How much cognitive therapy, for which patients, will prevent depressive relapse?
BACKGROUND
Although clinicians accept that relapse is probable when successful acute phase pharmacotherapy is discontinued, less is known about when to stop versus continue successful cognitive therapy. This report describes the development of "translational tools" to bridge the gap between research and practice on this and similar decisions that practitioners make daily. We aim to provide patients, clinicians, and public health administrators' practical tools to facilitate informed decisions about when to stop versus continue cognitive therapy with responders who presented with recurrent major depressive disorder (MDD).


METHODS
Data are drawn from a randomized clinical trial [Jarrett, R.B., Kraft, D., Doyle, J., Foster, B.M., Eaves, G.G., Silver, P.C., 2001. Preventing recurrent depression using cognitive therapy with and without a continuation phase: a randomized clinical trial. Arch. Gen. Psychiatry, 58, 381-388] showing that continuation-phase cognitive therapy (C-CT; [Jarrett, R.B., 1989. Cognitive therapy for recurrent unipolar depressive disorder: The continuation/maintenance phase]) reduced relapse more over 8 months than an assessment-only control, for responders to acute phase cognitive therapy (A-CT; [Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G., 1979. Cognitive therapy of depression. New York, Guilford Press]). We provide tools to translate the additional finding that, over 2 years, responders to A-CT for recurrent depression with higher residual symptoms were more likely to require C-CT to avoid relapse/recurrence than responders with lower or no residual symptoms.


RESULTS
To measure residual symptoms we provide the specific scores from six readily available measures of depressive symptom severity taken at the last acute phase session and their associated probabilities of relapse or recurrence over 8, 12, and 24 months.


CONCLUSIONS
These tools can aid individual patient and providers in making informed decisions when they decide to continue versus discontinue cognitive therapy.


CONCLUSIONS
The results are limited to a 20-session trial of A-CT for recurrent depression conducted by highly experienced therapists and require replication.
Jarrett
Robin B
RB
Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9149, United States. Robin.Jarrett@UTSouthwestern.edu
Vittengl
Jeffrey R
JR
Clark
Lee Anna
LA
D000328:Adult; D000553:Ambulatory Care; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D005163:Factor Analysis, Statistical; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D017410:Practice Guidelines as Topic; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome