Acute treatment of depression and long-term effects: What works for whom and new developments

CBT is a widespread effective treatment for depression and a relapse prevention strategy, but not effective for a large group of patients. In a previous study specific characteristics of depressed patients were identified who responded quite poorly to Beck's model of Cognitive Therapy (CT) but not to Behavioral Activation. The results of a study will be presented that examined such a profile in a large, independent sample of patients with recurrent Major Depressive Disorder. In addition, predictors of poor response to a CT relapse prevention program will be presented over another study that included 172 recurrently depressed patients. In addition, a new approach, i.e. Exposure-based cognitive therapy for depression (EBCT) will be presented that has been developed to accomplish more sustainable symptom relief by integrating principles of anxiety therapy (i.e., exposure), as well as emotion-focused therapy (i.e., emotional processing). First results from RCT's will be presented. Further, new evidence will be presented on a RCT that compared short and long term effects CBT to psychoanalysis.
Can the Principles of Exposure Be Applied to the Treatment of Depression, and What Are the Implications for Relapse Prevention?
Exposure-based therapies have been well-established as potent interventions for anxiety disorders. We combine the principles of exposure therapy with cognitive therapy in Exposure-Based Cognitive Therapy (EBCT) for depression. The first phase of this therapy involves preparation for change. The focus is on teaching skills to reduce potential inhibitors of change, including rumination, avoidance, and hopelessness. The second phase of therapy involves gradual exposure to the depressive network, which is akin to the fear network in anxiety disorders, but instead involves one?s most negative view of self and the associated cognitive, affective, behavioral, and somatic responses. This depressive network is activated and corrective information and exercises are introduced to destabilize and challenge this entrenched network. The last phase of therapy involves facilitating acceptance and developing a more adaptive network to compete with the old depressive network and to help prevent relapse.

The sample included 29 patients who met SCID criteria for depression and reported clinical levels of depression on the Hamilton Rating Scale for Depression (HRSD) or the Beck Depression Inventory II. Consistent with exposure principles in anxiety disorders, growth curve modeling revealed a significant cubic pattern of symptom change in this therapy for depression. There was an initial linear decrease in depression (HRSD scores), a period of worsening (?depression spike?) during the exposure phase, and then an additional decrease in symptoms. Experiencing a spike during the exposure phase of therapy, which is hypothesized to reflect the activation of the depressive network, predicted more change by the end of treatment. These findings suggest that the principles of exposure might apply to the treatment of depression and that a period of affective arousal and transient symptom exacerbation might be important in the change process. We will present process research to describe what is changing during the exposure phase of therapy and how this is related to long-term change.