Moderate to severely depressed clients showed greater improvement in cognitive therapy when therapists emphasized changing how they think rather than how they behave, new research has found.
Results of the study, appearing recently in the journal Behavior Research and Therapy, suggest cognitive therapists should concentrate, at least during the first few sessions, on using cognitive techniques to help those with more severe depression to break out of negative thought patterns and to see events in their lives more realistically.
Concentration on changing behavior – such as having patients schedule activities to get them out of the house, and tracking how they spent their time – did not significantly predict subsequent change in depressive symptoms, the study found.
“There has been a lot of attention recently on behavioral approaches to treating severe depression, and that may lead some people to suspect that cognitive techniques are not important for more severely depressed patients,” said Daniel Strunk, co-author of the study and assistant professor of psychology at Ohio State University.
“But our results suggest that it was the cognitive strategies that actually helped patients improve the most during the first critical weeks of cognitive-behavioral therapy.”
The study involved 60 patients who were diagnosed with major depression and who were being treated at two university clinics. Investigators focused on the first few weeks of therapy because other studies suggest that is when patients make the largest improvement in depression levels, Strunk said.
Results showed that patients’ depression scores improved significantly when their therapists focused on cognitive techniques, but didn’t change when their therapists focused on behavioral techniques.
Patients also improved more when they collaborated with their therapists about a plan for treatment and followed that plan and patients also showed greater improvement when they were more engaged in the therapy process and were open to suggestions from their therapist.
“If you’re a patient and willing to fully commit to the therapy process, our data suggest you will see more benefit,” Strunk sad.
“In our sample of cognitive therapy patients, cognitive techniques appeared to promote a lessening of depression symptoms in a way that was not true of behavioral techniques,” he said.