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The process of change in cognitive therapy for depression: predictors of early inter-session symptom gains.
Open accessAbstract
Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists' adherence to cognitive therapy techniques, the patients' facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists' adherence in treatment response.
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Metadata
- Authors
- Strunk, D. R., Brotman, M. A., & DeRubeis, R. J.
- Affiliations
- The Ohio State University (US)
- National Institutes of Health (US)
- University of Pennsylvania (US)
- Corresponding author
- Strunk, Daniel R.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 48
- Issue
- 7
- Pages
- 599-606
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC2878902
- OpenAlex
- W2008700827
- Cited by
- 169
- References
- 54
- Citations by year
- 2026: 8 · 2025: 2 · 2024: 1 · 2023: 8 · 2022: 12 · 2021: 23 · 2020: 5 · 2019: 12 · 2018: 13 · 2017: 10 · 2016: 10 · 2015: 18 · 2014: 13 · 2013: 11 · 2012: 14
- FWCI
- 11.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R10MH055875, R10MH055877)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- change processes, therapist adherence, cognitive strategies, therapeutic relationship, homework, treatment response
- MeSH terms
- Adult, Aged, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Models, Psychological, Patient Compliance, Professional-Patient Relations, Prognosis, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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