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EVATUATION

Overview

As indicated earlier, there is a tremendous amount of research literature on the effectiveness of various cognitive-behavioral interventions for different types of disorders. The most recent studies have focused on diverse groups. The continuously developing body of work on empirically supported treatments is indicative of research that demonstrates the efficacy of CBT for a variety of problems.

The following selected review is limited to research on the work of Beck and his work on depression. Reviewing the vast research that supports CBT is a task that requires a book of its own. Readers interested in CBT with other clinical issues are advised to look in the publications described here. Because research on cognitive-behavioral treatment is ongoing, readers may find interesting articles published in journals such as Cognitive Behavior Therapy, Cognitive and Behavioral Practice, Behavioral and Cognitive Psychotherapy, and the Journal of Cognitive and Behavioral Therapies.

Supporting Research

Beck's Cognitive Therapy for Depression

The treatment of depression has received a great deal of attention from cognitive-behavioral researchers. Beck's cognitive therapy, developed for the treatment of depression, has been the subject of numerous treatment outcome studies. It has been compared with waiting list controls, nondirective therapy, behavioral therapy, and various antidepressant medications with favorable findings. In an older but often-cited study, Shaw (1977) compared Beck's cognitive therapy with behavioral therapy treatment for depression developed to restore an adequate schedule of positive reinforcement (included activity scheduling, verbal contracts, and communication and social skill development), nondirective therapy, and a waiting list control. Those treated by cognitive therapy had the best outcomes on self-report measures of depression. In addition, ratings by clinicians unaware of the type of therapy received by individual clients also were more favorable for the cognitive therapy treatment group.

A meta-analysis of treatment studies comparing cognitive therapy with no-treatment controls yielded the finding that clients in the cognitive therapy group had lower final depression scores than 99% of the no-treatment control group (Dobson & Shaw, 1988). It is clear that cognitive therapy is better than no treatment. The next test involved a comparison of the effects of cognitive therapy with antidepressant medication. In a landmark comparative outcome study, Rush, Beck, Kovacs, and Hollon (1977) compared the use of cognitive therapy with pharmacotherapy based on the tricyclic antidepressant imipra- mine. The clients were moderately to severely depressed individuals seeking treatment for depression who were randomly assigned to cognitive therapy or drug treatment. Cognitive therapy consisted of no more than 20 sessions in 12 weeks, and the imipramine treatment consisted of 12 weekly sessions. Weekly self-report depression ratings were obtained. In addition, an independent clinician (though not unaware of the treatment being received) interviewed the clients to provide a clinical rating of depression. Although both interventions led to a reduction in depression, the results indicated that cognitive therapy outperformed medication in client self-report ratings and in clinician evaluations. Over 78% of the clients treated with cognitive therapy showed marked reductions in depression, whereas only 22% of those treated with medication experienced similar reductions in depression. In addition, there was a greater dropout rate associated with the medication treatment. These results are particularly astounding in light of the fact that many of the therapists were psychoanalytically oriented and were relatively inexperienced in conducting cognitive therapy (however, the therapists did follow a specified cognitive therapy treatment manual and received weekly supervision). It seems that cognitive therapy is an effective intervention for depression.

Another study that also used medication and cognitive therapy to treat depression found that the use of drugs and cognitive therapy was no better than cognitive therapy alone (Beck, Hollon, Young, Bedrosian, & Budenz, 1985). Cognitive therapy and drug treatment were better than drug treatment alone, leading Beck and colleagues to conclude that if a client needs antidepressant medication, the individual should get cognitive therapy with the medication. DeRubeis, Gelfand, Tang, and Simons (1999) reanalyzed individual patient data from four studies of cognitive therapy treatment for depression and concluded that cognitive therapy is as effective as medication for treatment of severely depressed patients. Conclusions from this research indicate that cognitive therapy is as effective as medication in the treatment of depression, even in cases of severe depression. Another analysis of different treatments for depression (Wampold, Minami, Baskin, & Tierney, 2002) reported that CBT, in comparison with other therapies for depression, is as effective as other "bona fide" treatments and more effective than non-bona fide treatments.

 
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