Cognitive Therapy for Affective Disorders

The first full description of a cognitive therapy format was cognitive therapy for depression (Beck et al., 1979). There have been numerous randomised clinical trials that support the efficacy and effectiveness of cognitive therapy for depression, across a variety of clinical settings and populations (for review, see Clark, Beck & Alford, 1999; De Rubeis & Crits-Cristoph, 1998; Dobson, 1989; Robinson, Berman & Neimeyer, 1990). In outpatient trials, effect sizes are considerable compared to no treatment controls, with about half of the intent-to-treat patients showing full recovery (Hollon & Shelton, 2001). Some studies suggest cognitive therapy has particular relapse prevention effects (see, for example, Evans et al, 1992). More recently there have been important developments for recurrent and severe depression (McCullough, 2000) and for the prevention of depression relapse in individuals at high risk by virtue of their history of recurrent depression (Jarrett et al., 2001; Segal, Williams & Teasdale, 2002). Extensive clinical expertise has been invested in the development of cognitive therapy for bipolar disorder (Basco & Rush, 1996; Newman et al., 2002) but it would be premature to comment on the emerging outcome literature (for example, Lam et al., 2000) although preliminary studies suggest that cognitive therapy may prove to be an efficacious psychotherapy for people diagnosed with bipolar disorder. A large scale trial is currently under way in the US.

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