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Predictors of depression relapse and recurrence after cognitive behavioural therapy: a systematic review and meta-analysis

Published online by Cambridge University Press:  21 March 2019

Caroline Wojnarowski ,
Nick Firth ,
Megan Finegan  and
Jaime Delgadillo
Caroline Wojnarowski*
Affiliation:
Department of Psychology, University of Sheffield, Sheffield, UK
Nick Firth
Affiliation:
School of Health and Related Research, University of Sheffield, Sheffield, UKxs
Megan Finegan
Affiliation:
Department of Psychology, University of Sheffield, Sheffield, UK
Jaime Delgadillo
Affiliation:
Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
*
*Corresponding author. Email: [email protected]
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Abstract

Background:

Cognitive behavioural therapy (CBT) is an effective psychological treatment for major depressive disorder, although some patients experience a return of symptoms after finishing therapy. The ability to predict which individuals are more vulnerable to deterioration would allow for targeted interventions to prevent short-term relapse and longer-term recurrence.

Aim:

This systematic review and meta-analysis aimed to identify factors associated with an increased risk of relapse and/or recurrence (RR) after CBT for depression.

Method:

We reviewed 13 relevant papers, of which a small set of unique samples were eligible for meta-analysis (k = 5, N = 369). Twenty-six predictor variables were identified and grouped into seven categories: residual depressive symptoms; prior episodes of depression; cognitive reactivity; stressful life events; personality factors; clinical and diagnostic factors; demographics.

Results:

Meta-analyses indicated that residual depressive symptoms (r = 0.34 [0.10, 0.54], p = .01) and prior episodes (r = 0.19 [0.07, 0.30], p = .002) were statistically significant predictors of RR, but cognitive reactivity was not (r = 0.18 [−0.02, 0.36], p = .08). Other variables lacked replicated findings. On average, 33.4% of patients experienced RR after CBT.

Conclusions:

Patients with the above risk factors could be offered evidence-based continuation-phase interventions to enhance the longer-term effectiveness of CBT.

