Cognitive therapy for depression : the moderating effect of personality beliefs on homework adherence and outcome for depression : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
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Date
2012
DOI
Open Access Location
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Massey University
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The Author
Abstract
Cognitive
Therapy
(CT)
is
an
efficacious
treatment
for
Major
Depressive
Disorder
(MDD)
(Butler,
Chapman,
Forman,
&
Beck,
2006).
Homework
(HW)
tasks
are
an
integral
facet
of
this
therapeutic
modality
(Beck
&
Tompkins,
2007),
and
are
believed
to
be
one
of
the
active
ingredients
in
its
therapeutic
effect
(Rees,
McEvoy,
&
Nathan,
2005).
The
current
literature
indicates
that
not
all
clients
adhere
to
their
HW
assignments
equally,
with
some
evidence
to
suggest
that
this
may
be
attributable
to
problem
type
(Kazantzis,
Deane,
&
Ronan
2000).
MDD
is
highly
comorbid
with
personality
disorders
(PD)
(George,
Milklowitz,
Richards,
Simoneau
&
Taylor,
2003)
and
the
beliefs
that
underpin
these
syndromes,
as
conceptualised
in
cognitive
theory,
have
been
anecdotally
linked
to
the
variance
in
HW
adherence
(Kuyken,
Kurzer,
DeRubeis,
Beck
&
Brown,
2001).
This
current
research
is
the
first
to
investigate
the
moderating
role
personality
beliefs
have
on
HW
adherence
and
outcome
in
CT
for
depression.
This
current
study
was
situated
within
a
larger
collaborative
research
project
investigating
HW
in
the
treatment
of
depression,
conducted
at
the
School
of
Psychology,
Massey
University,
Albany,
and
in
partnership
with
Harvard
University
and
the
London
Institute
of
Psychiatry.
A
final
sample
of
27
participants
experiencing
their
index
episode
of
MDD
were
recruited
from
the
wider
Auckland
region.
Participants
attended
up
to
20-‐sessions
of
CT
for
depression,
and
follow-‐up
sessions
at
2-‐
and
6-‐months,
provided
by
doctoral
students.
Depression
severity
was
measured
at
baseline
and
every
session
with
the
Beck
Depression
Inventory
–
Second
Edition
(BDI-‐II).
Personality
beliefs
were
assessed
at
Session
8
with
the
Personality
Beliefs
Questionnaire
–
Short
Form
(PBQ-‐SF).
Homework
adherence
was
assessed
from
Session
2
with
the
Homework
Rating
Scale
–
Second
Edition
(HRS-‐II).
A
prospective
longitudinal
multi-‐level
modelling
design
was
utilised
and
data
were
analysed
on
the
SPSS
suite.
All
participants
experienced
symptom
reduction
across
treatment
duration
with
a
mean
percentage
improvement
of
68.1%.
A
total
of
13
(49%)
participants
endorsed
at
least
one
scale
of
the
PBQ-‐SF
and
51%
(n=14)
did
not.
Results
indicated
that
the
endorsement
of
personality
beliefs
resulted
in
higher
levels
of
depressive
severity
at
intake,
and
moderated
client
rated
HW
adherence
and
the
beliefs
factor
of
the
HRS-‐II.
Specifically,
personality
beliefs
were
related
to
less
adherence
with
HW
tasks
and
higher
residual
symptoms
of
depression
at
termination.
Therapist
rated
HW
had
no
effect
on
outcome.
The
limitations,
contributions
to
the
literature
and
implications
for
clinical
practice
are
discussed.
Description
Keywords
Cognitive therapy, Depression