The Prevention Of Depression

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A number of outcome studies that examined the efficacy of cognitive therapy for depression found differential relapse rates among those treated with cognitive therapy, with or without medication, and those treated with medication alone. Specifically, it appears that cognitive therapy for depression prevents relapse. Currently, there is no evidence of a preventive effect after termination of antidepressant medication or any other psychotherapy. Interpersonal psychotherapy, another efficacious treatment for depression, appears to reduce risk only as long as it is continued.

As a result of these findings, there is interest in discerning whether cognitive therapy can truly prevent relapse and whether it can prevent a first episode of depression among populations at risk.

The Penn Prevention Program used a school-based, cognitive-behavioral intervention to prevent a first episode of depression in 10- to 13-year-old children. The children were identified as being at-risk for depression on the basis of depressive symptoms and their reports of parental conflict. The cognitive-behavioral techniques were designed to teach children coping strategies to use when confronted with negative life events, thereby increasing their sense of mastery and competence. In addition to preventing depressive symptoms, the intervention attempted to address problems associated with depression, such as aca

Cognitive Therapy demic difficulties, poor peer relations, low self-esteem, and behavior problems. [See Coping with Stress.]

The program consisted of a cognitive component, a social problem-solving component, and a coping skills component. The cognitive component taught flexible thinking and how to evaluate the accuracy of beliefs. It also included explanatory style training to foster more accurate, less pessimistic attributions. For situations in which an accurate interpretation of events was negative, children were taught to focus on solutions or on ways to cope with emotions. Coping techniques included decatastrophizing about potential outcomes of the problem, distraction, steps to distance oneself from stressful situations, relaxation training, and ways to seek social support. In this way, investigators tried to address both cognitive distortions and cognitive deficiencies. The cognitive interventions addressed dysfunctional thinking, and the problem-solving and coping skills components prevented impulsive actions.

Those children who received the intervention showed significant reductions in depressive symptoms and improved classroom behavior compared with controls. These differences persisted at 6-month follow-up. The decrease in depressive symptoms was greatest in the children most at risk for depression.

A controlled prevention trial was conducted by Munoz among adults at risk who comprised a multiethnic, low-income sample. This cognitive - behavioral intervention also resulted in a significantly lower incidence of depressive symptoms among those receiving treatment than those in the control group. In addition, there was a lower incidence rate of major depressive episodes in the treatment group, but the cases were too few to be statistically significant.

Prevention of actual depressive episodes was an outcome criterion in a study by Clarke and associates of adolescents at risk by virtue of their subclinical, depressive symptomotology. This 15-session, cognitive-behavioral intervention taught adolescents to identify and challenge negative or dysfunctional thoughts. Par ticipants had a total incidence of unipolar depression of about half of that of the control group, and this persisted through a 12-month follow-up.

Other controlled trials of cognitive therapy and other modalities for the prevention of depression are underway. In the meantime, cognitive therapy skills are being used to promote general social adjustment in school settings. School-based programs nationwide are applying cognitive-behavioral techniques as part of interpersonal skills training and conflict resolution. Cognitive skills such as disputing negative self-talk and problem solving are part of programs that typically include emotional awareness, communication skills, and behavioral self-control strategies. These programs are an example of health promotion, because they are applied at the community level and decrease the likelihood of occurrence of a range of psychological problems. Although cognitive therapy was designed as a treatment for psychological disorders, it may be beneficial in the prevention of psychological distress and in the promotion of well-being.

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