Is cognitive behavior therapy just a 'nonspecific' intervention for depression? A retrospective comparison of consecutive cohorts treated with cognitive behavior therapy or supportive counseling and pill placebo.
BACKGROUND
There is a dearth of placebo-controlled studies of cognitive behavior therapy (CBT) of depression and the largest such study, by Elkin et al. (Arch. Gen. Psychiatry 46 (1989) 971-982), failed to find a significant difference between CBT and a clinical management plus placebo condition.


METHODS
The outcomes of two consecutive cohorts of out-patients with major depressive disorder, treated with either CBT (n=90) or a nonspecific control condition (support-counseling-placebo; SCP: n=100), were compared. Although the principal comparisons between the CBT and SCP conditions were delimited to the first 4 weeks of treatment, a secondary set of analyses addressed the subset of 16 patients who received 12 additional weeks of supportive therapy.


RESULTS
A consistent pattern of statistically and clinically significant differences favoring CBT over SCP was found in both weeks 4 and 16.


CONCLUSIONS
Interpretation of these findings are subject to several potential confounds, including the non-randomized nature of the groups and the greater amount of therapeutic contact during the first 4 weeks of CBT.


CONCLUSIONS
While these results do not lessen the need for additional prospective studies, our findings do suggest that CBT has therapeutic effects beyond those attributable to placebo-expectancy and other nonspecific factors.
Thase
M E
ME
University of Pittsburgh School of Medicine, Department of Psychiatry, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. thaseme@msx.upmc.edu
Friedman
E S
ES
Berman
S R
SR
Fasiczka
A L
AL
Lis
J A
JA
Howland
R H
RH
Simons
A D
AD
D000328:Adult; D002986:Clinical Trials as Topic; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015331:Cohort Studies; D003376:Counseling; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome