An Evaluation of the ‘Coping with Depression Course’ for Relapse Prevention with Unipolar Depressed Patients

Abstract

Background: Patients with treated episodes of depression are at high risk of relapse and recurrence. This study describes the clinical course of patients who had received cognitive-behavioral group intervention for relapse prevention. Method: Forty-four remitted unipolar depressed patients with recently treated episodes of illness participated in a 16-week group program, the ‘Coping with Depression Course’ (CWD). The majority of patients had suffered from multiple episodes of depression and nearly half of them were only partially remitted when they started the program. Assessments took place throughout the intervention and 17–23 months after the pretest. Descriptive analyses included proportions of reliable and clinically significant improvements, and cumulative relapse rates were estimated using survival analysis. Results: At posttest, residual depression and dysfunctional attitudes had significantly decreased. Improvements were similar in patients with and those without parallel antidepressant medication. Two thirds of patients starting within a dysfunctional depression range showed a clinically significant improvement at the end of the intervention. The estimated cumulative relapse rates at 6, 12, 17, and 23 months after pretest were 13.6, 30.0, 37.0 and 44.9%. Conclusions: Participants appeared to be protected from relapse during active intervention, but a substantial proportion suffered relapses in the postintervention period. Further research into the CWD is needed within the framework of randomized controlled trials.

Differential Predictors of Response to Preventive Cognitive Therapy in Recurrent Depression: A 2-Year Prospective Study

“…The most striking nondifferential predictors of earlier time to recurrence were more residual depressive symptomatology and higher levels of dysfunctional attitudes. In previous studies cognitive behavior treatment was found to be effective in decreasing residual symptoms of depression and dysfunctional attitudes, although true mediation of treatment effect by these changes has not been tested [6, 32]. Unexpectedly in this study these presumed risk factors [30, 33] did not differentially predict recurrence.…”

Efficacy of the sequential integration of psychotherapy and pharmacotherapy in major depressive disorder: a preliminary meta-analysis

“…We excluded seven other studies because they either did not report relapse rates (Barhofer et al . 2007; Kingston et al 2007), were not randomized controlled trials (Klerman et al 1974; Kühner et al 1996; Blackburn & Moore, 1997; Kühner, 2005) or focused on telephone-based psychotherapy as opposed to face-to-face sessions (Miller & Weissman, 2002). We also excluded three studies of the sequential use of psychotherapy either because they involved patients who had successfully responded to antidepressant drugs, and then relapsed (Fava et al 2002; Fabbri et al 2007), or because they involved patients who had not remitted with acute-phase psychotherapy (Frank et al 2000).…”

Group cognitive–behavioural therapy for anxiety and depression

“…The recently updated NICE guidelines on depression (National Collaborating Centre for Mental Health 2009a) state that there is a place within the stepped care model of treatment for group CBT based on the 'Coping with Depression' approach (Lewinsohn 1989;Kuehner 2005). This approach, which uses the concepts of traditional CBT, has a strong psychoeducational element and consists of twelve 2-hour sessions over 8 weeks (sessions are twice weekly for the first 4 weeks).…”