COGNITIVE BEHAVIORAL THERAPY

Cognitive Behavioral Therapy in Depression

Critical Review on the Integration of Cognitive-Behavioral Therapy for Depression and Positive Psychology

Introduction

An abundance of data exists for the efficacy of cognitive-behavioral therapy (CBT) approaches for psychological disorders, such as anxiety and depression (Butler, Chapman, Forman, & Beck, 2006; Hoffman & Smits, 2008). Moreover, several studies support the efficacy of cognitive behavioral therapy for treating psychological disorders and reducing psychological distress. Such as patients with cancer, HIV/AIDS, type 2 diabetes, multiple sclerosis, primary insomnia and chronic pain. The studies presented in this special issue of the Journal of Cognitive Psychotherapy add to our knowledge by demonstrating the efficacy and utility of cognitive behavioral therapy approaches (Irvine et al, 2009) (Gonzalez et al., 2009) (Brown, Vanable, Carey, & Elin, in press). Why does cognitive behavioral therapy not always “work” as well as we expect it? How can we, as cognitive behavioral therapy researchers and practitioners, continue to advance the field in depression? There are a number of limitations to the current literature on cognitive behavioral therapy in depression. First, one shortcoming of the cognitive behavioral therapy research conducted to date (both in the depression and positive psychology) is the emphasis on internal validity to the detriment of external validity (see Glasgow, 2008, for a discussion).

Discussion

Although both types of validity are critical, we lack data as to how the findings of our randomized controlled trial (RCT) apply to other settings and populations. As clinicians, we lack information as to what extent a particular treatment will actually produce results in our clinical setting or with the particular population of patients whom we treat. Another limitation of cognitive behavioral therapy research with populations is in the shortage of data that provide support for the use of cognitive behavioral therapy to promote health behavior change. Cognitive behavioral therapy does not always emphasize the role of motivation for health behavioral change; a key problem may be the lack of attention and approaches with in cognitive behavioral therapy for patients who are unmotivated to change their health behaviors. The present paper will explore these current challenges for cognitive behavioral therapy, within behavioral medicine, and will propose some potential solutions to these problems by examining alternative research designs and integrative treatment methodologies.

Results show that most activities, regardless of difficulty, increased when targeted for activation, and not before. That is increases in participants' selected activities were largely a function of the brief behavioral activation treatment. Concomitantly, depressive symptomatology, measured with BDI-II and medical practitioner ratings, decreased from pretreatment levels of mild-moderate to minimal levels at post treatment and follow-up. These results confirm those of earlier studies of BATD (Hopko et al., 2005; Hopko et al., 2004; Hopko et al., 2003; Lejuez, Hopko, LePage, et al., 2001; Ruggiero et al., 2007).

The present results extend the BATD research in several ways. First, activity levels increased regardless of difficulty. Generally, participants engaged in activities of moderate or high difficulty as well as those of low difficulty. Close examination of the data shows that on several ...