The process of change in cognitive therapy for depression when combined with antidepressant medication: predictors of early intersession symptom gains
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OBJECTIVE: Previous studies of cognitive therapy (CT) for depression have examined therapist adherence and the therapeutic alliance as predictors of subsequent symptom change. However, little is known about these CT process variables when CT is delivered in combination with antidepressant medication. METHOD: In a sample of 176 depressed outpatients randomized to the combined condition of a clinical trial, we examined ratings of adherence and alliance as predictors of subsequent session-to-session symptom change across early CT sessions. RESULTS: Both adherence to Behavioral Methods/Homework and the therapeutic alliance significantly predicted session-to-session symptom change. In models in which patients' medication regimen and prior symptom change were covaried, only Behavioral Methods/Homework remained a significant predictor of subsequent symptom change. CONCLUSIONS: Our findings highlight the utility of Behavioral Methods/Homework in combined treatment for promoting early session-to-session symptom change.
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MethodResultStone, S. J., & Strunk, D. R. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10055-6 · Cited by 6 · see citing works
Self-citationThe alliance-outcome association in borderline and obsessive-compulsive personality disorder
Beiling, P., Schurig, S., Keller, A. K., Weidner, K., & Noack, R. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1094936 · Cited by 7 · see citing works
Evaluation of Treatment Integrity: The Treatment Specificity Index
Grikscheit, F., Weck, F., Hautzinger, M., Heidenreich, T., Weigel, M., Rudari, V., Schimming, C., & Stangier, U. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22172 · Cited by 5 · see citing works
Don, F. J., Driessen, E., Peen, J., Spijker, J., DeRubeis, R. J., Blankers, M., & Dekker, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.602294 · Cited by 5 · see citing works
Self-citationVittorio, L. N., Braun, J. D., Cheavens, J. S., & Strunk, D. R. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-021-10224-6 · Cited by 5 · see citing works
“, 2009), which could temper the effects of cognitive interventions in CBT (Strunk et al., 2012).”
BackgroundMethodSelf-citationIntegrating Between-Session Homework
Ryum, T., Bennion, A. M., & Kazantzis, N. (2023) · doi:10.1093/oso/9780197611012.003.0010 · Cited by 4 · see citing works
Khalifian, C. E., Beard, C., Björgvinsson, Þ., & Webb, C. A. (2019) · International Journal of Cognitive Therapy · doi:10.1007/s41811-019-00045-7 · Cited by 4 · see citing works
Ressourcenorientierung als Interventionsleitbild
Flückiger, C., Held, J., Wolfer, C., Allemand, M., & Vîslă, A. (2017) · Psychotherapeut · doi:10.1007/s00278-017-0168-x · Cited by 3 · see citing works
“Weiter werden eher allgemeinere Interventionsstrategien wie frühe Psychoedukation, frühe Verhaltensbeobachtungen, Hoffnungsinduktion oder Beziehungsaufbau für die Begünstigung von schnellen Veränderungssprüngen diskutiert (Strunk et al. 2012; Wampold et al. 2017).”
BackgroundDon, F. J., Driessen, E., Molenaar, P. J., Spijker, J., & Dekker, J. (2019) · Psychotherapy · doi:10.1037/pst0000219 · Cited by 3 · see citing works
Diehm, M. L., Kunz, J. I., Goerigk, S., Wolf, J., Lange, J., Jobst, A., Padberg, F., & Reinhard, M. A. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70200 · Cited by 2 · see citing works
“…alliance has been traditionally examined as a unidirectional predictor of symptom change (Crits-Christoph et al. 2011; Falkenström et al. 2013; Strunk et al. 2012; Webb et al. 2014), researchers suggest that symptom severity can also influence the quality of the therapeutic working alliance…”
Morgan, P. C., Wittenborn, A. K., & Edwards, C. (2023) · Family Process · doi:10.1111/famp.12926 · Cited by 2 · see citing works
Larsson, M. H., Björkman, K., Nilsson, K., Falkenström, F., & Holmqvist, R. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22704 · Cited by 2 · see citing works
Exploring therapeutic action in psychoanalytic psychotherapy : Attachment to therapist and change
Lilliengren, P. (2014) · DiVA (Stockholm University) · Cited by 2 · see citing works
Ezawa, I. D., & Hollon, S. D. (2023) · doi:10.1093/oso/9780197611012.003.0022 · Cited by 1 · see citing works
Self-citationNorton, P. J. (2015) · Australian Psychologist · doi:10.1111/ap.12148 · Cited by 1 · see citing works
Psychotherapie und Pharmakotherapie
Kapfhammer, H. (2016) · Elsevier eBooks · doi:10.1016/b978-3-437-21833-0.00043-7 · Cited by 1 · see citing works
Everitt, N., Cini, B., & Kazantzis, N. (2015) · doi:10.1002/9781394259229.ch22 · Cited by 1 · see citing works
La terapia cognitivo-comportamentale contemporanea: teoria, storia ed evidenze empiriche
Thoma, N., Pilecki, B., & McKay, D. (2016) · Psicoterapia e Scienze Umane · doi:10.3280/pu2016-001003
Braun, J. D. (2011) · The Knowledge Bank (The Ohio State University)
THERAPEUTIC ALLIANCE; EXPLORATION OF THE CONSTRUCT VALIDITY OF THE CONCEPT
Lindgren, A. (2014) · Figshare
Kember, T. (2013) · UCL Discovery (University College London)
Puuronen, R., & Tossavainen, S. (2013) · Jyväskylä University Digital Archive (University of Jyväskylä)
Moore, G. P., Phelan, D. J., Glover, R., McGonagle, C., & OʼSullivan, C. (2018)
(2016) · Elsevier eBooks · doi:10.1016/b978-3-437-21833-0.16001-2
Clinical Judgments of Response Profiles: Do They Tell Us What Matters for Whom?
Whelen, M. L., Ezawa, I. D., & Strunk, D. R. (2023) · Behavior Therapy · doi:10.1016/j.beth.2023.08.003
Self-citation
- Authors
- Strunk, D. R., Cooper, A. A., Ryan, E. T., DeRubeis, R. J., & Hollon, S. D.
- Affiliations
- The Ohio State University (US)
- University of Pennsylvania (US)
- Vanderbilt University (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2012
- Volume
- 80
- Issue
- 5
- Pages
- 730-738
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3458155
- OpenAlex
- W2111109264
- Cited by
- 77
- References
- 39
- Citations by year
- 2025: 1 · 2023: 10 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 8 · 2017: 6 · 2016: 8 · 2015: 13 · 2014: 7 · 2013: 8 · 2012: 2
- FWCI
- 10.91
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH060998)
- 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
- cognitive therapy, depression, antidepressants, combined psychotherapy and pharmacotherapy, therapist adherence, therapeutic relationship, behavioral techniques, homework, predictors of treatment outcome
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Antidepressive Agents, Combined Modality Therapy, Depression, Depressive Disorder, Female, Humans, Male, Middle Aged, Patient Compliance, Predictive Value of Tests, Professional-Patient Relations, Cognitive Behavioral Therapy, Treatment Outcome
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