Keywords

cognitive behavioural therapyCBTdepressionrecurrencerelapse
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 5 , September 2019 , pp. 514 - 529
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Alnaes, R. and Torgersen, S. (1997). Personality and personality disorders predict development and relapses of major depression. Acta Psychiatrica Scandinavica, 95, 336–342. doi: 10.1111/j.1600-0447.1997.tb09641.x CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000a). DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2000b). Practice guideline for the treatment of patients with major depressive disorder (revision). American Journal of Psychiatry, 157 (suppl 4), 1–45. Retrieved from: https://ajp.psychiatryonline.org/ Google Scholar
Antonuccio, D. O., Thomas, M. and Danton, W. G. (1997). A cost-effectiveness analysis of cognitive behavior therapy and fluoxetine (Prozac) in the treatment of depression. Behavior Therapy, 28, 187–210. doi: 10.1016/S0005-7894(97)80043-3 CrossRefGoogle Scholar
Beck, A. T., Epstein, N., Brown, G. and Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897. doi: 10.1037/0022-006X.56.6.893 CrossRefGoogle ScholarPubMed
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. and Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. doi: 10.1001/archpsyc.1961.01710120031004 CrossRefGoogle ScholarPubMed
Beck, A. T., Weissman, A., Lester, D. and Trexler, L. (1974). The measurement of pessimism: the hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861. doi: 10.1037/h0037562 CrossRefGoogle ScholarPubMed
Beshai, S., Dobson, K. S., Bockting, C. L. and Quigley, L. (2011). Relapse and recurrence prevention in depression: current research and future prospects. Clinical Psychology Review, 31, 1349–1360. doi: 10.1016/j.cpr.2011.09.003 CrossRefGoogle ScholarPubMed
Bifulco, A., Brown, G. W. and Harris, T. O. (1994). Childhood Experience of Care and Abuse (CECA): a retrospective interview measure. Journal of Child Psychology and Psychiatry, 35, 1419–1435. doi: 10.1111/j.1469-7610.1994.tb01284.x CrossRefGoogle ScholarPubMed
Bockting, C. L., Hollon, S. D., Jarrett, R. B., Kuyken, W. and Dobson, K. (2015). A lifetime approach to major depressive disorder: the contributions of psychological interventions in preventing relapse and recurrence. Clinical Psychology Review, 41, 16–26. doi: 10.1016/j.cpr.2015.02.003 CrossRefGoogle ScholarPubMed
Borenstein, M., Hedges, L. V., Higgins, J. P. T. and Rothstein, H. R. (2009). Introduction to Meta-Analysis. Sussex, UK: John Wiley and Sons.CrossRefGoogle Scholar
Brenner, K., Schmitz, N., Pawliuk, N., Fathalli, F., Joober, R., Ciampi, A. and King, S. (2007). Validation of the English and French versions of the Community Assessment of Psychic Experiences (CAPE) with a Montreal community sample. Schizophrenia Research, 95, 86–95. doi: 10.1016/j.schres.2007.06.017 CrossRefGoogle ScholarPubMed
Burcusa, S. L. and Iacono, W. G. (2007). Risk for recurrence in depression. Clinical Psychology Review, 27, 959–985. doi: 10.1016/j.cpr.2007.02.005 CrossRefGoogle ScholarPubMed
Centre for Reviews and Dissemination (2009). Systematic Reviews: CRD’s Guidance for Undertaking Reviews in Healthcare. York, UK: University of York.Google Scholar
Chopra, K. K., Segal, Z. V., Buis, T., Kennedy, S. H. and Levitan, R. D. (2008). Investigating associations between cortisol and cognitive reactivity to sad mood provocation and the prediction of relapse in remitted major depression. Asian Journal of Psychiatry, 1, 33–36. doi: 10.1016/j.ajp.2008.09.006 CrossRefGoogle ScholarPubMed
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. doi: 10.1037/0033-2909.112.1.155 CrossRefGoogle ScholarPubMed
Cox, D. R. and Oakes, D. (1984). Analysis of Survival Data (vol. 21). Boca Raton, FL, USA: CRC Press.Google Scholar
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A. and Dobson, K. S. (2013a). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58, 376–385. doi: 10.1177/070674371305800702 CrossRefGoogle ScholarPubMed
Cuijpers, P., Hollon, S. D., van Straten, A., Bockting, C., Berking, M. and Andersson, G. (2013b). Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. British Medical Journal Open, 3, 25–42. doi: 10.1136/bmjopen-2012-002542 Google ScholarPubMed
