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Conditional Beliefs of Primary-Care Patients with Treatment-Resistant Depression

Published online by Cambridge University Press:  04 November 2015

Alex Burrage ,
Samantha Green ,
Katrina Turner ,
Willem Kuyken ,
Chris Williams ,
Nicola Wiles  and
Glyn Lewis
Alex Burrage
Affiliation:
University of Bristol, UK
Samantha Green
Affiliation:
University of Bristol, UK
Katrina Turner
Affiliation:
University of Bristol, UK
Willem Kuyken
Affiliation:
University of Oxford, UK
Chris Williams
Affiliation:
University of Glasgow, UK
Nicola Wiles*
Affiliation:
University of Bristol, UK
Glyn Lewis
Affiliation:
University College London, UK
*
Reprint requests to Nicola Wiles, Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK. E-mail: [email protected]
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Abstract

Background: Cognitive behaviour therapy (CBT) for patients with treatment-resistant depression (TRD) aims to reframe underlying conditional beliefs that are thought to maintain depression. Aim: To systematically explore conditional beliefs expressed by primary-care based patients with TRD, defined as non-response to at least 6 weeks of antidepressants. Method: Conditional beliefs (stated in an “If. . .then. . .” format) were extracted from a random sample of 50 sets of therapist notes from the CoBalT trial, a large randomized controlled trial of CBT for TRD in primary care. The beliefs were separated into their two constituent parts; the demands (Ifs) and consequences (thens). An approach based on framework analysis provided a systematic way of organizing the data, and identifying key themes. Results: Four main themes emerged from the demand part of the conditional beliefs (Ifs): 1. High standards; 2. Putting others first/needing approval; 3. Coping; and 4. Hiding “true” self. Three main themes emerged from the consequence part of the conditional beliefs (thens): 1. Defectiveness; 2. Responses of others; 3. Control of emotions. Conclusions: Identifying common themes in the conditional beliefs of patients with TRD adds to our clinical understanding of this client group, providing useful information to facilitate the complex process of collaborative case conceptualization and working with conditional beliefs within CBT interventions.

Keywords

Treatment-resistant depressionchronic depressionCBTconditional beliefs
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 44 , Issue 5 , September 2016 , pp. 513 - 526
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2015 

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