Childhood Abuse Survivors Respond Well to CBT for Depression

The most commonly used methods to treat major depressive disorder (MDD) are interpersonal psychotherapy (IPT), cognitive behavioral therapy (CBT), and antidepressants (ADM). Many people who seek treatment for MDD respond well to one or a combination of these types of treatments. But many who try them do not. For these individuals, the chance of relapse, recurrence, and further stress is significantly high. Being able to address the factors that prevent people from responding to treatment can help clinicians focus on finding treatments that work best for these unique individuals.

Childhood maltreatment is a significant life event that can severely traumatize an individual and lead to serious mental health problems, including MDD. Previous research has shown that individuals with a history of childhood abuse engage in avoidant behaviors that can prevent them from interacting with others and are at heightened risk for relapse and recurrence of depression. To determine which approach would best help these people recover from their depression, Kate L. Harkness of the Department of Psychology at Queen’s University in Ontario, Canada, led a study evaluating the outcomes of 203 participants with MDD with a history of extreme childhood trauma or abuse.

Harkness evaluated the participants as they went through 16 weeks of IPT, CBT, or ADM. They were assessed for childhood abuse, including emotional, sexual, and physical abuse and a follow-up was completed at 12 months. The results revealed that the participants with no history of abuse responded equally well to all forms of treatment. However, those with the most severe forms of childhood maltreatment responded the best to ADM, followed closely by CBT. Harkness believes there could be multiple explanations for these findings. First, these participants may need more than just 4 months of treatment to see improvements. Second, the avoidant behaviors used by these participants may prevent them from fully engaging with the therapist during IPT, thus compromising the therapeutic alliance, a key component of treatment success. Additionally, the most severely maltreated participants were also the most likely to suffer depression relapses, regardless of gains made in treatment. Harkness added, “These results suggest that proper assignment of patients to treatment and rigorous follow-up of these patients at greatest risk for recurrence has the potential to prevent a life-long pattern of illness.”

Harkness, K. L., Bagby, R. M., Kennedy, S. H. (2012). Childhood maltreatment and differential treatment response and recurrence in adult major depressive disorder. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0027665

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  • regan

    March 24th, 2012 at 4:46 AM

    I know that there are all of these elements that when combined can help those who have suffered abuse at the hands of another. What I think that we need to remember though is that for much of their lives a lot of them have been made to feel that they are not worth saving, that life would be better without them, so who is to say that even though they need it they are going to be willing to seek out the treatment when they feel this shamed and unworthy about theemselves?

  • Morgan

    March 25th, 2012 at 5:20 AM

    Sadly there are bound to be many victims of abuse who neither have the moneynor do they have the ability to seekout these multiple treatments.Some of them may just not have the strength to relive the abuse,and that is something that is so critical, to be able to confront the past and come up with some ways with your therapist that can help you to beat it. I am encouraged that IF the person is ready to come forward and heal, then there are ways that could ensure and more successful recovery. But it does take some willingness to seek out the help, and I honestly think that many abuse survivors are afraid to do just that.

  • Courtney

    March 25th, 2012 at 5:49 AM

    How we respond to therapy definitely depends on what we’ve been through.And if they are able to treat people based on that then there is fair chance that the treatment is better than what would have been if everyone was given the same therapy.Everybody’s needs are different and this couldn’t be more true in anything other than therapy.

  • shannon

    March 26th, 2012 at 4:19 AM

    Wonder if this works best alone or with the aids of antidepressants. I am a strong proponent of the fewer drugs to be ingested, then all the better. But I am certainly aware that in some cases meds can help to boost the effects of other treatments and that used in conjunction with cbt it could provide even greater chances for recovery.

  • dana

    October 7th, 2014 at 9:32 AM

    My stepfather from age 7 to 14 did sexual mental and physical abuse . medication and therapy are not working . I am 57 years old and I have been trying since 1995. I am giving up on faith and hope . there is no reason for me to keep trying. Can you tell me what this is all about what you are taking about?
    Is it some kind of treatment?

  • GoodTherapyAdmin

    October 7th, 2014 at 9:57 AM

    Thank you for your comment, Dana. We wanted to provide links to some resources that may be relevant to you here. We have more information about what to do in a crisis at

    Warm regards,
    The Team

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