counterparts. However, DV wives were as verbally aggressive toward their husbands as DV husbands were toward their wives. Language: en

Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Prevention of Relapse and Recurrence in Major Depression

This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy and that both psychotherapies are less expensive and longer lasting alternatives to medication in the treatment of depression.

Who (or What) Can Do Psychotherapy: The Status and Challenge of Nonprofessional Therapies

Research suggests that paraprofessional therapists usually produce effects that are greater than effects for control conditions and comparable to those for professional therapist treatment Other nonprofessional psychological treatments, such as self-administered materials and self-help groups, have also demonstrated positive effects Because of the promise of these nonprofessional treatments, their potential for low-cost service delivery, and the important theoretical questions that studies comparing them can answer, psychotherapy outcome research should shift away from comparisons of different professional therapies and instead compare nonprofessional therapies with professional therapy

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.

The relationship between heart rate reactivity, emotionally aggressive behavior, and general violence in batterers.

This study examined the relationships among physiological responses during marital conflict, aggressive behavior, and violence in battering couples. As an index of physiological response, the authors used the male batterers heart rate reactivity, assessed as the change from an eyes-closed baseline to the first 5 min of their marital conflict interaction. During marital interaction, violent husbands who lowered their heart rates below baseline levels were more verbally aggressive toward their wives. Wives responded to these men with anger, sadness, and defensiveness. The husbands were classified as Type 1 batterers. When compared to the remaining violent husbands (classified as Type 2 batterers), Type 1 men were also more violent toward others (friends, strangers, coworkers, and bosses), had more elevated scales reflecting antisocial behavior and sadistic aggression, and were lower on dependency than Type 2 men. The 2-year followup revealed a separation-div orce rate of 0 for marriages involving Type 1 men and a divorce rate of 21.5% for marriages involving Type 2 men.