EPRESSION IS COMMON, WITHthe 1-year prevalence rate of major depressive disorder estimated at between 6.6% and 10.3% in the general population 1,2 and roughly 25% of all primary care visits involving patients with clinically significant levels of depression. 3 Psychotherapy is effective at treating depression, 4 and most primary care patients prefer psychotherapy to antidepressant medication. 5 When referred for psychotherapy, however, only a small percentage of patients follow through. 6 Attrition from psychotherapy in randomized controlled trials is often 30% or greater 7 and can exceed 50% in clinical practice. 8 The discrepancy between patients' preference for psychotherapy and the low rates of initiation and adherence is likely due to access barriers. Approximately 75% of depressed primary care patients report barriers that make it extremely difficult or impossible to attend regular psychotherapy sessions. 9,10 These barriers are largely structural and include time constraints, lack of available and accessible services, transportation problems, and cost.

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Focused cognitive therapy offers a promising nonpharmacological alternative for the treatment of panic disorder.