Evans, M. D., Hollon, S. D., Garvey, M. J., Piasecki, J. M., Grove, W. M., Garvey, M. J., & Tuason, V. B. (1992). Differential relapse following Cognitive Therapy and pharmacotherapy for depression. Archives of General Psychiatry, 49(10), 802–808. https://doi.org/10.1001/archpsyc.1992.01820100046009

Type of Study: Randomized controlled trial
Number of Participants: 50

Population:

• Age — Approximately 30-34 years
• Race/Ethnicity — Primarily White
• Gender — Primarily Female
• Status — Participants were nonbipolar, nonpsychotic depressed outpatients requesting treatment for depression.

Location/Institution: Department of Psychology, University of Minnesota, Minneapolis and Department of Psychiatry, St Paul Ramsey – Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the effectiveness of imipramine hydrochloride pharmacotherapy, Cognitive Therapy (CT), or combined CT and pharmacotherapy two years after participant completion of successful treatment during a 3-month period. Participants were randomly assigned to either imipramine hydrochloride pharmacotherapy, CT, or combined CT and pharmacotherapy. Measures utilized include the Beck Depression Inventory, the Hamilton Rating Scale for Depression, and the Raskin Depression Scale. Results indicate that participants treated with CT (either alone or in combination with medication) evidenced less than half the rate of relapse shown by participants in the medication–no continuation condition, and their rate did not differ from that of participants provided with continuation medication. Limitations include small sample size and lack of generalizability to total population.

Length of controlled postintervention follow-up: 2 years.

Blackburn, I. M., & Moore, R. G. (1997). Controlled acute and follow-up trial of Cognitive Therapy and pharmacotherapy in out-patients with recurrent depression. British Journal of Psychiatry, 171, 328–334. https://doi.org/10.1192/bjp.171.4.328

Type of Study: Randomized controlled trial
Number of Participants: 75

Population:

• Age — Mean=37.8–40.1 years
• Race/Ethnicity — Not specified
• Gender — 48 Female and 27 Male
• Status — Participants were recruited from outpatient referrals to consultants in a large teaching psychiatric hospital and from two general practices.

Location/Institution: Department of Psychiatry, University of Edinburgh

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on a randomized controlled trial, in both the acute and maintenance stage of treatment, in 75 outpatients with recurrent major depression. Participants were randomly assigned to one of three groups, either antidepressants and maintenance antidepressants; Cognitive Therapy (CT) and maintenance CT; or antidepressants and maintenance CT. Measures utilized include the Hamilton Rating Scale for Depression (HRSD) and Beck Depression Inventory (BDI). Both completers' and end-point data were analyzed. Results indicate that in the acute phase of treatment, all participants improved significantly and there was no significant difference among treatments, or in the pattern of improvement over time. In the maintenance stage of treatment, participants kept improving over time in all three groups and there was no significant difference among treatments. CT was consistently superior to medication. Results indicate that maintenance CT has a similar prophylactic effect to maintenance medication and is a viable option for maintenance after acute treatment with medication in recurrent depression. Limitations include small sample, no objective measure of compliance with medication was used, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Paykel, E. S., Scott, J., Teasdale, J. D., Johnson, A. L., Garland, A., Moore, R., Jenaway, A., Cornwall, P. L., Hayhurst, H., Abbott, R., & Pope, M. (1999). Prevention of relapse in residual depression by Cognitive Therapy: A controlled trial. Archives of General Psychiatry, 56(9), 829–835. https://doi.org/10.1001/archpsyc.56.9.829

Type of Study: Randomized controlled trial
Number of Participants: 158

Population:

• Age — Mean=43 years
• Race/Ethnicity — Not specified
• Gender — 50% Male
• Status — Participants were recruited from psychiatric outpatient clinics in Cambridge and Newcastle, England.

Location/Institution: Departments of Psychiatry, University of Cambridge, Cambridge, England; University of Glasgow, Glasgow, Scotland; University of Newcastle, Newcastle, England; and MRC Cognition and Brain Sciences Unit and Medical Research Council Biostatistics Unit, University of Cambridge Institute of Public Health

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of treatments for participants with recent major depression, partially remitted with antidepressant treatment but with residual symptoms of 2 to 18 months’ duration. Participants were randomly assigned to receive clinical management alone or clinical management plus Cognitive Therapy (CT) for 16 sessions during 20 weeks, with 2 subsequent booster sessions. Measures utilized include the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Results indicate that CT reduced relapse rates for acute major depression and persistent severe residual symptoms, in both intention to treat and treated per protocol samples. The cumulative relapse rate at 68 weeks was reduced significantly from 47% in the clinical management control group to 29% in the CT group. CT also increased full remission rates at 20 weeks but did not significantly improve symptom ratings. Limitations include that the study did not include a control group equated for therapeutic contact, selection bias, and medication doses were higher than standard practice.

Length of controlled postintervention follow-up: 1 year.

