Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-19T01:42:28.377Z Has data issue: false hasContentIssue false
  • English
  • Français

Pattern of Changes during Treatment: A Comparison between a Positive Psychology Intervention and a Cognitive Behavioral Treatment for Clinical Depression

Published online by Cambridge University Press:  26 October 2017

Irene Lopez-Gomez ,
Covadonga Chaves ,
Gonzalo Hervas  and
Carmelo Vazquez
Irene Lopez-Gomez
Affiliation:
Universidad Rey Juan Carlos (Spain)
Covadonga Chaves
Affiliation:
Universidad Francisco de Vitoria (Spain)
Gonzalo Hervas
Affiliation:
Universidad Complutense (Spain)
Carmelo Vazquez*
Affiliation:
Universidad Complutense (Spain)
*
*Correspondence concerning this article should be addressed to Carmelo Vazquez. Facultad de Psicología, Universidad Complutense. Madrid (Spain). Phone: +34–913943090. Fax: +34–913943189. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Research on psychotherapy has traditionally focused on analyzing changes between the beginning and the end of a treatment. Few studies have addressed the pattern of therapeutic change during treatment. The aim of this study was to examine the pattern of changes in clinical and well-being variables during a cognitive behavioral therapy (CBT) program compared with an integrative positive psychology interventions program for clinical depression IPPI-D. 128 women with a diagnosis of major depression or dysthymia were assigned to the CBT or PPI group. A measure of depressive symptoms (i.e., Beck Depression Inventory) and well-being (i.e., Pemberton Happiness Index) were administered four times: at the beginning and end of the treatment, as well as during treatment (at sessions 4 and 7). Through mixed-model repeated measures ANOVAs, both depressive symptoms (p < .001, partial η2 = .52) and well-being (p < .001, partial η2 = .29) showed a significant improvement through the four assessment times. No significant interactions between time and treatment modality were found (ps > .08). The percentage of improvement in depressive symptoms in the first treatment period was higher than in the later ones (ps < .005). On the contrary, well-being showed a more gradual improvement (p = .15). These results highlight the importance of assessing the pattern of changes in symptoms and well-being separately.

Keywords

depressiondysthymiapattern of changespositive psychologywell-being
Type
Research Article
Information
The Spanish Journal of Psychology , Volume 20 , 2017 , E52
Copyright
Copyright © Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This work was partially supported by the Spanish Ministry of Economy and Competitiveness (PSI2015–69253-R); the PROMOSAM excellence network (PSI2014–56303-REDT); and by a scholarship from the Spanish Ministerio de Educación Cultura y Deporte (FPU12/02342). We would like to thank Loreto de la Carrera for her continuous support of the study, and to Trinidad Soria, Silvia Moreno, Almudena Duque, Natalia Poyato, Pablo Roca, Ivan Blanco, Teodoro Pascual, Laura Machado, Alina Rigabert, Regina Espinosa, Marta Fernandez-Salineros, Beatriz Fernandez, Vanesa Agudo, Nerea Barrachina, Victoria Guillen, and Ariadna de la Vega for their collaboration at different stages of this research. Special thanks to Matthew P. Abrams and Miriam Mower for editing this manuscript.

How to cite this article:

Lopez-Gomez, I., Chaves, C., Hervas, G., & Vazquez, C. (2017). Pattern of changes during treatment: A comparison between a positive psychology intervention and a cognitive behavioral treatment for clinical depression. The Spanish Journal of Psychology, 20. e52. Doi:10.1017/sjp.2017.44

