An efficacy study of group and individual cognitive-behavioral therapy combined with pharmacotherapy in the treatment of major depression.

摘要

This study was designed to address the following hypothesis: "Is there a significant difference in effectiveness of individual or group cognitive-behavioral therapy in treating moderately and severely depressed outpatients?" A field practice outpatient setting was utilized. The 30 subjects scored 20 or above on the Beck Depression Inventory, 14 or higher on the Hamilton Rating Scale for Depression, had a T score above 70 on the Minnesota Multiphasic Personality Inventory-D scale, and met the DSM III-R criteria for major depression. The 26 patients continuing treatment beyond four weeks included 7 males and 19 females ages 22-70. They were treated for 12 weeks in one of three modalities: (a) individual cognitive-behavioral therapy with pharmacotherapy, (b) group cognitive-behavioral therapy with pharmacotherapy, or (c) pharmacotherapy only.;Intake and outcome measurements included two well established self rating scales, the BDI and MMPI-D, and one clinician scale, the HRSD which was also used at midpoint by the psychiatrist.;Three treatment methods were utilized for comparative purposes. An analysis of variance performed on initial scores of the three dependent measures established no systematic bias of patients to treatment with regard to severity.;All patients were prescribed specific medications according to individual symptomatologies and drug characteristics as a common clinic procedure. Neither type nor dosage was limited. Medication monitoring included obtaining drug levels. The cognitive-behavioral component was based on principles and goals in David Burns' Feeling Good.;Low attrition rates were noted especially in cognitive-behavioral therapy modalities where one patient from each discontinued treatment. In the pharmacotherapy group, two subjects dropped.;Study findings indicated significant change in all treatment modalities on each scale with no significant differences delineated between the treatment modes. No significant difference between the groups was found at midpoint as measured by the HRSD or any of the three outcome measures at termination.;It is concluded that a basis for including cognitive-behavioral therapy in group format is substantiated for moderate and severely depressed outpatients. Individual cognitive-behavioral therapy combined with pharmacotherapy and pharmacotherapy alone were equally efficacious, at least in the initial treatment period.