Bockting, C. L. H., Schene, A. H., Spinhoven, P., Koeter, M. W. J., Wouters, L. F., Huyser, J., Kamphuis, J. H., & DELTA Study Group. (2005). Preventing relapse/recurrence in recurrent depression with Cognitive Therapy: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 73(4), 647–657. https://doi.org/10.1037/0022-006X.73.4.647

Type of Study: Randomized controlled trial
Number of Participants: 187

Population:

• Age — Treatment: Mean=45.9 years; Control: Mean=43.4 years
• Race/Ethnicity — Treatment: 98% White; Control: 99% White
• Gender — Treatment: 73% Female; Control: 74% Female
• Status — Participants were recruited from February 2000 through September 2000 at psychiatric centers (31% of the participants) and through media announcements (69% of the participants) in the Netherlands.

Location/Institution: Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on the outcome of a randomized controlled trial of group Cognitive Therapy (CT) to prevent relapse/recurrence in high-risk participants diagnosed with recurrent depression. Participants were randomly assigned to treatment as usual, including continuation of pharmacotherapy, or to treatment as usual augmented with brief CT. Measures utilized include the Structured Clinical Interview for DSM–IV, the Hamilton Rating Scale for Depression (HRSD), the Dysfunctional Attitude Scale, and the Everyday Problem Checklist. Results indicate that augmenting treatment as usual with CT resulted in a significant protective effect, which intensified with the number of previous depressive episodes experienced. Participants with 5 or more previous episodes (41% of the sample), CT reduced relapse/recurrence from 72% to 46%. Limitations include no control for nonspecific factors, such as extra attention and group participation, and unclear whether the beneficial effect was attributable to specific skills in CT or to a total package of the treatment as usual in combination with this CT.

Length of controlled postintervention follow-up: 2 years.

Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Freeman, B. B., & Gallop, R. (2005). Prevention of relapse following cognitive therapy vs. medications in moderate to severe depression. Archives of General Psychiatry, 62, 417–422. https://doi.org/10.1001/archpsyc.62.4.417

Type of Study: Randomized controlled trial
Number of Participants: 104

Population:

• Age — Mean=40 years
• Race/Ethnicity — 82% White
• Gender — 59% Female
• Status — Participants were patients with moderate to severe unipolar depression aged 18 to 70 years who were recruited from outpatient psychiatric clinics.

Location/Institution: Outpatient clinics at the University of Pennsylvania and Vanderbilt University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine whether Cognitive Therapy (CT) has an enduring effect and to compare this effect against the effect produced by continued antidepressant medication. Participants who responded to CT in a randomized controlled trial were withdrawn from treatment and compared during a 12-month period with medication responders who had been randomly assigned to either continuation medication or placebo withdrawal. Measures utilized include the Hamilton Rating Scale for Depression. Results indicate that participants withdrawn from CT were significantly less likely to relapse during continuation than participants withdrawn from medications, and no more likely to relapse than participants who kept taking continuation. There were also indications that the effect of CT extends to the prevention of recurrence. Limitations include lack of generalizability of results due to race/ethnicity.

Length of controlled postintervention follow-up: 2 years.

Floyd, M., Rohen, N., Shackelford, J. A. M., Hubbard, K. L., Parnell, M. B., Scogin, F., & Coates, A. (2006). Two-year follow-Up of bibliotherapy and individual Cognitive Therapy for depressed older adults. Behavior Modification, 30(3), 281–294. https://doi.org/10.1177/0145445503261176

Type of Study: Randomized controlled trial
Number of Participants: 23

Population:

• Age — 60 years or older
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were older adults recruited from the community.

Location/Institution: Tuscaloosa and Birmingham, Alabama

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the stability of treatment gains after receiving either cognitive bibliotherapy or individual Cognitive Therapy (CT) for depression in older adults. Participants were randomly assigned to receive either bibliotherapy or individual CT and were also assigned to receive the treatment either immediately or after a 4-week waiting period. Measures utilized include the Hamilton Rating Scale for Depression (HRSD) and the Geriatric Depression Scale (GDS). Results indicate that treatment gains from baseline to the 2-year follow-up period were maintained on the HRSD and GDS, and there was not a significant decline from posttreatment to follow-up. There were no significant differences between the treatments on the GDS or HRSD at the 2-year follow-up; however, bibliotherapy participants had significantly more recurrences of depression during the follow-up period. Limitations include small sample size, attrition, and reliance on self-reported measures.

Length of controlled postintervention follow-up: 2 years.

Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., Gallop, R., McGlinchey, J. B., Markley, D. K., Gollan, J. K., Atkins, D. C., Dunner, D. L., & Jacobson, N. S. (2006). Randomized trial of behavioral activation, Cognitive Therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658–670. https://doi.org/10.1037/0022-006X.74.4.658

Type of Study: Randomized controlled trial
Number of Participants: 241

Population:

• Age — 16–60 years, Mean=39.90 years
• Race/Ethnicity — 197 White
• Gender — 159 Female
• Status — Participants were individuals who suffered from depression.