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th Ed., Rev.). Washington, DC: American Psychiatric Association.Google Scholar
Baldwin, S. A., Berkeljon, A., Atkins, D. C., Olsen, J. A., & Nielsen, S. L. (2009). Rates of change in naturalistic psychotherapy: Contrasting dose–effect and good-enough level models of change. Journal of Consulting and Clinical Psychology, 77, 203–211. https://doi.org/10.1037/a0015235 Google Scholar
Barkham, M., Connell, J., Stiles, W. B., Miles, J. N. V., Margison, F., Evans, C., & Mellor-Clark, J. (2006). Dose-effect relations and responsive regulation of treatment duration: The good enough level. Journal of Consulting and Clinical Psychology, 74, 160–167. https://doi.org/10.1037/0022-006X.74.1.160 Google Scholar
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Bolier, L., Haverman, M., Westerhof, G. J., Riper, H., Smit, F., & Bohlmeijer, E. (2013). Positive psychology interventions: A meta-analysis of randomized controlled studies. BMC Public Health, 13, 119. https://doi.org/10.1186/1471-2458-13-119 Google Scholar
Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91–121. https://doi.org/10.1146/annurev-clinpsy-050212-185608 CrossRefGoogle Scholar
Chaves, C., Lopez-Gomez, I., Hervas, G., & Vazquez, C. (2017a). A comparative study on the efficacy of a positive psychology intervention and a cognitive behavioral therapy for clinical depression. Cognitive Therapy and Research, 41, 417–433. https://doi.org/10.1007/s10608-016-9778-9 Google Scholar
Chaves, C., Lopez-Gomez, I., Hervas, G., & Vazquez, C. (2017b). The integrative positive psychological intervention for depression (IPPI-D). Paper submitted for publication.Google Scholar
Cuijpers, P., Muñoz, R. F., Clarke, G. N., & Lewinsohn, P. M. (2009). Psychoeducational treatment and prevention of depression: The ‘coping with depression’ course thirty years later. Clinical Psychology Review, 29, 449–458. https://doi.org/10.1016/j.cpr.2009.04.005 Google Scholar
Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2008). Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology, 76, 909–922. https://doi.org/10.1037/a0013075 Google Scholar
Demyttenaere, K., Donneau, A. F., Albert, A., Ansseau, M., Constant, E., & Van Heeringen, K. (2015a). What is important in being cured from depression? Discordance between physicians and patients (1). Journal of Affective Disorders, 174, 390–396. https://doi.org/10.1016/j.jad.2014.12.004 Google Scholar
Demyttenaere, K., Donneau, A. F., Albert, A., Ansseau, M., Constant, E., & Van Heeringen, K. (2015b). What is important in being cured from: Does discordance between physicians and patients matter? (2). Journal of Affective Disorders, 174, 372–377. https://doi.org/10.1016/j.jad.2014.12.002 Google Scholar
Díaz, D., Blanco, A., Horcajo, J., & Valle, C. (2007). La aplicación del modelo del estado completo de salud al estudio de la depresión [Applying the model of complete health state to the study of depression]. Psicothema, 19, 286–294.Google Scholar
Falkenström, F., Josefsson, A., Berggren, T., & Holmqvist, R. (2016). How much therapy is enough? Comparing dose-effect and good-enough models in two different settings. Psychotherapy, 53, 130–139. https://doi.org/10.1037/pst0000039 Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders Research Version (SCID-I). New York, NY: New York State Psychiatric Institute. Biometrics Research.Google Scholar
Geschwind, N., Nicolson, N. A., Peeters, F., van Os, J., Barge-Schaapveld, D., & Wichers, M. (2011). Early improvement in positive rather than negative emotion predicts remission from depression after pharmacotherapy. European Neuropsychopharmacology, 21, 241–247. https://doi.org/10.1016/j.euroneuro.2010.11.004 Google Scholar
Greene, L. R. (2012). Studying the how and why of therapeutic change: The increasingly prominent role of mediators in group psychotherapy research. International Journal of Group Psychotherapy, 62, 325–331. https://doi.org/10.1521/ijgp.2012.62.2.325 CrossRefGoogle ScholarPubMed
Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1, 293–319. https://doi.org/10.1146/annurev.clinpsy.1.102803.143938 Google Scholar
Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9, 329–343. https://doi.org/10.1093/clipsy.9.3.329 Google Scholar
Hayes, A., Hope, D. A., & Hayes, S. (2007). Towards an understanding of the process and mechanisms of change in cognitive behavioral therapy: Linking innovative methodology with fundamental questions. Clinical Psychology Review, 27, 679–681. https://doi.org/10.1016/j.cpr.2007.01.006 Google Scholar
Hervás, G., & Vázquez, C. (2013). Construction and validation of a measure of integrative well-being in seven languages: The Pemberton Happiness Index. Health & Quality of Life Outcomes, 11, 66. https://doi.org/10.1186/1477-7525-11-66 Google Scholar
Hofmann, S. G., Curtiss, J., & McNally, R. J. (2016). A complex network perspective on clinical science. Perspectives on Psychological Science, 11, 597–605. https://doi.org/10.1177/1745691616639283 Google Scholar
Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose– effect relationship in psychotherapy. American Psychologist, 41, 159–164. https://doi.org/10.1037/0003-066X.41.2.159 Google Scholar
