title: Identifying moderators of the adherence-outcome relation in cognitive therapy for depression.
abstract: OBJECTIVE
  Little is known about the influence of patients' pretreatment characteristics on the adherence-outcome relation in cognitive therapy (CT) for depression. In a sample of 57 depressed adults participating in CT, the authors examined interactions between pretreatment patient characteristics and therapist adherence in predicting session-to-session symptom change.
  
  
  METHODS
  Using items from the Collaborative Study Psychotherapy Rating Scale, the authors assessed 3 facets of therapist adherence: cognitive methods, negotiating/structuring, and behavioral methods/homework. Two graduate students rated Sessions 1-4 for adherence. Symptoms were assessed prior to each session with the Beck Depression Inventory-II. Moderators were assessed as part of patients' intake evaluations.
  
  
  RESULTS
  After correcting for multiple comparisons, patient gender remained a significant moderator of the relationship between cognitive methods and next-session symptom change; cognitive methods more strongly predicted greater symptom improvement for women as compared to men. Pretreatment anxiety and number of prior depressive episodes were significant moderators of the relationship between behavioral methods/homework and next-session symptom change, with greater behavioral methods/homework predicting symptom improvement more strongly among patients high in pretreatment anxiety and among patients with relatively few prior depressive episodes.
  
  
  CONCLUSIONS
  This is the first study to provide evidence of how therapist adherence is differentially related to outcome among depressed patients with different characteristics. If replicated, these findings may inform clinical decisions regarding the use of specific facets of adherence in CT for depression with specific patients.
authors.affiliation: Department of Psychology, The Ohio State University.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Sasso
authors.affiliation: Department of Psychology, The Ohio State University.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Strunk
authors.affiliation: Department of Psychology, The Ohio State University.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Braun
authors.affiliation: Department of Psychology, University of Pennsylvania.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: DeRubeis
authors.affiliation: Mood and Anxiety Disorders Program, National Institute of Mental Health.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Brotman
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000150:complications / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000706:statistics & numerical data*; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010555:Personality Inventory; D011369:Professional-Patient Relations; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult