In the NIMH Treatment of Depression Collaborative Research Program (TDCRP), 250 depressed outpatients were randomly assigned to interpersonal psychotherapy, cognitive-behavioral therapy, imipramine plus clinical management, or pill placebo plus clinical management treatments. Although all treatments demonstrated significant symptom reduction with few differences in general outcomes, an important question concerned possible effects specific to each treatment. The therapies differ in rationale and procedures, suggesting that mode-specific effects may differ among treatments, each of which was precisely specified, applied appropriately, and shown to be discriminable. Outcome measures were selected for presumed sensitivity to the different treatments. Findings provided only scattered and relatively insubstantial support for mode-specific differences. None of the therapies produced consistent effects on measures related to its theoretical origins.

Objective: The authors investigated patient characteristics predictive of treatment response in the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program. Method: Two hundred thirty-nine outpatients with major depressive disorder according to the Research Diagnostic Criteria entered a 16-week multicenter clinical trial and were randomly assigned to interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Pretreatment sociodemographic features, diagnosis, course of illness, function, personality, and symptoms were studied to identify patient predictors of depression severity (measured with the Hamilton Rating Scale for Depression) and complete response (measured with the Hamilton scale and the Beck Depression Inventory). Results: One hundred sixty-two patients completed the entire 16-week trial. Six patient characteristics, in addition to depression severity previously reported, predicted outcome across all treatments:social dysfunction, cognitive dysfunction, expectation of improvement, endogenous depression, double depression, and duration of current episode. Significant patient predictors of differential treatment outcome were identified. 1) Low social dysfunction predicted superior response to interpersonal psychotherapy. 2) Low cognitive dysfunction predicted superior response to cognitive-behavior therapy and to imipramine. 3) High work dysfunction predicted superior response to imipramine. 4) High depression severity and impairment of function predicted superior response to imipramine and to interpersonal psychotherapy. Conclusions: The results demonstrate the relevance of patient characteristics, including social, cognitive, and work function, for prediction of the outcome of major depressive disorder.They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities, which may be of value in the selection of patients for alternative treatments.

An instrument was developed to measure the cognitive triad conceptualized by Beck to be an important variable in depression (Beck, Rush, Shaw, & Emery, 1979). Reliability and validity statistics are reported on an original sample of 26 depressed patients and a replication sample of 28 depressed patients. The scale and its subscales were found to have high internal reliability. Comparison with rater measures and with two self-report measures, the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and the Hopelessness Scale (Beck, Weissman, Lester, and Traxler, 1974) showed the Cognitive Triad Inventory (CTI) and its subscales to have good convergent validity.

Thirty-seven middle-aged alcoholics and 20 nonalcoholic controls equated for age and education were examined on measures of verbal, learning/memory, abstracting/problem-solving, and perceptual-motor abilities 7 weeks after beginning detoxification and 13 months later. At 7 weeks, the alcoholics were significantly different from the controls on the verbal, abstracting/problem-solving, and perceptual-motor clusters and tended to differ on the learning/memory tests. At 13 months, the same pattern of differences was found except the groups no longer differed on the verbal tests. Alcoholics who resumed drinking during the 13 months differed from the controls to a greater extent than did abstainers on both the initial and final testings. These results have implications for treatment programs and recidivism.

No abstract