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Title: A study of the effectiveness of cognitive therapy and pharmacotherapy, each alone, and in combination, in the treatment of depressed outpatients
Author: Bishop, S.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1980
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The three main aims of this research were: (1) to compare a specific and time-limited form of psychotherapy, namely cognitive therapy, with pharmacotherapy (drug of choice) in the treatment of depression, (2) to test out the effect of combining cognitive therapy and pharmacotherapy (drug of choice) and (3) to investigate the efficacy of these modes of treatment relative to one another in two populations, outpatients from a teaching hospital from the community, i.e. a general practice. Depressed patients were referred from two sources, a hospital outpatient clinic and a general practice clinic, and were screened using a standard psychiatric interview, the Present State Examination, for elicitation of symptoms and signs. On the basis of this interview, Spitzer's research diagnostic criteria were checked. All of the patients admitted to the study satisfied the criteria for primary major depressive disorder. In addition, level of self-reported depression had to be at least mild according to the British norms of the Back Depression Inventory (i.e. > 14). Eighty-eight patients were randomly assigned to pharmacotherapy (drug of choice), individual treatment with cognitive therapy or a combination of pharmacotherapy (drug of choice) and individual cognitive therapy. For the cognitive therapy and combination treatment, the protocol specified a maximum of 20 weeks, with both cognitive therapy groups attending twice a week at the beginning and once a week thereafter. The pharmacotherapy patients were prescribed therapeutic doses appropriate to each drug. If no response occurred (i.e. at least a 50% reduction in level of depression) after a maximum of twelve weeks of treatment, patients wore dropped from the trial whatever type of treatment they received. In the hospital sample all three treatment groups showed statistically significant decreases in depressive symptoms. Combination treatment resulted in greater improvement then did cognitive therapy alone and pharmacotherapy alone on a number of mood and cognitive measures. In the general practice population, combination treatment and cognitive therapy alone resulted in statistically significant decreases in depressive symptoms whereas pharmacotherapy, on the whole, failed to reduce depressive symptoms. Both combination treatment and cognitive therapy alone resulted in significantly greater decreases in depressive symptoms than did pharmacotherapy on several measures of mood and a cognitive measure. When responders only were examined, pharmacotherapy, cognitive therapy and combination treatment produced different patterns of response over the treatment period in terms of self-reported depression and hopelessness. Combination treatment in particular, but cognitive therapy as well, resulted in a quicker and sharper effect then pharmacotherapy, especially on hopelessness, a variable that is reported to correlate highly with suicidal intent. In terms of attrition, no one treatment was better than any other in reducing the number of drop outs from therapy in each population. It was concluded that cognitive therapy is at least as effective as pharmacotherapy in the treatment of hospital outpatients end that it is more effective than pharmacotherapy in depressed general practice patients. Further, the combination of pharmacotherapy and individual cognitive therapy may be particularly useful in the treatment of chronically depressed hospital outpatients.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available