Improvement after evaluation in psychotherapy of depression: Evidence of a placebo effect?

Abstract

Thirty‐two patients were seen by psychiatry residents, psychology interns, and social work fellows who were learning congnitive therapy of depression. Of these, 23 patients attended sufficient sessions for early response to be categorized as responding or not responding. Rapid response was not associated with positive perception of the therapist by the patient, self‐control scores, or patient collaboration as viewed by the therapist. The BDI score at intake was moderately predicitive of the BDI score at session 6, but it did not predict percent improvement. However, depressive severity at the beginning of session one was strongly predictive of the sixth session BDI, and it also predicted percent improvement. Another prdictor of respose was improvement in mood in the first therapy session, as measured by the VAS. However, outcome variance explained by the VAS did not significantly add to outcome variance explained by the first session BDI. Results are interpreted as indicating that imrpvement may be due to (1) a powerful beneficial effect the originates within the patient‐therapist matrix and independent of therapist techniques; or (2) a continuing improvement process that began prior to entering treatment.

The influence of interpersonal factors on the speed of recovery from major depression

“…This method exclusively emphasizes the importance of early changes and their impact on therapeutic outcome (e.g., Ilardi & Craighead, 1994). As in sudden gain research, early response studies have found that patients who experience an early response are more likely to benefit from better end-of-treatment and followup outcomes than those who do not (Beckham, 1989;Fennell & Teasdale, 1987;Haas et al, 2002;Olmsted, Kaplan, Rockert, & Jacobsen, 1996;Renaud et al, 1998). In contrast to the sudden gain methodology, the early response approach does not necessarily require symptoms to be measured on a sessional basis; symptom reductions accruing over a predetermined number of early sessions are of primary interest.…”

“…One example of the early response method (Beckham, 1989) examined the recovery of 32 adults treated with CBT for major depression. An early response was defined as a reduction of 50% or more of a patient's BDI score from intake to Session 6.…”

“…Following the methodology of Beckham (1989), we considered an early rapid response (ERR) as having occurred whenever a patient experienced a reduction of at least 50% of the intake BDI score by Session 6. After identifying ERR patients, the acute and long-term effects of this recovery pattern were identified.…”

“…Like Ilardi and Craighead (1994), we limit our focus to symptom changes occurring during the first six sessions. Our method of early response classification draws on the method outlined by Beckham (1989), who categorized those patients experiencing a reduction of up to 50% of their intake symptoms by this time as having experienced an early response. The current approach offers several advantages over previous investigations.…”

“…It has been established that a considerable number of patients experience large reductions in depression in early sessions of psychotherapy, across both adolescent (Renaud et al, 1998) and adult (Beckham, 1989;Fennell & Teasdale, 1987;Haas, Hill, Lambert, & Morrell, 2002;Hardy et al, 2005;Ilardi & Craighead, 1994;Tang & DeRubeis, 1999) populations and across psychotherapeutic modalities (Gaynor et al, 2003;Stiles et al, 2003). Although research designs vary across studies, findings to date suggest that patients who respond earlier (or more rapidly) tend to have superior end-of-treatment and long-term outcomes compared with those who do not.…”