Delgadillo, J., Rhodes, L., Moreea, O., McMillan, D., Gilbody, S., Leach, C., Lucock, M., Lutz, W. and Ali, S. (2018). Relapse and recurrence of common mental health problems after low intensity cognitive behavioural therapy: the WYLOW Longitudinal Cohort Study. Psychotherapy and Psychosomatics, 87, 116–117. doi: 10.1159/000485386 CrossRefGoogle ScholarPubMed
Dimidjian, S., Kleiber, B. V. and Segal, Z. V. (2010). Mindfulness-based cognitive therapy. In Kazantzis, N., Reinecke, M. A., and Freeman, A. (eds), Cognitive and Behavioral Theories in Clinical Practice (pp. 307–331). New York, NY, USA: Guilford Press.Google Scholar
Elgersma, H. J., Glashouwer, K. A., Bockting, C. L. H., Penninx, B. W. J. H. and de Jong, P. J. (2013). Hidden scars in depression? Implicit and explicit self-associations following recurrent depressive episodes. Journal of Abnormal Psychology, 122, 951–960. doi: 10.1037/a0034933 CrossRefGoogle ScholarPubMed
Evans, M. D., Hollon, S. D., DeRubeis, R. J., Piasecki, J. M., Grove, W. M., Garvey, M. J. and Tuason, V. B. (1992). Differential relapse following cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry, 49, 802–808. doi: 10.1001/archpsyc.1992.01820100046009 CrossRefGoogle Scholar
Eysenck, H. J. (1968). Eysenck Personality Inventory Manual. San Diego, CA, USA: Educational and Industrial Testing Service.Google Scholar
Forand, N. R. and DeRubeis, R. J. (2013). Pretreatment anxiety predicts patterns of change in cognitive behavioral therapy and medications for depression. Journal of Consulting and Clinical Psychology, 81, 774–782. doi: 10.1037/a0032985 CrossRefGoogle Scholar
Fresco, D. M., Segal, Z. V., Buis, T. and Kennedy, S. (2007). Relationship of posttreatment decentering and cognitive reactivity to relapse in major depression. Journal of Consulting and Clinical Psychology, 75, 447–455. doi: 10.1037/0022-006X.75.3.447 CrossRefGoogle ScholarPubMed
Frank, E., Prien, R. F., Jarrett, R. B., Keller, M. B., Kupfer, D. J., Lavori, P. W., Rush, A. J., and Weissman, M. M. (1991). Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Archives of General Psychiatry, 48, 851–855. doi: 10.1001/archpsyc.1991.01810330075011 CrossRefGoogle ScholarPubMed
Gollan, J. K., Gortner, E. T. and Dobson, K. S. (2006). Predictors of depressive relapse during a two-year prospective follow-up after cognitive and behavioral therapies. Behavioural and Cognitive Psychotherapy, 34, 397–412. doi: 10.1017/S1352465806002839 CrossRefGoogle Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62. doi: 10.1136/jnnp.23.1.56 CrossRefGoogle Scholar
Harkness, K. L., Bagby, R. M. and Kennedy, S. H. (2012). Childhood maltreatment and differential treatment response and recurrence in adult major depressive disorder. Journal of Consulting and Clinical Psychology, 80, 342–353. doi: 10.1037/a0027665 CrossRefGoogle ScholarPubMed
Harkness, K. L., Theriault, J. E., Stewart, J. G. and Bagby, R. M. (2014). Acute and chronic stress exposure predicts 1-year recurrence in adult outpatients with residual depression symptoms following response to treatment. Depression and Anxiety, 31, 1–8. doi: 10.1002/da.22177 CrossRefGoogle ScholarPubMed
Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savović, J., Schulz, K. F., Weeks, L. and Sterne, J. A. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. British Medical Journal, 343, d5928. doi: 10.1136/bmj.d5928 CrossRefGoogle ScholarPubMed
Higgins, J. P. and Green, S. (2011). Cochrane Handbook for Systematic Reviews of Interventions (vol. 4). New York, NY, USA: John Wiley and Sons.Google Scholar
Higgins, J. P., Thompson, S. G., Deeks, J. J. and Altman, D. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327, 557–560. doi: 10.1136/bmj.327.7414.557 CrossRefGoogle ScholarPubMed
Hirschfeld, R. M., Williams, J. B., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck, P. E. Jr, Lewis, L., McElroy, S. L., Post, R. M., Rapport, D. J. and Russell, J. M. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American Journal of Psychiatry, 157, 1873–1875. doi: 10.1176/appi.ajp.157.11.1873 CrossRefGoogle ScholarPubMed
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Freeman, B. B. and Gallop, R. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62, 417–422. doi: 10.1001/archpsyc.62.4.417 CrossRefGoogle ScholarPubMed
Keller, M. B., Lavori, P. W., Lewis, C. E. and Klerman, G. L. (1983). Predictors of relapse in major depressive disorder. Journal of American Medical Association, 250, 3299–3304. doi: 10.1001/jama.250.24.3299 CrossRefGoogle ScholarPubMed