Howard, K. I., Lueger, R. J., Maling, M. S., & Martinovich, Z. (1993). A phase model of psychotherapy: Causal mediation of outcome. Journal of Consulting and Clinical Psychology, 61, 678–685. https://doi.org/10.1037/0022-006X.61.4.678 Google Scholar
Howard, K. I., Moras, K., Brill, P. L., Martinovich, Z., & Lutz, W. (1996). Evaluation of psychotherapy: Efficacy, effectiveness, and patient progress. American Psychologist, 51, 1059–1064. https://doi.org/10.1037/0003-066X.51.10.1059 Google Scholar
Joseph, S., & Wood, A. (2010). Assessment of positive functioning in clinical psychology: Theoretical and practical issues. Clinical Psychology Review, 30, 830–838. https://doi.org/10.1016/j.cpr.2010.01.002 Google Scholar
Kahneman, D., Krueger, A. B., Schkade, D. A., Schwarz, N., & Stone, A. A. (2004). A survey method for characterizing daily life experience: The day reconstruction method. Science, 306, 1776–1780. https://doi.org/10.1126/science.1103572 Google Scholar
Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child and adolescent therapy: Methodological issues and research recommendations. Journal of Child Psychology and Psychiatry, 44, 1116–1129. https://doi.org/10.1111/1469-7610.00195 Google Scholar
Kelly, M. A. R., Roberts, J. E., & Ciesla, J. A. (2005). Sudden gains in cognitive behavioral treatment for depression: When do they occur and do they matter? Behaviour Research and Therapy, 43, 703–714. https://doi.org/10.1016/j.brat.2004.06.002 Google Scholar
Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73, 539–548. https://doi.org/10.1037/0022-006X.73.3.539 Google Scholar
Lewinsohn, P. M., Antonuccio, D. O., Breckenridge, J. S., & Teri, L. (1984). The ‘Coping with Depression’ course. Eugene, OR: Castalia Publishing Company.Google Scholar
López-Gómez, I., Chaves, C., Hervás, G., & Vázquez, C. (2017). Comparing the acceptability of a positive psychology intervention versus a cognitive-behavioral therapy for clinical depression. Clinical Psychology & Psychotherapy. https:/ /doi.org/10.1002/cpp.2129 Google Scholar
Lutz, W., Lowry, J., Kopta, S. M., Einstein, D. A., & Howard, K. I. (2001). Prediction of dose-response relations based on patient characteristics. Journal of Clinical Psychology, 57, 889–900. https://doi.org/10.1002/jclp.1057 Google Scholar
Muñoz, R. F., & Mendelson, T. (2005). Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals. Journal of Consulting and Clinical Psychology, 73, 790–799. https://doi.org/10.1037/0022-006X.73.5.790 Google Scholar
Muñoz, R. F., Aguilar-Gaxiola, S., & Guzman, J. (1995). Group cognitive-behavioral therapy for major depression. Spanish version. Santa Monica, CA: Rand.Google Scholar
Newman, D. A. (2014). Missing data five practical guidelines. Organizational Research Methods, 17, 372–411. https://doi.org/10.1177/1094428114548590 Google Scholar
Sanz, J., Navarro, M. E., & Vázquez, C. (2003). Adaptación española del inventario para la depresión de Beck-II (BDI-II): 1. Propiedades psicométricas en estudiantes universitarios [Spanish adaptation of the Beck Depression Inventory-II (BDI-II): 1. Psychometric properties with university students]. Análisis y Modificación de Conducta, 29, 239–288.Google Scholar
Sin, N. L., & Lyubomirsky, S. (2009). Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis. Journal of Clinical Psychology, 65, 467–487. https://doi.org/10.1002/jclp.20593 Google Scholar
Stulz, N., Lutz, W., Kopta, S. M., Minami, T., & Saunders, S. M. (2013). Dose-effect relationship in routine outpatient psychotherapy: Does treatment duration matter? Journal of Counseling Psychology, 60, 593–600. https://doi.org/10.1037/a0033589 Google Scholar
Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894–904. https://doi.org/10.1037/0022-006X.67.6.894 Google Scholar
van de Leemput, I. A., Wichers, M., Cramer, A. O. J., Borsboom, D., Tuerlinckx, F., Kuppens, P., … Scheffer, M. (2014). Critical slowing down as early warning for the onset and termination of depression. Proceedings of the National Academy of Sciences of the United States of America, 111, 87–92. https://doi.org/10.1073/pnas.1312114110 Google Scholar
Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B. (2016). Defined symptom-change trajectories during acute-phase cognitive therapy for depression predict better longitudinal outcomes. Behaviour Research and Therapy, 87, 48–57. https://doi.org/10.1016/j.brat.2016.08.008 Google Scholar
Wichers, M., Myin-Germeys, I., Jacobs, N., Peeters, F., Kenis, G., Derom, C., … Van Os, J. (2007). Genetic risk of depression and stress-induced negative affect in daily life. The British Journal of Psychiatry: The Journal of Mental Science, 191, 218–223. https://doi.org/10.1192/bjp.bp.106.032201 Google Scholar
Wise, E. A., Streiner, D. L., & Gallop, R. J. (2016). Predicting individual change during the course of treatment. Psychotherapy Research, 26, 623–631. https://doi.org/10.1080/10503307.2015.1104421 Google Scholar
Zimmerman, M., McGlinchey, J. B., Posternak, M. A., Friedman, M., Attiullah, M., & Boerescu, D. (2006). How should remission from depression be defined? The depressed patient’s perspective. The American Journal of Psychiatry, 163, 148–150. https://doi.org/10.1176/appi.ajp.163.1.148 Google Scholar