Me. Thase et al., PSYCHOBIOLOGICAL CORRELATES OF POOR RESPONSE TO COGNITIVE-BEHAVIOR THERAPY - POTENTIAL INDICATIONS FOR ANTIDEPRESSANT PHARMACOTHERAPY, Psychopharmacology bulletin, 29(2), 1993, pp. 293-301
Correlates of outcome were studied in a sample of 142 unmedicated pati
ents with major depressive disorder treated with cognitive behavior th
erapy (CBT) in outpatient (n = 110) or inpatient (n = 32) protocols. O
utpatients received up to 20 sessions of therapy over 16 weeks; inpati
ents received up to 20 sessions over 4 weeks. Across all three protoco
ls, nonresponse was associated with unemployment, higher levels of pre
treatment severity, and an abnormal electroencephalographic (EEG) slee
p profile. Chronicity was associated with poor outcomes in male outpat
ients, whereas high scores on a measure of dysfunctional attitudes wer
e associated with a trend for poor outcome only in female patients. Am
ong inpatients, male gender, diagnostic comorbidity, and elevated urin
ary free cortisol levels also were associated with poor outcome. Altho
ugh a majority of the unmedicated patients experienced full or partial
remissions, our findings suggest that assessments of both clinical (e
.g., severity, chronicity, and comorbidity) and psychobiological (EG s
leep and adrenocortical function) factors may identify those depressed
patients who are less likely to benefit from CBT alone. Such patients
may be preferentially responsive to treatment with pharmacotherapy, e
ither alone or, in more complicated cases, in combination with psychot
herapy.