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Evidence for the cognitive mediational model of cognitive behavioural therapy for depression

Published online by Cambridge University Press:  26 June 2008

L. C. Quilty ,
C. McBride  and
R. M. Bagby
L. C. Quilty
Affiliation:
Clinical Research Department, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada
C. McBride
Affiliation:
Clinical Research Department, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada
R. M. Bagby*
Affiliation:
Clinical Research Department, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada
*
*Address for correspondence: R. M. Bagby, Ph.D., Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada. (Email: [email protected])
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Abstract

Background

Although empirical support for the efficacy of cognitive behavioural therapy (CBT) as a treatment for major depressive disorder (MDD) is well established, its mechanism of action is uncertain. In this investigation, we examined evidence for the cognitive mediational model in a randomized control trial involving CBT, interpersonal therapy (IPT) and pharmacotherapy (PHT) in patients with MDD.

Method

One hundred and thirty participants diagnosed with MDD were treated with CBT, IPT or PHT. Participants completed the Hamilton Depression Rating Scale, Beck Depression Inventory – II and Dysfunctional Attitudes Scale prior to and following treatment.

Results

The cognitive mediational model, in which dysfunctional attitudes are proposed to mediate depressive symptom reduction in response to treatment, provided a good fit to the data when contrasting CBT v. IPT, with results supporting a mediational role for dysfunctional attitude change in depressive symptom reduction. The complication model, in which dysfunctional attitudes are proposed to be a consequence of depressive symptom reduction, provided a good fit to the data when contrasting CBT v. PHT, with results supporting a mediational role for depressive symptom reduction in dysfunctional attitude change.

Conclusions

There was no evidence for a mediational role for dysfunctional attitude change in IPT. Changes in dysfunctional attitudes accompanied both CBT and PHT; however, empirical evidence suggests that the role of attitudes in treatment outcome may differ between these two treatments.

Keywords

Cognitive behavioural therapydysfunctional attitudesinterpersonal therapymediationtreatment outcome
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 11 , November 2008 , pp. 1531 - 1541
Copyright
Copyright © 2008 Cambridge University Press

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