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Am J Psychiatry 1992; 149:1046-1052
Copyright © 1992 by American Psychiatric Association
Relapse after cognitive behavior therapy of depression: potential implications for longer courses of treatment
ME Thase, AD Simons, J McGeary, JF Cahalane, C Hughes, T Harden and E Friedman
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15213.
OBJECTIVE: The authors studied the risk of relapse among depressed patients
after cognitive behavior therapy in order to document the need and
potential indications for longer-term models of treatment. METHOD:
Forty-eight patients with major depression who responded during a 16- week
course of cognitive behavior therapy entered a 1-year prospective follow-up
study, as did two patients who received 20 weeks of therapy. Standardized,
independent clinical assessments were completed 1, 3, 6, 9, and 12 months
after treatment. Relapse was defined as, at minimum, a 2-week period in
which the subject met the DSM-III-R criteria for major depression and had a
Hamilton depression scale score of 15 or more. RESULTS: Sixteen patients
(32%) relapsed during the 1-year follow-up. Correlates of relapse included
a history of depressive episodes, higher levels of depressive symptoms and
dysfunctional attitudes, slower response to therapy, and being unmarried.
Patients who fully recovered during therapy (Hamilton depression score of 6
or less for 8 weeks or more) were at significantly lower risk for relapse
than those who partially recovered (9% and 52%, respectively). Slower
response to therapy, unmarried status, and high residual scores on the
Dysfunctional Attitudes Scale were independently and additively related to
increased risk of relapse. CONCLUSIONS: These findings provide further
evidence of a relation between residual symptoms and relapse after
cessation of active treatment. The authors strongly recommend that models
of longer-term psychotherapy be developed for depressed patients who do not
recover fully during time-limited cognitive behavior therapy.
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