Predictors of Depressive Relapse During a Two Year Prospective Follow-up after Cognitive and Behavioral Therapies

Abstract

Patient characteristics may partly explain individual differences in long-term maintenance of treatment gains in response to cognitive and behavioral therapies (CBT). This study evaluated the relative contribution of negative cognitive style, behavioral activation, and personality patterns, measured at the end of treatment among treatment responders, towards the risk of relapse of major depressive disorder over a 2-year prospective follow-up. The sample included depressed adults who were randomized and received an adequate dose of one of three forms of CBT, who then fully responded and completed a 2-year prospective follow-up (N = 93) (Jacobson et al., 1996;Gortner, Gollan, Dobson and Jacobson, 1998). Cox regression analyses revealed that for treatment responders, self-devaluative depressogenic cognitive style did not predict relapse during the 2-year follow-up. Separate cox regression analyses indicated that without considering the contribution of personality patterns, it was important to distinguish the level of behavioral activation (e.g. frequency of pleasant events) from its associated pleasure in predicting relapse. With the introduction of personality patterns; however, an integrated model revealed that only dependent personality pattern was associated with hazard of relapse during the 2-year prospective follow-up. Dependent personality pattern may increase relapse through behavioral passivity.

Exploring sudden gains in behavioral activation therapy for Major Depressive Disorder

“…About half of patients with MDD treated with behavioral psychotherapy report partial treatment response (Gollan, Gortner, & Dobson, 2006), and up to 75% achieve response or remission at long-term follow-up after a course of behavioral therapy (Dimidjian et al, 2006; Hopko et al, 2011). Identifying predictors of positive changes during behavioral therapies will improve our understanding of differential course of improvement during treatment.…”

A Behavior Genetic Analysis of Pleasant Events, Depressive Symptoms, and Their Covariation

“…As such, it may be that people who report receiving less enjoyment from the experience of pleasant events may be less likely to benefit from behavioral treatments for depression. In support of this perspective, Gollan et al (2006) reported that lower enjoyment of pleasant events, but not frequency of pleasant events, was associated with higher relapse rates following cognitive and behavioral treatments of depression. Although there has been little research on predictors of outcome specifically on behavioral treatments for depression, the current findings suggest that genetic vulnerability, as evidenced by family history of depression or presence of genetically-influenced personality traits (e.g., high neuroticism, low positive emotionality), may predict poorer response to BA or higher relapse rates following BA.…”

“…Although there has been little research on predictors of outcome specifically on behavioral treatments for depression, the current findings suggest that genetic vulnerability, as evidenced by family history of depression or presence of genetically-influenced personality traits (e.g., high neuroticism, low positive emotionality), may predict poorer response to BA or higher relapse rates following BA. In partial support of this perspective, Gollan et al (2006) found that a higher level of dependent personality traits was associated with greater likelihood of relapse following cognitive and behavioral treatments of depression, and that the association between enjoyment of pleasant events and depressive relapse was no longer significant when controlling for dependent personality. Therefore, to the extent that genetically influenced traits contribute both to the experience of pleasant events and depression, then individuals with high genetic vulnerability for depression may be less likely to respond to and more likely to relapse following behavioral treatments for depression.…”

“…More recent findings regarding pleasant events and depression are consistent with these earlier studies evaluating the behavioral model of depression (e.g., Mausbach, Roepke, Depp, Patterson, & Grant, 2009). For example, in a 2-year follow-up of people who responded to cognitive-behavior therapy, people with lower ratings of enjoyment from pleasant events were more likely to relapse than people with higher ratings of enjoyment (Gollan, Gortner, & Dobson, 2006). …”

The negativity bias predicts response rate to Behavioral Activation for depression

“…Patient predictors of positive treatment response for BA include a lower endorsement of existential reasons for depression (Addis & Jacobson, 1996); higher depressive severity (Dimidjian et al, 2006), limited comorbidity, being married (Colman et al, 2009), and diminished hostility (Gollan, Gortner, & Dobson, 2006). BA responders show an increased activation of a brain region involved with affective responses to positive and negative stimuli (paracingulate gyrus) and with cognitive flexibility (Dichter et al, 2010; Dichter, Felder & Smolski, 2009).…”