An examination of dysfunctional attitudes and extreme response styles as predictors of relapse in guided internet‐based cognitive behavioral therapy for depression

Abstract

Objectives: Internet-based cognitive behavioral therapy (iCBT) is an effective treatment option for depression, but its long-term effects are not well understood. We investigate for whom iCBT may have more enduring effects by evaluating dysfunctional attitudes as predictors of relapse. Methods:The sample consists of 31 iCBT responders (20 women, average age 31.6) who were followed for 1 year.Results: Higher Dysfunctional Attitudes Scale scores predicted higher risk of relapse (hazard ratio = 1.98). This relation remained significant when controlling for high style (dysfunctional) or content (functional) responses.Having relatively more positive extreme responses on style rather than content items did not predict risk of relapse. Conclusions:Our results were consistent with the value of differentiating an extreme style of responding from otherwise endorsing belief in dysfunctional attitudes.Research that refines our understanding of patients' individual risk for relapse has the potential to inform how treatment might be individually tailored. K E Y W O R D S depression, dysfunctional attitudes, internet-based cognitive behavioral therapy, relapse

Impact of the CBT-Meno protocol on menopause-specific beliefs, dysfunctional attitudes, and coping behaviors

“…In addition to improvements in all three menopause-specific belief domains assessed, women in CBT-Meno reported significantly greater improvements than waitlist in dysfunctional attitudes associated with depressive symptoms. This finding is particularly promising given that endorsement of dysfunctional attitudes has been identified as a risk factor for depressive episodes 42 and may increase the risk for later relapse after treatment 43,44 …”

“…This finding is particularly promising given that endorsement of dysfunctional attitudes has been identified as a risk factor for depressive episodes 42 and may increase the risk for later relapse after treatment. 43,44 With respect to problematic menopause-related behaviors, women in the CBT-Meno condition reported improvements, including reductions in avoidance of situations in which menopause symptoms might occur and improvements in their ability to engage in positive coping behaviors related to their symptoms. By the end of the CBT-Meno protocol, participants were therefore actively engaging in positive strategies that are thought to reduce the impact of distress related to common menopausal symptoms.…”

Impact of messaging on views of depression treatment options: Examining credibility and expectations

“…As noted above, a historical version assessed the worst 2‐week period. This version of the PHQ‐9 asked participants to identify a 2‐week period in their life when their depressive symptoms have been most severe and asked: “For the questions that follow, please indicate how often during that 2‐week period you were bothered by the following problems.” Although use of this version of the PHQ‐9 still needs further psychometric evaluation (see Ezawa et al, 2020), the approach is similar to that used in assessed depressive episodes using the Longitudinal Interval Follow‐up Evaluation (LIFE; Keller et al, 1987). The LIFE is a gold standard for assessing the onset of depressive episodes longitudinally (see Hollon et al, 2005).…”

Guest editorial: Introduction to the special issue on telepsychology: Research, training, practice, and policy

“…Their findings provide informative insights about the client experience of an intervention ostensibly designed to facilitate client strengths and assets. Client dysfunctional attitudes associated with relapse one‐year following an internet‐based cognitive behavioral therapy are investigated in the study by Ezawa, Forand, and Strunk (2020).…”