Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T20:56:24.100Z Has data issue: false hasContentIssue false
  • English
  • Français

The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination

Published online by Cambridge University Press:  29 January 2018

I. M. Blackburn ,
S. Bishop ,
A. I. M. Glen ,
L. J. Whalley  and
J. E. Christie
I. M. Blackburn
Affiliation:
MRC Brain Metabolism Unit, Thomas Clouston Clinic, Royal Edinburgh Hospital, Edinburgh
S. Bishop*
Affiliation:
MRC Brain Metabolism Unit, Thomas Clouston Clinic, Royal Edinburgh Hospital, Edinburgh
A. I. M. Glen*
Affiliation:
MRC Brain Metabolism Unit, Thomas Clouston Clinic, Royal Edinburgh Hospital, Edinburgh
L. J. Whalley
Affiliation:
MRC Brain Metabolism Unit, Thomas Clouston Clinic, Royal Edinburgh Hospital, Edinburgh
J. E. Christie
Affiliation:
MRC Brain Metabolism Unit, Thomas Clouston Clinic, Royal Edinburgh Hospital, Edinburgh
*
∗Present address: Centre for Cognitive Therapy, University of Pennsylvania, Philadelphia.
† Present address: Craig Dunain Hospital, Inverness.
Get access Rights & Permissions [Opens in a new window]

Summary

We report an extensive study which compares cognitive therapy, antidepressant drugs and a combination of these two, in depressed patients seen either in general practice or an out-patient department. One-hundred and forty patients were screened for primary major depression and 64 patients completed the trial. All were rated on seven measures of mood, including independent observer-rated and self-rated depression and scales of anxiety and irritability. Patients were randomly assigned to cognitive therapy, antidepressants or a combination of the two. The antidepressant drug group did less well in both hospital and general practice and combination treatment was superior to drug treatment in both hospital and general practice. In general practice, cognitive therapy was superior to drug treatment. The presence of endogenous features did not affect response to treatment. The results are discussed in terms of Beck's cognitive theory of depression and factors of presumed causal importance of depression in general practice.

Type
Papers
Information
The British Journal of Psychiatry , Volume 139 , Issue 3 , September 1981 , pp. 181 - 189
Copyright
Copyright © Royal College of Psychiatrists, 1981 

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.)

