Extreme nonresponse in cognitive therapy: can behavioral activation succeed where cognitive therapy fails?
In a recent placebo-controlled comparison, behavioral activation was superior to cognitive therapy in the treatment of moderate to severely depressed adults. Moreover, a subset of patients exhibited a pattern of extreme nonresponse to cognitive therapy on self-reports of depression not evident on the clinician ratings. These patients were severely depressed, functionally impaired, and had primary support group problems; most also described themselves as having life-long depressions. Comparable numbers of patients with such characteristics were assigned to behavioral activation, indicating that randomization did not fail, and most instances occurred in the context of adequate cognitive therapy. If this pattern of self-reported extreme nonresponse to cognitive therapy replicates, it would suggest that there might be a subset of patients who see themselves as doing better with sustained attention to behavior change in time-limited treatment.
Coffman
Sandra J
SJ
Department of Psychology, University of Washington, Seattle, WA, USA. scoffman@u.washington.edu
Martell
Christopher R
CR
Dimidjian
Sona
S
Gallop
Robert
R
Hollon
Steven D
SD
D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D012720:Severity of Illness Index; D012919:Social Behavior; D013997:Time Factors; D017211:Treatment Failure