Relapse after cognitive behavior therapy of depression: potential implications for longer courses of treatment
Abstract
OBJECTIVE: The authors studied the risk of relapse among depressed patients after cognitive behavior therapy in order to document the need and potential indications for longer-term models of treatment. METHOD: Forty-eight patients with major depression who responded during a 16-week course of cognitive behavior therapy entered a 1-year prospective follow-up study, as did two patients who received 20 weeks of therapy. Standardized, independent clinical assessments were completed 1, 3, 6, 9, and 12 months after treatment. Relapse was defined as, at minimum, a 2-week period in which the subject met the DSM-III-R criteria for major depression and had a Hamilton depression scale score of 15 or more. RESULTS: Sixteen patients (32%) relapsed during the 1-year follow-up. Correlates of relapse included a history of depressive episodes, higher levels of depressive symptoms and dysfunctional attitudes, slower response to therapy, and being unmarried. Patients who fully recovered during therapy (Hamilton depression score of 6 or less for 8 weeks or more) were at significantly lower risk for relapse than those who partially recovered (9% and 52%, respectively). Slower response to therapy, unmarried status, and high residual scores on the Dysfunctional Attitudes Scale were independently and additively related to increased risk of relapse. CONCLUSIONS: These findings provide further evidence of a relation between residual symptoms and relapse after cessation of active treatment. The authors strongly recommend that models of longer-term psychotherapy be developed for depressed patients who do not recover fully during time-limited cognitive behavior therapy.
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Slower decrease in symptom scores (longer time to treatment response) predicts higher chance of relapse/recurrence after CBT for depression (Thase et al., 1992).
“A slower decrease in symptom scores (i.e. a longer time to treatment response) also significantly predicted a higher chance of RR (Thase et al. , 1992).”
From Predictors of depression relapse and recurrence after cognitive behavioural therapy: a systematic review and meta-analysis (2019) · cites this paper as Thase et al. , 1992
Unmarried participants are more likely to experience relapse/recurrence after CBT for depression (Thase et al., 1992).
“Thase et al. (1992) found that unmarried participants were more likely to experience RR; however, Evans et al. (1992) did not find marital status to be a significant predictor.”
From Predictors of depression relapse and recurrence after cognitive behavioural therapy: a systematic review and meta-analysis (2019) · cites this paper as Thase et al. (1992)
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- Authors
- Thase, M. E., Simons, A. D., McGeary, J. E., Cahalane, J. F., Hughes, C., Harden, T., & Friedman, E. S.
- Affiliations
- University of Pittsburgh (US)
- ORCID
- Michael E. Thase
- Venue
- American Journal of Psychiatry
- Published
- 1992-08-01
- Volume
- 149
- Issue
- 8
- Pages
- 1046-1052
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W80099719
- Cited by
- 252
- References
- 27
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 6 · 2015: 9 · 2014: 6 · 2013: 16 · 2012: 9
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH-41884, R01MH041884, MH30915)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- relapse, cognitive behavioral therapy, major depressive disorder, long-term psychotherapy, treatment response, residual symptoms, dysfunctional attitudes, marital status, recurrence risk factors
- MeSH terms
- Adult, Ambulatory Care, Attitude to Health, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Psychiatric Status Rating Scales, Recurrence, Risk Factors, Severity of Illness Index, Single Person, Time Factors, Cognitive Behavioral Therapy, Survival Analysis
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