title: Changes in causal attributions and relationship representations: Are they specific or common mechanisms in the treatment of depression?
abstract: BACKGROUND
  The goal of the study was to examine two central theory-driven mechanisms of change, causal attributions and relational representations, to account for symptomatic improvement in psychodynamic treatment and supportive clinical management, combined with either pharmacotherapy or placebo, in a randomized control trial (RCT) for depression.
  
  
  METHODS
  We used data from an RCT for depression, which reported non-significant differences in outcome among patients (N=149) who received supportive-expressive psychotherapy (SET), clinical management combined with pharmacotherapy (CM+MED), or clinical management with placebo pill (CM+PBO) (Barber et al., 2012). Mechanism and outcome measures were administered at intake, mid-treatment, end of treatment, and at a 4-month follow-up.
  
  
  RESULTS
  Improvements in causal attributions and in relational representations were found across treatments. Changes in causal attributions did not predict subsequent symptomatic level when controlling for prior symptomatic level. In contrast, decrease in negative relational representations predicted subsequent symptom reduction across all treatments, and increase in positive relational representations predicted subsequent symptom reduction only in SET.
  
  
  CONCLUSIONS
  The study is limited by its moderate sample size. Additional studies are needed to examine the same questions using additional treatment orientations, such as cognitive treatments.
  
  
  CONCLUSIONS
  Findings demonstrate that changes in negative relational representations may act as a common mechanism of change and precede symptom reduction across psychodynamic therapy and supportive case management combined with either pharmacotherapy or placebo, whereas an increase in positive relational representation may be a mechanism of change specific to psychodynamic therapy.
authors.affiliation: The Department of Psychology, University of Haifa, Israel. Electronic address: sigalzil@gmail.com.
authors.forename: Sigal
authors.initials: S
authors.lastname: Zilcha-Mano
authors.affiliation: The Derner Institute of Advanced Psychological Studies, Adelphi University, United States.
authors.forename: Harold
authors.initials: H
authors.lastname: Chui
authors.affiliation: The Department of Psychology, University of Haifa, Israel.
authors.forename: Tohar
authors.initials: T
authors.lastname: Dolev
authors.affiliation: Department of Psychology, Chestnut Hill College, United States.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: McCarthy
authors.affiliation: Clinic for General Internal Medicine and Psychosomatics, University of Heidelberg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Dinger
authors.affiliation: The Derner Institute of Advanced Psychological Studies, Adelphi University, United States.
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Barber
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D003863:Depression / Q000523:psychology* / Q000628:therapy*; D004358:Drug Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011582:Psychological Theory; D011613:Psychotherapy / Q000379:methods; D012938:Social Perception; D016896:Treatment Outcome
chemical_list: D010919:Placebos
keywords: Attributional style; Common mechanisms; Depression; Psychodynamic therapy; Relational representations; Specific mechanisms