Cognitive Therapy and Research

, Volume 1, Issue 1, pp 17–37 | Cite as

Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients

  • Augustus J. Rush
  • Aaron T. Beck
  • Maria Kovacs
  • Steven Hollon
Article

Abstract

Forty-one unipolar depressed outpatients were randomly assigned to individual treatment with either cognitive therapy (N =19)or imipramine (N =22).As a group, the patients had been intermittently or chronically depressed with a mean period of 8.8 years since the onset of their first episode of depression, and 75%were suicidal. For the cognitive therapy patients, the treatment protocol specified a maximum of 20 interviews over a period of 12 weeks. The pharmacotherapy patients received up to 250 mg/day of imipramine for a maximum of 12 weeks. Patients who completed cognitive therapy averaged 10.90 weeks in treatment; those in pharmacotherapy averaged 10.86 weeks. Both treatment groups showed statistically significant decreases in depressive symptomatology. Cognitive therapy resulted in significantly greater improvement than did pharmacotherapy on both a self-administered measure of depression (Beck Depression Inventory)and clinical ratings (Hamilton Rating Scale for Depression and Raskin Scale).Moreover, 78.9%of the patients in cognitive therapy showed marked improvement or complete remission of symptoms as compared to 22.7%of the pharmacotherapy patients. In addition, both treatment groups showed substantial decrease in anxiety ratings. The dropout rate was significantly higher with pharmacotherapy (8 Ss)than with cognitive therapy (1 S).Even when these dropouts were excluded from data analysis, the cognitive therapy patients showed a significantly greater improvement than the pharmacotherapy patients. Follow-up contacts at three and six months indicate that treatment gains evident at termination were maintained over time. Moreover, while 68%of the pharmacotherapy group re-entered treatment for depression, only 16%of the psychotherapy patients did so.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Reference Notes

  1. Morris, N. E.A group self-instruction method for the treatment of depressed outpatients. Unpublished doctoral dissertation, University of Toronto, 1975.Google Scholar
  2. Schmickley, V. G.The effects of cognitive-behavior modification upon depressed outpatients. Unpublished doctoral disseration, Michigan State University, 1976.Google Scholar
  3. Gioe, V. J.Cognitive modification and positive group experience as a treatment for depression. Unpublished doctoral dissertation, Temple University, 1975.Google Scholar
  4. Beck, A. T., Rush, A. J., & Kovacs, M.Individual treatment manual for cognitive/behavioral psychotherapy of depression. Unpublished manuscript, 1975. Available from Dr. Aaron T. Beck, 429 Stouffer Building, Philadelphia General Hospital, Philadelphia, Pennsylvania 19104.Google Scholar
  5. Rush, A. J., Beck, A. T., Kovacs, M., Khatami, M., Fitzgibbons, R., & Wolman, T.Comparison of cognitive and pharmacotherapy in depressed outpatients: A preliminary report. Paper presented at meetings of the Society for Psychotherapy Research, Boston, Massachusetts, 1975.Google Scholar

