This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (77)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Randomized Controlled Trial  • Cognitive Therapy  • Depression  • Alert me on articles by topic

A Randomized Clinical Trial

Robin B. Jarrett, PhD; Dolores Kraft, PhD; Jeanette Doyle, MA; Barbara M. Foster, PhD; G. Greg Eaves, PhD; Paul C. Silver, PhD

Arch Gen Psychiatry. 2001;58:381-388.

Background  Cognitive therapy (CT) may reduce depressive relapse and recurrence when patients learn and use the associated skills. Reported relapse and recurrence rates after CT discontinuation vary widely. The factors that determine when CT is preventive remain unidentified. We developed continuation-phase CT (C-CT) to teach responders skills to prevent relapse. This is the first randomized trial comparing CT with and without a continuation phase in responders to CT who were vulnerable, given their history of recurrent unipolar depression.

Methods  Patients aged 18 to 65 years (n = 156) with recurrent DSM-IV major depressive disorder (MDD) entered 20 sessions of acute-phase CT (A-CT). Unmedicated responders (ie, no MDD and 17-item Hamilton Rating Scale for Depression score 9; n = 84) were randomized to either 8 months (10 sessions) of C-CT or control (evaluation without CT). Follow-up lasted an additional 16 months. A clinician blind to assignment evaluated relapse and recurrence (ie, DSM-IV MDD).

Results  Over an 8-month period, C-CT significantly reduced relapse estimates more than control (10% vs 31%). Over 24 months, including the CT-free follow-up, age of onset and quality of remission during the late phase of A-CT each interacted with condition assignment to influence durability of effects. In patients with early-onset MDD, C-CT significantly reduced relapse and recurrence estimates (16% vs 67% in control). When patients had unstable remission during late A-CT, C-CT significantly reduced relapse and recurrence estimates to 37% (vs 62% in control).

Conclusions  Findings suggest that 8 months of C-CT significantly reduces relapse and recurrence in the highest-risk patients with recurrent MDD. Risk factors influenced the necessity for C-CT.

From The University of Texas Southwestern Medical Center at Dallas.

Corresponding author and reprints: Robin B. Jarrett, PhD, The University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd, Dallas, TX 75390-9149.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cognitive Therapy Versus Medication in Augmentation and Switch Strategies as Second-Step Treatments: A STAR*D Report
Thase et al.
Focus 2008;6:104-119.
ABSTRACT | FULL TEXT  

Randomized Trial of Weekly, Twice-Monthly, and Monthly Interpersonal Psychotherapy as Maintenance Treatment for Women With Recurrent Depression
Frank et al.
Focus 2008;6:120-127.
ABSTRACT | FULL TEXT  

A Pilot Study of Telephone Care Management and Structured Disease Self-Management Groups for Chronic Depression
Ludman et al.
Psychiatr. Serv. 2007;58:1065-1072.
ABSTRACT | FULL TEXT  

Cognitive Therapy Versus Medication in Augmentation and Switch Strategies as Second-Step Treatments: A STAR*D Report
Thase et al.
Am. J. Psychiatry 2007;164:739-752.
ABSTRACT | FULL TEXT  

Randomized Trial of Weekly, Twice-Monthly, and Monthly Interpersonal Psychotherapy as Maintenance Treatment for Women With Recurrent Depression
Frank et al.
Am. J. Psychiatry 2007;164:761-767.
ABSTRACT | FULL TEXT  

Antidepressants and Psychotherapy: A Clinical Research Review
Frank et al.
Focus 2006;4:581.
FULL TEXT  

Cognitive Behavior Therapy: Basic Principles and Recent Advances
Wright
Focus 2006;4:173.
FULL TEXT  

The Current State of Cognitive Therapy: A 40-Year Retrospective
Beck
Arch Gen Psychiatry 2005;62:953-959.
ABSTRACT | FULL TEXT  

Relapse Prevention in Patients With Bipolar Disorder: Cognitive Therapy Outcome After 2 Years
Lam et al.
Am. J. Psychiatry 2005;162:324-329.
ABSTRACT | FULL TEXT  

Six-Year Outcome of Cognitive Behavior Therapy for Prevention of Recurrent Depression
Fava et al.
Am. J. Psychiatry 2004;161:1872-1876.
ABSTRACT | FULL TEXT  

Effect on Disability Outcomes of a Depression Relapse Prevention Program
Von Korff et al.
Psychosom. Med. 2003;65:938-943.
ABSTRACT | FULL TEXT  

Continuation phase cognitive therapy reduced relapse or recurrence in recurrent DSM-IV major depressive disorder
Garland
Evid. Based Ment. Health 2001;4:111-111.
FULL TEXT  

Other Articles Noted
Evid. Based Nurs. 2001;4:E1-11.
FULL TEXT  

Continuation Psychotherapy for Major Depression
JWatch Psychiatry 2001;2001:4-4.
FULL TEXT  

Continuation of Cognitive Therapy Prevents Depression Relapse
JWatch Women's Health 2001;2001:7-7.
FULL TEXT