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Unread September 16th, 2008, 10:04 AM
James Pretzer James Pretzer is offline
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Default Cognitive Therapy Skills and Risk of Relapse

While we assume that the skills we teach to clients are an important part of the effectiveness of CT, relatively few studies have tested to see if this is indeed the case. In a recent study Strunk, et al. (2007) examined whether clients' competence in using CT skills and their independent use of the skills is related to the risk of relapse. They studies 35 moderately- to severely-depressed individuals who responded to CT. Both competence in CT skills and in-session evidence of independent use of CT skills predicted lower relapse rate. This effect was not accounted for by symptom severity, degree of symptom change over the course of treatment, or post-treatment self-esteem.

Strunk, D. R., DeRubeis, R. J., Chiu, A. W., & Alvarez, J. (2007). Patients' competence in and performance of cognitive therapy skills: Relation to the reduction of relapse risk following treatment for depression. Journal of Consulting and Clinical Psychology, 75, 523-530.
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Unread January 7th, 2009, 11:11 PM
sk8rgrl23 sk8rgrl23 is offline
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Default Re: Relapse and recurrent major depression

Originally Posted by Gary Schroeder View Post
I think that for a long time it has been "common knowledge" among mental health professionals that the more episodes of clinical depression a patient has had (I'm talking about unipolar depression here, not bipolar disorder), the more likely it is that they need to take antidepressant medications for the rest of their lives, to prevent relapse.

However, I am aware that in recent years there has been some research (e.g., Hollon, et. al.) showing a lower relapse rate for patients receiving cognitive therapy than for patients taken off medications. I don't know if any such studies have included patients with recurrent major depression, or if the subjects were being treated for their first episode.

My question is, is there a body of research showing that if a patient with RECURRENT major depression succeeds with cognitive therapy, the patient may be able to remain euthymic over time without using antidepressant medications?

The reason I am asking this is that I am a psychologist seeing a patient with recurrent major depressive disorder in individual cognitive psychotherapy, and the patient (who is also being followed on meds by a psychiatrist colleague of mine) asked us if she will need to take the antidepressant medications for the rest of her life.

Thank you very much.
What about the role of eating right and exercise in combatting recurrent depression? Sometimes medicine focuses on the symptoms more than the cause. And I don't think enough recognition is given to the mind-body connection, which works both ways. If you don't feel well physically, you tend to be not in the best mood. And imagine feeling this way on a near-daily basis. How could that not lead to depression if everything feels like an insurmountable chore?

Which is not to say that people who exercise and eat well don't get depression. But if you combine mood enhancing behaviors with CT, the results may a source of natural antidepressants and possibly eliminate the need for medication. Also, if exercise can be something fun rather than a chore, this is time spent doing something construcitive instead of time left open to ruminate about depressing things.

I know this is all outside the CT box, but I truly believe that if clients want to get off meds they need to give diet and exercise a try.
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Unread January 8th, 2009, 05:28 PM
James Pretzer James Pretzer is offline
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Default Re: Relapse and recurrent major depression

Whether or not clients want to get off of medication, diet and exercise can be important. Certainly, if an individual is not eating a reasonably balanced diet, getting regular exercise, getting enough sleep, participating in rewarding relationships, and engaging in enjoyable activities, they are at increased risk for a variety of problems. Books on CT often don't emphasize this because authors assume it should be obvious and because it applies to all approaches to therapy, not just CT or CBT. This doesn't mean that CT doesn't address these issues, we address them routinely. For example, see judy Beck's recent books on diet.

Yesterday I had a session with a client complaining of tension, anxiety, and insomnia. He also mentioned drinking 40 oz/day of caffeinated soda. This obviously is something we need to address.
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