Location/Institution: Seattle, Washington

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of behavioral activation (BA) by comparing it with Cognitive Therapy (CT), and antidepressant medication (ADM) in adults with major depressive disorder. Participants were randomly assigned to one of four acute treatment conditions: BA, CT, ADM, or pill placebo (PLA). Measures utilized include the Cognitive Therapy Scale (CTS), Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hamilton Rating Scale for Depression (HRSD), and the Beck Depression Inventory - 2nd Edition (BDI-II). Results indicate that that BA is comparable in efficacy to ADM, and more efficacious than CT among more severely depressed participants. Additionally, among more severely depressed participants in this trial, ADM significantly outperformed placebo through 8 weeks of treatment. There were no significant differences in outcome between ADM and placebo for the less severely depressed participants. Limitations include missing data and lack of follow-up.

Length of controlled postintervention follow-up: None.

Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., Rizvi, S. L., Gollan, J. K., Dunner, D. L., & Jacobson, N. S. (2008). Randomized trial of behavioral activation, Cognitive Therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76(3), 468–477. https://doi.org/10.1037/0022-006X.76.3.468

Type of Study: Randomized controlled trial
Number of Participants: 241

Population:

• Age — Mean=39.9 years
• Race/Ethnicity — 82% Caucasian
• Gender — 66% Female and 34% Male
• Status — Participants were adult outpatients who responded to acute phase treatment for depression.

Location/Institution: Seattle, WA

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Dimidjian et al. (2006). The purpose of the study was to follow treatment responders from a randomized controlled trial of adults with major depression. Participants were randomly assigned to 16 weeks of antidepressant medication (ADM), Cognitive Therapy (CT), or behavioral activation (BA). Measures utilized include the Beck Depression Inventory II and the Hamilton Rating Scale for Depression. Results indicate that participants previously exposed to CT were significantly less likely to relapse following treatment termination than participants withdrawn from medication, and participants previously exposed to behavioral activation did almost as well relative to participants withdrawn from medication, although the difference was not significant. Differences between behavioral activation and CT were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. Limitations include possible researcher bias and lack of generalizability to overall population due to race and gender.

Length of controlled postintervention follow-up: 2 years.

Hollon, S. D., DeRubeis, R. J., Fawcett, J., Amsterdam, J. D., Shelton, R. C., Zajecka, J., Young, P. R., & Gallop, R. (2014). Effect of Cognitive Therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: A randomized clinical trial. JAMA Psychiatry, 71(10), 1157–1164. https://doi.org/10.1001/jamapsychiatry.2014.1054

Type of Study: Randomized controlled trial
Number of Participants: 452

Population:

• Age — Mean=43.2 years
• Race/Ethnicity — 388 White, 37 Not Specified, and 27 Hispanic
• Gender — 266 Female
• Status — Participants were adult outpatients with chronic or recurrent major depressive disorder.

Location/Institution: Outpatient clinics at the University of Pennsylvania, Philadelphia; Rush Medical Center, Chicago, Illinois; and Vanderbilt University, Nashville, Tennessee

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of combining Cognitive Therapy (CT) with Antidepressant Medication (ADM) versus ADM alone on remission and recovery in major depressive disorder (MDD). Participants were randomly assigned to ADM treatment alone or CT combined with ADM treatment. Measures utilized include the Structured Clinical Interviews for DSM-IVII and the Hamilton Rating Scale for Depression (HRSD). Results indicate that CT combined with medication treatment enhanced rates of recovery relative to medications alone, with the effect limited to participants with severe nonchronic depressions. Combined treatment also reduced the frequency of severe adverse events, but largely because it reduced time in episode. Limitations include high attrition rate, lack of follow-up, and the absence of another psychotherapy or psychotherapy control, in combination with medications, to test for the specificity of CT in accounting for the combined treatment advantage.

Length of controlled postintervention follow-up: None.

Adler, A. D., Strunk, D. R., & Fazio, R. H. (2015). What changes in Cognitive Therapy for depression? An examination of Cognitive Therapy skills and maladaptive beliefs. Behavior Therapy, 46(1), 96–109. https://doi.org/10.1016/j.beth.2014.09.001

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 88

Population:

• Age — Mean=37.8 years
• Race/Ethnicity — 89% White
• Gender — 100% Female
• Status — Participants were individuals who suffered from depression.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine effortful cognitive skills and underlying maladaptive beliefs among patients treated with Cognitive Therapy (CT) for depression. Participants were a sample of depressed patients and a sample of never-depressed participants. Measures utilized include the Ways of Responding Scale, (WOR), Implicit Association Test, (IAT), Patient Health Questionnaire (PHQ), Generalized Anxiety Disorder Questionnaire- IV (GAD-Q-IV), Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hamilton Rating Scale for Depression (HRSD), Beck Depression Inventory - 2nd Edition (BDI-II), and the Dysfunctional Attitude Scale (DAS). Results indicate that among participants in the CT, large improvements in CT skills were significantly related to symptom improvement. Combined treatment also reduced the frequency of severe adverse events, but largely because it reduced time in episode. Limitations include lack of randomization of participants, small sample size, and lack of follow-up

Length of controlled postintervention follow-up: None.