Changes in self-schema structure in cognitive therapy for major depressive disorder: a randomized clinical trial.

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory-II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed

Changes in Core Beliefs (Early Maladaptive Schemas) and Self-Representation in Cognitive Therapy and Pharmacotherapy for Depression

Randomized clinical trials suggest that cognitive therapy (CT) is comparable to antidepressant medication for the acute treatment of depression. Compelling data also indicate that CT has an added prophylactic benefit relative to pharmacotherapy (PT). The purpose of this study was to examine cognitive change in CT for depression. Participants (N = 42) met diagnostic criteria for a current major depressive episode and were randomly assigned to CT + PT or PT. Participants completed indices of depressive symptomatology, core beliefs (i.e., early maladaptive schemas), and self-attribute redundancy before and after therapy. Self-attribute redundancy was conceptualized as a form of schema organization and operationalized as the number of similar traits that permeate different aspects of self (e.g., as a partner, friend, employee). Treatment change was evident in both groups on self-reported core belief domains, with few between-group differences. Although no group differences were found on attribute redundancy at pre-treatment, there was a significant increase in positive redundancy at post-treatment favoring CT + PT. No group differences were found for negative content. These findings suggest that something about CT may uniquely impact self-representation and that CT may operate by bolstering compensatory schemas

Association of psychotherapy with disability benefit claim closure among patients disabled due to depression.

BackgroundDepression is the most frequent reason for receiving disability benefits in North America, and treatment with psychotherapy is often funded by private insurers. No studies have explored the association between the provision of psychotherapy for depression and time to claim closure.MethodsUsing administrative data from a Canadian disability insurer, we evaluated the association between the provision of psychotherapy and short-term disability (STD) and long-term disability (LTD) claim closure by performing Cox proportional hazards regression.ResultsWe analyzed 10,508 STD and 10,338 LTD claims for depression. In our adjusted analyses, receipt of psychotherapy was associated with longer time to STD closure (HR [99% CI] = 0.81 [0.68 to 0.97]) and faster LTD claim closure (1.42 [1.33 to 1.52]). In both STD and LTD, older age (0.90 [0.88 to 0.92] and 0.83 [0.80 to 0.85]), per decade), a primary diagnosis of recurrent depression versus non-recurrent major depression (0.78 [0.69 to 0.87] and 0.80 [0.72 to 0.89]), a psychological secondary diagnosis (0.90 [0.84 to 0.97] and 0.66 [0.61 to 0.71]), or a non-psychological secondary diagnosis (0.81 [0.73 to 0.90] and 0.77 [0.71 to 0.83]) versus no secondary diagnosis, and an administrative services only policy ([0.94 [0.88 to 1.00] and 0.87 [0.75 to 0.996]) or refund policy (0.86 [0.80 to 0.92] and 0.73 [0.68 to 0.78]) compared to non-refund policy claims were independently associated with longer time to claim closure [corrected].ConclusionsWe found, paradoxically, that receipt of psychotherapy was independently associated with longer time to STD claim closure and faster LTD claim closure in patients with depression. We also found multiple factors that were predictive of time to both STD and LTD claim closure. Our study has limitations, and well-designed prospective studies are needed to establish the effect of psychotherapy on disabling depression

Description of variables

<p><u>ICD</u>: International classification of diseases; +: associated with faster claim closure; −: associated with slower claim closure; O: associated with similar resolution; * − classifications of industry in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0067162#pone.0067162.s001" target="_blank">Table S1</a>; <u>LTD</u> – long term disability</p

Comparison between predictors associated with time to claim closure for short-term disability versus long-term disability claims

<p>Bold rows represent associations that were in the opposite directions of what we anticipated</p><p><u>STD</u>: short-term disability; <u>LTD</u>: long-term disability; +: associated with faster claim closure; -: associated with slower claim closure; O: associated with similar resolution; <u>NS*</u>: not significant but consistent with anticipated direction; <u>NS**</u>: not significant and not consistent with anticipated direction; <u>N/A</u> =  not included in the model</p

Kaplan Meier time to event curve of time to long-term disability claim closure

<p>Kaplan Meier time to event curve of time to long-term disability claim closure</p

Kaplan Meier time to event curve of time to short-term disability claim closure

<p>Kaplan Meier time to event curve of time to short-term disability claim closure</p

Factors predictive of time to short-term disability claim closure

<p>HR – hazard ratio; CI –confidence interval; ICD-10 – International Classification of Diseases version 10; * - Consists of Alberta, Saskatchewan, and Manitoba; ** - Consists of New Brunswick, NewFoundland, Nova Scotia and Prince Edward Island; ASO – Administrative Services Only</p><p>Factors that have a p-value of less than 0.01 are significant predictors of claim closure</p><p>An HR of greater than 1 is associated with faster claim closure; an HR of less than 1 is associated with slower claim closure</p

Factors predictive of time to long-term disability claim closure

<p>HR – hazard ratio; CI –confidence interval; ICD-10 – International Classification of Diseases version 10; * - Consists of Alberta, Saskatchewan, and Manitoba; ** - Consists of New Brunswick, NewFoundland, Nova Scotia and Prince Edward Island; ASO – Administrative Services Only</p><p>Factors that have a p-value of less than 0.01 are significant predictors of claim closure</p><p>An HR of greater than 1 is associated with faster claim closure; an HR of less than 1 is associated with slower claim closure</p