title: Improved cognitive content endures for 2 years among unstable responders to acute-phase cognitive therapy for recurrent major depressive disorder.
abstract: BACKGROUND
  The cognitive model of depression suggests that cognitive therapy (CT) improves major depressive disorder (MDD) in part by changing depressive cognitive content (e.g. dysfunctional attitudes, hopelessness). The current analyses clarified: (1) the durability of improvements in cognitive content made by acute-phase CT responders; (2) whether continuation-phase CT (C-CT) or fluoxetine (FLX) further improves cognitive content; and (3) the extent to which cognitive content mediates continuation treatments' effects on depressive symptoms and major depressive relapse/recurrence.
  
  
  METHODS
  Out-patients with recurrent MDD who responded to acute-phase CT (n = 241) were randomized to 8 months of C-CT, FLX or pill placebo (PBO) and followed for an 24 additional months. Cognitive content was assessed approximately every 4 months using five standard patient-report measures.
  
  
  RESULTS
  Large improvements in cognitive content made during acute-phase CT were maintained for 32 months, with 78-90% of patients scoring in normal ranges, on average. Cognitive content varied little between C-CT, FLX and PBO arms, overall. Small, transient improvements in cognitive content in C-CT or FLX compared with PBO patients did not clearly mediate the treatments' effects on depressive symptoms or on major depressive relapse/recurrence.
  
  
  CONCLUSIONS
  Outpatients with recurrent MDD who respond to acute-phase CT show durable improvements in cognitive content. C-CT or FLX may not continue to improve patient-reported cognitive content substantively, and thus may treat recurrent MDD by other paths.
authors.affiliation: Department of Psychology,Truman State University,Kirksville,MO,USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Vittengl
authors.affiliation: Department of Psychology,University of Notre Dame,Notre Dame,IN,USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Clark
authors.affiliation: Department of Psychiatry,Perelman School of Medicine,University of Pennsylvania,Philadelphia,PA,USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Thase
authors.affiliation: Department of Psychiatry,The University of Texas Southwestern Medical Center,Dallas,TX,USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Jarrett
mesh_terms: D000328:Adult; D001290:Attitude; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage / Q000494:pharmacology*; D005500:Follow-Up Studies; D065026:Hope; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012008:Recurrence; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D013850:Thinking / Q000187:drug effects / Q000502:physiology*
chemical_list: D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Cognitive content; cognitive therapy; continuation; fluoxetine; major depressive disorder