Two elements of cognitive therapy (CT) that have been shown to influence overall treatment outcome are therapeutic alliance and treatment adherence. When clients are also using antidepressant medication (ADM) in conjunction with therapy, these elements can dramatically increase positive outcome and reduce symptom severity. The early stages of therapy, specifically, the first few sessions, are critical to recovery, and change that occurs during these first sessions can be indicative of overall prognosis. Therefore, to further examine how alliance and adherence predict change, Daniel R. Strunk of the Department of Psychology at Ohio State University conducted a study that looked at how each of these variables affected symptom severity in a sample of 176 individuals with depression.
All of the participants were taking ADMs and were assessed after the first and third session of CT. Strunk found that the most significant indicator of change was the behavioral aspect of CT, although alliance did account for some change in the early sessions. The results showed that the participants were able to realize dramatic changes in depressive symptom severity when they adhered to the behavioral homework tasks instructed by the therapists. When Strunk compared these results to those of participants with varying ADM protocols, he found that again, the behavioral element of the CT was the strongest indicator of change in early sessions.
Strunk believes the findings of his study are important because they demonstrate the impact that the behavioral component of therapy has on symptom trajectory. Although therapeutic alliance is an important aspect of positive therapy and forms the foundation of future disclosure and transformation, focusing on behavioral trends appears to have a more immediate effect on negative symptoms. Strunk hopes that future endeavors in this area will yield similar results and if they do, would have profound clinical implications. He added, “Our results would suggest that behavioral methods/homework are uniquely important in combined treatment, while the positive effects of cognitive methods are less robust or negligible in this context.”
Strunk, D. R., Cooper, A. A., Ryan, E. T., DeRubeis, R. J., Hollon, S. D. (2012). The process of change in cognitive therapy for depression when combined with antidepressant medication: Predictors of early intersession symptom gains. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0029281
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