Although many studies report that the therapeutic alliance predicts psychotherapy outcome, few exclude the possibility that this association is accounted for by 3rd variables, such as prior improvement and prognostically relevant patient characteristics. The authors treated 367 chronically depressed patients with the cognitive-behavioral analysis system of psychotherapy (CBASP), alone or with medication. Using mixed effects growth-curve analyses, they found the early alliance significantly predicted subsequent improvement in depressive symptoms after controlling for prior improvement and 8 prognostically relevant patient characteristics. In contrast, neither early level nor change in symptoms predicted the subsequent level or course of the alliance. Patients receiving combination treatment reported stronger alliances with their psychotherapists than patients receiving CBASP alone. However, the impact of the alliance on outcome was similar for both treatment conditions.

The main theme of this volume is that depression needs to be understood in its interpersonal context. Regardless of what other factors may be involved, the interpersonal context affects greatly whether a person becomes depressed, the person's subjective experience while depressed, and the behavioral manifestations and resolution of the disorder. Consideration of the interpersonal context of depression is simply a necessity for an adequate account of the disorder. A failure to take into account the intricacies of depressed persons' involvement with other people causes one to attribute to depressed persons characteristics they do not possess and to leave significant aspects of their experience unexplained.Clinicians have long been impressed by the impact of depressed patients on others. Consider the following passages from clinicians:Sigmund Freud (1917/1951): Their complaints are really "plaints" in the legal sense of the word . . . everything derogatory that they say of themselves at bottom relates to someone else.. . . They give a great deal of trouble, perpetually taking offense and behaving as if they had been treated with great injustice. (p-247) 3

This study evaluated the relationship between precessation depressed mood and smoking abstinence and assessed the mediation of this effect by postcessation self-efficacy, urges to smoke, nicotine withdrawal, and coping behavior. The sample included 121 smokers previously treated in a randomized controlled trial involving behavior therapy and the nicotine patch. The results showed that precessation depressed mood was inversely related to 6-month abstinence. This effect remained significant after controlling for treatment, possible depression history, baseline smoking rates, and several other demographic factors. Postcessation self-efficacy, at the 2-, 4-, and 8-week postquit assessments, was the strongest mediator of the effects of precessation depressed mood on abstinence, accounting for 32%, 38%, and 48% of the effect of mood on abstinence, respectively.

Objective-The objective of this study was to evaluate a depression-focused treatment for smoking cessation in pregnant women, versus a time and contact health education control. We hypothesized that the depression-focused treatment would lead to improved abstinence and reduced depressive symptoms among women with high levels of depressive symptomatology. No significant main effects of treatment were hypothesized.Method-Pregnant smokers (N=257) were randomly assigned to a 10-week intensive depressionfocused intervention (Cognitive Behavioral Analysis System of Psychotherapy-CBASP) or to a time and contact control focused on health and wellness (HW); both included equivalent amounts of behavioral and motivational smoking cessation counseling. Fifty-four percent of the sample was African American; 37% met DSM-IV criteria for major depression; mean age (SD) was 25 (5.9) and women averaged 19.5 (8.5) weeks gestation at study entry. Ongoing symptoms of depression were measured using the Center for Epidemiological Studies Depression scale (CES-D).Results-The results showed that at 6-months posttreatment, women with higher levels of baseline depressive symptoms treated with CBASP had a higher probability of prolonged abstinence (F(1,253) =5.61, p=.02) and more improved depression (F(1,2620)=10.49, p=.001) than those treated with HW, whereas those with low baseline depression fared better in HW. The differences in abstinence were not retained at 6-months postpartum. Conclusions-The results suggest that pregnant women with high levels of depressive symptoms may benefit from a depression-focused treatment in terms of improved abstinence and depressive symptoms, both of which could have a combined positive effect on maternal and child health.Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/ccp NIH Public Access Pritchard, 1994;Solomon et al., 2006;Zhu & Valbo, 2002) as well as post-partum relapse . There is evidence that depression clusters with SES and other risk factors for persistent smoking during pregnancy, and that the clustering of such factors predicts smoking in a gradient fashion (Kahn, Certain, & Whitaker, 2002). That depression cooccurs with low SES is not surprising. Children who grow up with low SES parents are at two to three times greater risk for developing major depressive disorder (MDD) than those who grow up with parents of higher SES, even when parental MDD status is controlled (Ritsher, Warner, Johnson, & Dohrenwend, 2001;Gilman, Kawachi, Fitzmaurice, & Buka, 2002). Because persistent smoking du...

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