References

  1. Adler, A.Understanding human nature. New York: Garden City, 1927.Google Scholar
  2. American Psychiatric Association.Diagnostic and statistical manual of mental disorders. Washington, D.C.: Author, 1968.Google Scholar
  3. Arnold, M.Emotion and personality (Vol. 1). New York: Columbia University Press, 1960.Google Scholar
  4. Beck, A. T. Thinking and depression: I. Idiosyncratic content and cognitive distortions.Archives of General Psychiatry 1963,9 324–333.Google Scholar
  5. Beck, A. T. Thinking and depression: II. Theory and therapy.Archives of General Psychiatry 1964,10 561–571.Google Scholar
  6. Beck, A. T.Depression: Clinical, experimental, and theoretical aspects. New York: Hoeber, 1967. (Republished asDepression: Causes and treatment. Philadelphia: University of Pennsylvania Press, 1972.)Google Scholar
  7. Beck, A. T.Cognitive therapy and the emotional disorders. New York: International Universities Press, 1976.Google Scholar
  8. Beck, A. T., & Beamesderfer, A. Assessment of depression: The depression inventory. In P. Pichot (Ed.),Modern problems in pharmacopsychiatry (Vol. 7). Basel, Switzerland: Karger, 1974.Google Scholar
  9. Beck, A. T., & Shaw, B. F. Cognitive approaches to depression. In A. Ellis & R. Grieger (Eds.),Handbook of rational emotive theory and practice. New York: Springer, 1977.Google Scholar
  10. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E., & Erbaugh, J. K. An inventory for measuring depression.Archives of General Psychiatry 1961,4 561–571.Google Scholar
  11. Covi, L., Lipman, R., Derogatis, L., Smith, J., & Pattison, I. Drugs and group psychotherapy in neurotic depression.American Journal of Psychiatry 1974,131 191–198.Google Scholar
  12. Ellis, A.Reason and emotion in psychotherapy. New York: Lyle Stuart, 1962.Google Scholar
  13. Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G., & Munoz, R. Diagnostic criteria for use in psychiatric research.Archives of General Psychiatry 1972,26 57–63.Google Scholar
  14. Friedman, A. S. Interaction of drug therapy with marital therapy in depressive patients.Archives of General Psychiatry 1975,32 619–637.Google Scholar
  15. Hamilton, M. The assessment of anxiety states by rating.British Journal of Medical Psychology 1959,32 50–55.Google Scholar
  16. Hamilton, M. A rating scale for depression.Journal of Neurology, Neurosurgery, and Psychiatry 1960,23 56–61.Google Scholar
  17. Hamilton, M. Standardized assessment and recording of depressive symptoms.Psychiatria, Neurologia, Neurochirurgia 1969,72 201–205.Google Scholar
  18. Horney, K.Neurosis and human growth: The struggle toward self-realization. New York: Norton, 1950.Google Scholar
  19. Kelly, G. A.The psychology of personal constructs (Vols. 1 & 2). New York: Norton & Company, 1955.Google Scholar
  20. Klerman, G., DiMascio, A., Weissman, M., Prusoff, B., & Paykel, E. Treatment of depression by drugs and psychotherapy.American Journal of Psychiatry 1974,131 186–191.Google Scholar
  21. Lazarus, A.Behavior therapy and beyond. New York: McGraw-Hill, 1972.Google Scholar
  22. Lazarus, R.Psychological stress and the coping process. New York: McGraw-Hill, 1966.Google Scholar
  23. Morris, J. B., & Beck, A. T. The efficacy of antidepressant drugs: A review of research (1958–1972).Archives of General Psychiatry 1974,30 667–674.Google Scholar
  24. Raskin, A., Schulterbrandt, J. G., Reatig, N., & McKeon, J. J. Differential response to chlorpromazine, imipramine, and placebo: A study of subgroups of hospitalized depressed patients.Archives of General Psychiatry 1970,23 164–173.Google Scholar
  25. Schwab, J., Bialow, M., Clemmons, R., Martin, P., & Holzer, C. The Beck depression inventory with medical inpatients.Acta Psychiatrica Scandinavica 1967,43 255–266.Google Scholar
  26. Shaw, B. F. A comparison of cognitive therapy and behavior therapy in the treatment of depression.Journal of Consulting and Clinical Psychology, in Press.Google Scholar
  27. Taylor, F. G., & Marshall, W. L. A cognitive-behavioral therapy for depression.Cognitive Therapy and Research, in press.Google Scholar

Copyright information

© Plenum Publishing Corp. 1977

Authors and Affiliations

  • Augustus J. Rush
    • 1
  • Aaron T. Beck
    • 2
  • Maria Kovacs
    • 2
  • Steven Hollon
    • 2
  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of OklahomaUSA
  2. 2.Department of PsychiatryUniversity of PennsylvaniaUSA

Personalised recommendations