Cognitive therapy (CT) is one of the most commonly used approaches for the treatment of major depression. The techniques used in CT are broad and diverse and allow for therapists to either adhere stringently to the traditional CT strategies or to use more liberal and abstract delivery methods. Also at the core of CT and many other therapies is the therapeutic alliance, which embodies the relationship bond between the client and therapist. This is seen as vital to the foundation of treatment and is the base from which all future progress is formed. There is a wealth of research that demonstrates the importance of the therapeutic alliance and some research that has shown the importance of CT adherence. But until recently, little research has focused on which factor impacts treatment outcome the most. To determine whether CT adherence or therapeutic alliance is more influential on depressive symptoms, Christian A. Webb of the Department of Psychology at the University of Pennsylvania recently conducted a study involving patients with depression.
Webb examined data collected from the Cognitive Pharmacotherapy–II study (CPT-II) and the University of Washington (UW) cognitive therapy study. He found mixed results among the 105 participants. Specifically, Webb discovered that among the individuals who had participated in the CPT-II study, CT adherence was the most influential factor relating to their acquisition of CT tools and knowledge. This was measured by assessing how often the participants used their new skills between sessions, an important indicator of future symptom reduction. However, Webb also found that in the UW study, the participants realized bigger gains as a direct result of the therapeutic alliance. After further examination, Webb found that this effect existed only in those participants with mild symptom severity. For the participants with significant depressive symptoms, CT adherence was the strongest predictor of symptom reduction in both studies. Webb believes these results, although somewhat contradictory, can expand the understanding of how to best help depressed clients. He added, “Such findings could ultimately yield important clinical implications for the treatment of depression with CT.”
Webb, C. A., DeRubeis, R. J., Dimidjian, S., Hollon, S. D., Amsterdam, J. D., Shelton, R. C. (2012). Predictors of patient cognitive therapy skills and symptom change in two randomized clinical trials: The role of therapist adherence and the therapeutic alliance. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0027663
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