Kessing, L. V., Hansen, M. G., Andersen, P. K. and Angst, J. (2004). The predictive effect of episodes on the risk of recurrence in depressive and bipolar disorders– a lifelong perspective. Acta Psychiatrica Scandinavica, 109, 339–344. doi: 10.1046/j.1600-0447.2003.00266.x CrossRefGoogle Scholar
Kuyken, W., Dalgleish, T. and Holden, E. R. (2007). Advances in cognitive-behavioural therapy for unipolar depression. Canadian Journal of Psychiatry, 52, 5–13. doi: 10.1177/070674370705200103 CrossRefGoogle ScholarPubMed
Lethbridge, R. and Allen, N. B. (2008). Mood induced cognitive and emotional reactivity, life stress, and the prediction of depressive relapse. Behaviour Research and Therapy, 46, 1142–1150. doi: 10.1016/j.brat.2008.06.011 CrossRefGoogle ScholarPubMed
Lok, A., Bockting, C. L. H., Koeter, M. W. J., Snieder, H., Assies, J., Mocking, R. J. T., Vinkers, C. H., Kahn, R. S., Boks, M. P. and Schene, A. H. (2013). Interaction between the MTHFR C677T polymorphism and traumatic childhood events predicts depression. Translational Psychiatry, 3, e288. doi: 10.1038/tp.2013.60 CrossRefGoogle ScholarPubMed
Lok, A., Mocking, R. J. T., Ruhé, H. G., Visser, I., Koeter, M. W. J., Assies, J., Bockting, C. L. H., Olff, M. and Schene, A. H. (2012). Longitudinal hypothalamic-pituitary-adrenal axis trait and state effects in recurrent depression. Psychoneuroendocrinology, 37, 892–902. doi: 10.1016/j.psyneuen.2011.10.005 CrossRefGoogle ScholarPubMed
MacPhillamy, D. J. and Lewinsohn, P. M. (1982). The Pleasant Events Schedule: studies on reliability, validity, and scale intercorrelation. Journal of Consulting and Clinical Psychology, 50, 363–380. doi: 10.1037/0022-006X.50.3.363 CrossRefGoogle Scholar
McCrone, P., Dhanasiri, S., Patel, A., Knapp, M. and Lawton-Smith, S. (2008). Paying the Price: The Cost of Mental Health Care in England to 2026. London, UK: King’s Fund.Google Scholar
Millon, T. (1987). Millon Clinical Multiaxial Inventory Manual (2nd edn). Minneapolis, MN, USA: National Computer Systems.Google Scholar
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. and The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLOS Medicine, 6, e1000097. doi: journal.pmed.1000097 CrossRefGoogle ScholarPubMed
Möller, H. J., Riedel, M. and Seemüller, F. (2011). Relapse or recurrence in depression: why has the cutoff been set at 6 months. Medicographia, 33, 125–131. Retrieved from: https://www.medicographia.com Google Scholar
Monroe, S. M. and Harkness, K. L. (2005). Life stress, the ‘kindling’ hypothesis, and the recurrence of depression: considerations from a life stress perspective. Psychological Review, 112, 417–445. doi: 10.1037/0033-295X.112.2.417 CrossRefGoogle ScholarPubMed
Mueller, T. I., Leon, A. C., Keller, M. B., Solomon, D. A., Endicott, J., Coryell, W., Warshaw, M. and Maser, J. D. (1999). Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. American Journal of Psychiatry, 156, 1000–1006. doi: 10.1176/ajp.156.7.1000 Google ScholarPubMed
National Institute for Health and Care Excellence (NICE) (2010). Depression: The Treatment and Management of Depression in Adults (updated edition). London, UK: The British Psychological Society and The Royal College of Psychiatrists.Google Scholar
Orwin, R. G. (1983). A fail-safe N for effect size in meta-analysis. Journal of Educational Statistics, 8, 157–159. doi: 10.2307/1164923 Google Scholar
Paykel, E. (2007). Cognitive therapy in relapse prevention in depression. International Journal of Neuropsychopharmacology, 10, 131–136. doi: 10.1017/S1461145706006912 CrossRefGoogle ScholarPubMed
Piet, J. and Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical Psychology Review, 31, 1032–1040. doi: 10.1016/j.cpr.2011.05.002 CrossRefGoogle ScholarPubMed
Quiring, J. M., Monroe, S. M., Simons, A. D. and Thase, M. E. (2002). Does early intervention increase latency to relapse in major depressive disorder?: re-evaluation with cognitive behavior therapy. Journal of Affective Disorders, 70, 155–163. doi: 10.1016/S0165-0327(01)00341-X CrossRefGoogle ScholarPubMed
Reimherr, F. W., Amsterdam, J. D., Quitkin, F. M., Rosenbaum, J. F., Fava, M., Zajecka, J., Beasley, C. M. Jr, Michelson, D. Roback, P. Sundell, K. (1998). Optimal length of continuation therapy in depression: a prospective assessment during long-term fluoxetine treatment. American Journal of Psychiatry, 155, 1247–1253. doi: 10.1176/ajp.155.9.1247 CrossRefGoogle ScholarPubMed
