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Dysfunctional Attitudes as a Moderator of Pharmacotherapy and Psychotherapy for Chronic Depression

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posted on 22.11.2013, 00:00 by Stewart A. Shankman, Miranda L. Campbell, Daniel N. Klein, Andrew C. Leon, Bruce A. Arnow, Rachel Manber, Martin B. Keller, John C. Markowitz, Barbara O. Rothbaum, Michael E. Thase, James H. Kocsis
Objective: Individuals with chronic depression exhibit heterogeneous responses to treatment. Important individual differences may therefore exist within this particularly difficult to treat population that act as moderators of treatment response. Method: The present study examined whether pretreatment levels of dysfunctional attitudes (DA) moderated treatment response in a large sample of chronically depressed individuals. Data were taken from the Research Evaluating the Value of Augmenting Medication with Psychotherapy (REVAMP) treatment study – a multi-site treatment and augmentation study of 808 chronically depressed individuals. REVAMP comprised two phases: 1) a 12-week open-label antidepressant trial and 2), a subsequent phase, in which phase 1 non-remitters (N=491) were randomized to either receive an ongoing medication algorithm alone, medication plus cognitive behavioral analysis system of psychotherapy, or medication plus brief supportive psychotherapy. Result: In phase 1, compared to the pharmacotherapy response of patients with lower DA scores, the response for patients with higher DA scores was steeper, but leveled off towards the end of the phase. In phase 2, DA predicted a differential response in the medication only arm, but not in the two psychotherapy+medication conditions. Specifically, in the phase 2 medication only condition, patients with higher DA improved while those with lower DA scores did not. Conclusion: These results indicate that the relation between DA and treatment response in chronic depression is complex, but suggest that greater DA may be associated with a steeper reduction and/or better response to pharmacotherapy.


The study was supported by National Institute of Mental Health Grants U01 MH62475, U01 MH61587, U01 MH62546, U01 MH61562, U01 MH63481, U01 MH62465, U01 MH61590, U01 MH61504, and U01 MH62491.


Publisher Statement

NOTICE: This is the author’s version of a work that was accepted for publication in Journal of Psychiatric Research . Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Psychiatric Research, Vol 47, Issue 1, (2013) DOI:10.1016/j.jpsychires.2012.09.018


Shankman SA, Campbell ML, Klein DN, Leon AC, Arnow BA, Manber R, Keller MB, Markowitz JC, Rothbaum BO, Thase ME, Kocsis JH. Dysfunctional attitudes as a moderator of pharmacotherapy and psychotherapy for chronic depression. Journal of Psychiatric Research . 2013 Jan;47(1):113-21. doi: 10.1016/j.jpsychires.2012.09.018.







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