A component analysis of cognitive-behavioral treatment for depression.

TLDR

The study experimentally tested Beck et al.’s theory of change explaining why cognitive‑behavioral therapy (CBT) is effective for depression. One hundred fifty outpatients with major depression were randomly assigned to receive either behavioral activation alone, behavioral activation plus automatic‑thought modification, or full CBT, all delivered by four experienced therapists. Results showed that full CBT did not outperform the component treatments in symptom reduction or 6‑month follow‑up, and that both behavioral activation and automatic‑thought modification were equally effective in changing negative thinking and attributional styles, with attributional style predicting outcomes only in the behavioral activation group.

Abstract

The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.