A COMPONENT ANALYSIS OF COGNITIVE-BEHAVIORAL TREATMENT FOR DEPRESSION

The purpose of this study was to provide an experimental test of the t heory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G . Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 o utpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that incl uded both BA and the teaching of skills to modify automatic thoughts ( AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted al l treatments. Despite excellent adherence to treatment protocols by th e therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced bett er outcomes, at either the termination of acute treatment or the 6-mon th follow-up, than either component treatment. Furthermore, both BA an d AT treatments were just as effective as CT at altering negative thin king as well as dysfunctional attributional styles. Finally, attributi onal style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.