Rucci, P., Frank, E., Calugi, S., Miniati, M., Benvenuti, A., Wallace, M., Fagiolini, A., Maggi, L., Kupfer, D. J. and Cassano, G. B. (2011). Incidence and predictors of relapse during continuation treatment of major depression with SSRI, interpersonal psychotherapy, or their combination. Depression and Anxiety, 28, 955–962. doi: 10.1002/da.20894 CrossRefGoogle ScholarPubMed
Rush, A. J., Kraemer, H. C., Sackeim, H. A., Fava, M., Trivedi, M. H., Frank, E., Ninan, P. T., Thase, M. E., Gelenberg, A. J., Kupfer, D. J. and Regier, D. A. (2006). Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology, 31, 1841–1853. doi: 10.1038/sj.npp.1301131 CrossRefGoogle ScholarPubMed
Scott, J., Palmer, S., Paykel, E., Teasdale, J. and Hayhurst, H. (2003). Use of cognitive therapy for relapse prevention in chronic depression: cost effectiveness study. British Journal of Psychiatry, 182, 221–227. doi: 10.1192/bjp.182.3.221 CrossRefGoogle ScholarPubMed
Segal, Z. V., Gemar, M. and Williams, S. (1999). Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression. Journal of Abnormal Psychology, 108, 3–10. doi: 10.1037/0021-843X.108.1.3 CrossRefGoogle ScholarPubMed
Segal, Z. V., Kennedy, S., Gemar, M., Hood, K., Pedersen, R. and Buis, T. (2006). Cognitive reactivity to sad mood provocation and the prediction of depressive relapse. Archives of General Psychiatry, 63, 749–755. doi: 10.1001/archpsyc.63.7.749 CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. and Robins, E. (1985). Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders. New York, NY, USA: Department of Research Assessment and Training, New York State Psychiatric Institute.Google Scholar
Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M. and Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623. doi: 10.1037/0022-006X.68.4.615 CrossRefGoogle ScholarPubMed
Thase, M. E., Simons, A. D., McGeary, J., Cahalane, J. F., Hughes, C., Harden, T. and Friedman, E. (1992). Relapse after cognitive behavior therapy of depression: potential implications for longer courses of treatment. American Journal of Psychiatry, 149, 1046–1052. doi: 10.1176/ajp.149.8.1046 Google Scholar
Thase, M. E., Simons, A. D. and Reynolds, C. F. (1996). Abnormal electroencephalographic sleep profiles in major depression: association with response to cognitive behavior therapy. Archives of General Psychiatry, 53, 99–108. doi: 10.1001/archpsyc.1996.01830020013003 CrossRefGoogle ScholarPubMed
U.S. Department of Health and Human Services (2014). Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Retrieved from: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort.Google Scholar
Valentine, J. C., Pigott, T. D. and Rothstein, H. R. (2010). How many studies do you need? A primer on statistical power for meta-analysis. Journal of Educational and Behavioral Statistics, 35, 215–247. doi: 10.3102/1076998609346961 CrossRefGoogle Scholar
van Rijsbergen, G. D., Bockting, C. L., Burger, H., Spinhoven, P., Koeter, M. W., Ruhé, H. G., Hollon, S. D. and Schene, A. H. (2013). Mood reactivity rather than cognitive reactivity is predictive of depressive relapse: a randomized study with 5.5-year follow-up. Journal of Consulting and Clinical Psychology, 81, 508–517. doi: 10.1037/a0032223 CrossRefGoogle ScholarPubMed
Vittengl, J. R., Clark, L. A., Dunn, T. W. and Jarrett, R. B. (2007). Reducing relapse and recurrence in unipolar depression: a comparative meta-analysis of cognitive behavioural therapy’s effects. Journal of Consulting and Clinical Psychology, 75, 475–488. doi: 10.1037/0022-006X.75.3.475 CrossRefGoogle Scholar
Weissman, A. N. (1979). The dysfunctional attitude scale: a validation study. Publicly Accessible Penn Dissertations 1182. Retrieved from: https://repository.upenn.edu Google Scholar
Wigman, J. T. W., Van Os, J., Abidi, L., Huibers, M. J. H., Roelofs, J., Arntz, A., Kelleher, I. and Peeters, F. P. M. L. (2014). Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy. Psychological Medicine, 44, 325–336. doi: 10.1017/S0033291713000871 CrossRefGoogle ScholarPubMed
World Health Organisation (2017). Depression. Retrieved from: http://www.who.int Google Scholar
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