References

Baldessarini, R. J. (1977) Chemotherapy in Psychiatry. Cambridge: Harvard University Press.Google Scholar
Ball, J. & Kiloh, L. G. (1959) A controlled trial of imipramine in treatment of depressive states. British Medical Journal, ii, 1052–5.Google Scholar
Beck, A. T. (1967) Depression: Clinical, Experimental and Theoretical Aspects. New York: Hoeber.Google Scholar
Beck, A. T. (1976) Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E. & Erbaugh, J. K. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561–71.CrossRefGoogle ScholarPubMed
Beck, A. T., Rush, A. J., Shaw, B. F. & Emery, G. (1979) Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Blackburn, I. M. & Bishop, S. (1981) Is there an alternative to drugs in the treatment of depressed ambulatory patients? Behavioural Psychotherapy, 9, 96—104.CrossRefGoogle Scholar
Brown, G. W. & Harris, T. O. (1978) Social Origins of Depression. London: Tavistock Press.Google ScholarPubMed
Covi, L., Lipman, R. S., Derogatis, L. R., Smith, J. E. & Pattison, J. H. (1974) Drugs and group psychotherapy in neurotic depression. American Journal of Psychiatry, 131, 191–8.CrossRefGoogle ScholarPubMed
Downing, R. W. & Richel, S. K. (1972) Predictors of amitriptyline response in outpatient depressives. Journal of Nervous and Mental Diseases, 154, 248–63.CrossRefGoogle ScholarPubMed
Feinberg, M., Carroll, B. J., Steiner, M. & Commorato, A. J. (1979) Misdiagnosis of endogenous depression with research diagnostic criteria. Lancet, i, 267.CrossRefGoogle Scholar
Friedman, A. (1975) Interaction of drug therapy with marital therapy in depressed patients. Archives of General Psychiatry, 32, 619–37.CrossRefGoogle Scholar
Garfield, S. (1978) Research on client variables in psychotherapy. In Handbook of Psychotherapy and Behaviour Change, pp 191—232, 2nd edition, (eds. Garfield, S. and Bergin, A.). New York: John Wiley.Google Scholar
Gioe, V. J. (1975) Cognitive modification and positive group experience as treatment for depression. Doctoral Dissertation, Temple University, Dissertation Abstracts, 36, 3039–40.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56—61.CrossRefGoogle ScholarPubMed
Hollon, S. D. & Beck, A. T. (1978) Psychotherapy and drug therapy: comparison and combinations. In Handbook of Psychotherapy and Behaviour Change, pp 437—490, 2nd edition (eds. Garfield, S. and Bergin, A.). New York: John Wiley.Google Scholar
Hollon, S. D. & Beck, A. T. (1979) Cognitive therapy of depression. In Cognitive-behavioural Interventions, Theory, Research and Procedures. New York: Academic Press.Google Scholar
Johnston, D. A. (1973) Treatment of depression in general practice. British Medical Journal, ii, 18—20.CrossRefGoogle Scholar
Kiloh, L. G., Ball, J. R. B. & Garside, R. F. (1962) Prognostic factors in treatment of depressive states with imipramine. British Medical Journal, i, 1225–7.Google Scholar
Klerman, G. L., Dimascio, A., Weissman, M., Prusoff, B. & Paykel, E. S. (1974) Treatment of depression by drugs and psychotherapy. American Journal of Psychiatry, 131, 186–91.CrossRefGoogle ScholarPubMed
Kovacs, M. (1980) The efficacy of cognitive and behaviour therapies for depression. American Journal of Psychiatry, 137, 1495.Google ScholarPubMed
Kovacs, M., Rush, A. J., Beck, A. T. & Hollon, S. D. (1981) Depressed out-patients treated with cognitive therapy or pharmacotherapy: A one year follow-up. Archives of General Psychiatry, 38, 33—41.CrossRefGoogle ScholarPubMed
Little, J. L., Kerr, T. A. & McClelland, H. A. (1978) Where are the untreated depressives? British Medical Journal, i, 1593–4.Google Scholar
Luborsky, L., Chandler, M., Auerbach, A. H., Cohen, J. A. & Backrach, H. M. (1971) Factors influencing the outcome of psychotherapy: a review of quantitative research. Psychological Bulletin, 75, 145–85.CrossRefGoogle ScholarPubMed
McLean, P. D. & Hakstian, A. R. (1979) Clinical depression: comparative efficacy of out-patient treatments. Journal of Consulting and Clinical Psychology, 47, 818–36.CrossRefGoogle Scholar
Metcalfe, M. & Goldman, E. (1965) Validation of an inventory for measuring depression. British Journal of Psychiatry, 111, 240–2.CrossRefGoogle ScholarPubMed
Morris, N. E. (1975) A group of self-instruction method for the treatment of depressed out-patients. Doctoral Dissertation. In Dissertation Abstracts, Toronto.Google Scholar
Morris, J. B. & Beck, A. T. (1974) The efficacy of antidepressant drugs: a review of research (1958—1972) Archives of General Psychiatry, 30, 667–74.CrossRefGoogle ScholarPubMed
Neisser, U. (1976) Cognition and Reality: Principles and Implications of Cognitive Psychology. San Francisco: S. M. Freeman and Co.Google Scholar
Nelson, J. C., Charney, D. S. & Vingiano, A. W. (1978) False positive diagnosis with primary affective disorder criteria. Lancet, ii, 1252–3.Google Scholar
Pare, C. M. B. (1974) Treatment of resistant depression. Pharmakopsychiatrie, 7, 118–21.CrossRefGoogle ScholarPubMed
Pichot, P. (1974) Therapy resistant depressions: methodological problems. Pharmakopsychiatrie, 7, 80–4.CrossRefGoogle ScholarPubMed
Raskin, A., Crook, T. H. & Odle, D. (1974) Depression sub-types and response to phenelzine, diazepam and a placebo. Archives of General Psychiatry, 30, 66—75.CrossRefGoogle Scholar
Rush, A. J., Beck, A. T., Kovacs, M. & Hollon, S. D. (1977) Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cognitive Therapy and Research, 1, 17—37.CrossRefGoogle Scholar
Shapiro, A. & Morris, L. (1978) The placebo effect in medical and psychological therapies. In Handbook of Psychotherapy and Behaviour Change, pp 364—410, 2nd edition (eds. Garfield, S. and Bergin, A.). New York: John Wiley.Google Scholar
Shaw, B. F. (1977) A comparison of cognitive therapy and behaviour therapy in the treatment of depression. Journal of Consulting and Clinical Psychology, 45, 549–51.CrossRefGoogle ScholarPubMed
Sheard, M. H. (1963) The influence of doctor's attitude on the patient response to antidepressant medication. Journal of Nervous and Mental Disease, 136, 555–60.CrossRefGoogle ScholarPubMed
Snaith, R. P., Constantopoulos, A. A., Jardine, M. Y. & McGuffin, P. (1978) A clinical scale for the self-assessment of irritability. British Journal of Psychiatry, 132, 164–71.CrossRefGoogle ScholarPubMed
Snedecor, G. W. & Cochran, W. G. (1974) Statistical Methods, 6th edition. Iowa: Iowa State University Press.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders, 3rd edition, New York State Psychiatric Institute, Biometrics Research.Google Scholar
Taylor, F. G. & Marshall, W. L. (1977) Experimental analyses of a cognitive behavioural therapy for depression. Cognitive Therapy and Research, 1, 59—72.CrossRefGoogle Scholar
Weissman, M. M. (1978) Psychotherapy and its relevance to the pharmacotherapy of affective disorders: from ideology to evidence. In Psychopharmacology: A Generation of Progress (eds. Lipton, M. A., Dimascio, A. and Killam, K.). New York: Raven Press.Google Scholar
Weissman, M. M., Prusoff, B., Dimascio, A., Neu, C., Goklaney, M. & Klerman, G. L. (1979) The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. American Journal of Psychiatry, 136, 555–8.CrossRefGoogle ScholarPubMed
Wheatley, D. (1972) Evaluation of psychotropic drugs in general practice. Proceedings of the Royal Society of Medicine, 65, 317–20.Google ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego Programme. London: Cambridge University Press.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.