Discontinuities and cognitive changes in an exposure-based cognitive therapy for depression.

Abstract

Significant shifts or discontinuities in symptom course can mark points of transition and reveal important change processes. The authors investigated 2 patterns of change in depression-the rapid early response and a transient period of apparent worsening that the authors call a depression spike. Participants were 29 patients diagnosed with major depressive disorder who enrolled in an open trial of an exposure-based cognitive therapy. Hierarchical linear modeling revealed an overall cubic shape of symptom change and that both the rapid response and spike patterns predicted lower posttreatment depression. Patients wrote weekly narratives about their depression. Early narratives of rapid responders were coded as having more hope than those of nonrapid responders. The narratives of patients with a depression spike had more cognitive-emotional processing during this period of arousal than those without a spike. Findings are discussed in the context of cognitive-emotional processing theories in depression and anxiety disorders.

Internalizing and Externalizing Symptoms Moderate Treatment Response to School-Based Trauma and Grief Component Therapy for Adolescents

“…As expected, students with more internalizing symptoms showed the most benefit from treatment components in which they shared their trauma narratives (a Module II component) or loss narratives (a Module III component). These findings are consistent with prior research showing that depressed or anxious adults participating in exposure therapy experience an initial increase in symptoms due to anticipated distress, though their symptoms continue to dissipate during the exposure phase as they learn they are able to tolerate this distress (e.g., Hayes et al, 2007;Heimberg & Becker, 2002). The sharing of narratives in a supportive group context may be particularly valuable for reducing negative self-attributions or shame associated with trauma or lossrelated experiences in internalizing students (Davies et al, 2006).…”

Felicidad y esperanza subjetiva

“…In this context, hope to be the best predictor for resilience was in line with the literature suggesting that hope encourages resilience (Benard, 1999;Brooks, 2006;Gizir, 2004;Masten, 2001;Ong, Edwards, & Bergeman, 2006;Synder et al, 2000). Moreover, hope is a protective factor for human adaptation, and for psychotherapeutic change (Magaletta & Oliver, 1999;Hayes et al, 2007), being consistently identified as a key factor in psychological counseling by client, family members and therapists in various settings (Schrank, Stanghellini, & Slade, 2008;Redlich, Hadas-Lidor, Weiss, & Amirav, 2010). …”

Complexity and Nonlinear Dynamics in Psychotherapy

“…Because these changes occurred before the flooding procedure was started, this can be seen as indicator of an early rapid response in the therapy. 5,13,14 Additionally, marked alternations in brain activity were to be Figure 7. Functions of repeated internet-based self-evaluations (by the use of a therapy process questionnaire or other usual instruments) and of the computer based feedback for patient and therapist.…”

“…Specific effects can occur even before the specific treatment components were realized and brought into action in a treatment program. [11][12][13][14][15][16] For example: cognitive restructuring takes place before the beginning of irrational beliefs treatment in cognitive behavioral therapy, or reduction of compulsions before the flooding begins. 3.…”