Paula Truax

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.

Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist.

The Revised Memory and Behavior Problems Checklist (RMBPC), a 24-item, caregiver-report measure of observable behavioral problems in dementia patients, provides 1 total score and 3 subscale scores for patient problems (memory-related, depression, and disruptive behaviors) and parallel scores for caregiver reaction. Data were obtained from 201 geriatric patients and their caregivers. Factor analysis confirmed 3 first-order factors, consistent with subscales just named, and 1 general factor of behavioral disturbance. Overall scale reliability was good, with alphas of .84 for patient behavior and .90 for caregiver reaction. Subscale alphas ranged from .67 to .89. Validity was confirmed through comparison of RMBPC scores with well-established indexes of depression, cognitive impairment, and caregiver burden. The RMBPC is recommended as a reliable and valid tool for the clinical and empirical assessment of behavior problems in dementia patients.

The relationship of problem behaviors in dementia patients to the depression and burden of caregiving spouses

This study examined how 70 caregiving spouses of Alzheimer patients varied in their reports of depression and burden, and how these reports were associated with the nature and severity of patient behavior problems, in particular memory-related, depressive, and disruptive behaviors. Depression and burden were found to be overlapping, but separate constructs, with about half of the variance unshared. Caregivers were divided into subgroups according to high and low levels of depression and burden, with the three most common groups being low depression/low burden (46 percent), high depression/high burden (26 percent), and low depression/high burden (23 percent). Only 6 percent of caregivers reported high depression/low burden. The level of patient behavior problems varied significantly among the remaining depression/burden classifications. Caregivers in the high depression/high burden and low depression/high burden categories reported greater numbers of disruptive behaviors and greater reactivity to memory-related and disruptive behavior problems, compared to the low depression/low burden group. The implications of these findings as they pertain to further elaboration of individual differences in caregiving experiences and interventions are discussed