, Volume 11, Issue 2, pp 253-271

Cognitive therapy for depression: Individual differences and the process of change

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Abstract

Changes in depression over the first weeks of therapy were examined in detail in patients taking part in a trial of cognitive-behavioral therapy for depression (CBT). Within 2 weeks of starting treatment, marked differences were apparent between CBT and comparison patients and, within CBT, some patients showed a very rapid response to treatment. Such rapid responders had significantly better long-term outcome than those responding more slowly. Compared to the latter, rapid responders more strongly endorsed the cognitive conceptualization of depression initially offered, reported a more positive response to initial homework assignments, and, prior to treatment, scored higher on a measure of “depression about depression.” These results support the importance of providing an acceptable rationale for treatment, followed by homework assignments that empirically validate the rationale offered. Implications for the practice of CBT for depression are discussed. It is suggested that the process of change may well be different in rapid and slow responders, and that the delivery system of CBT should be modified to take account of these differences.
This work was supported by the Medical Research Council of the United Kingdom. Many thanks to Sally Carr and David Clark for rating patients' responses toCoping with Depression and to homework assignments.