title: In cognitive therapy for depression, early focus on maladaptive beliefs may be especially efficacious for patients with personality disorders.
abstract: OBJECTIVE
  Patients with major depressive disorder (MDD) and a comorbid personality disorder (PD) have been found to exhibit relatively poor outcomes in cognitive therapy (CT) and other treatments. Adaptations of CT focusing heavily on patients' core beliefs have yielded promising findings in the treatment of PD. However, there have been no investigations that have specifically tested whether increased focus on maladaptive beliefs contributes to CT's efficacy for these patients.
  
  
  METHODS
  CT technique use from an early CT session was assessed for 59 patients (33 without PD, 26 with PD-predominantly Cluster C) who participated in a randomized controlled trial for moderate to severe MDD. Scores were calculated for directive CT techniques (CT-Concrete) and a set of belief-focused items (CT-Belief) as rated by the Collaborative Study Process Rating Scale. Robust regressions were conducted to estimate relations between scores on each of these measures and change in depressive and PD symptoms. A PD status by CT-Belief use interaction tested the hypothesis that therapist use of CT-Belief techniques would exhibit a stronger association with symptom change in the PD group relative to the non-PD group.
  
  
  RESULTS
  As hypothesized, a significant interaction between PD status and use of CT-Belief techniques emerged in the prediction of depressive and PD symptom change. Among PD patients, higher early CT-Belief interventions were found to predict significantly greater improvement. CT-Belief use did not predict greater symptom change among those without PD.
  
  
  CONCLUSIONS
  Early focus on CT-Belief interventions may facilitate changes in depression and PD symptoms for patients with MDD-PD comorbidity.
authors.affiliation: Department of Psychology, University of Pennsylvania.
authors.forename: John R
authors.identifier: 0000-0001-7250-8960
authors.initials: JR
authors.lastname: Keefe
authors.affiliation: Department of Psychiatry, McLean Hospital, Harvard Medical School.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Webb
authors.affiliation: Department of Psychology, University of Pennsylvania.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: DeRubeis
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003863:Depression / Q000628:therapy; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome