Abstract
A pilot study was conducted with 20 unipolar depressed outpatients with high levels of cognitive dysfunction. They were treated with either Lofepramine or Lofepramine plus rational-emotive therapy (RET) for 24 weeks. Previous studies of combined treatment versus pharmacotherapy have been criticized for selecting untypical clinical cases and for delivery of suboptimal pharmacotherapy. The present study was designed to address these issues as a preliminary to conducting a larger trial. The treatment protocol permitted a maximum of 30 RET sessions and 280 mg/day of Lofepramine. Ellis's rational-emotive therapy was used. There were significantly more responders in the combined-treatment group than in the pharmacotherapy group. At treatment termination, combined treatment similarly produced significantly greater changes in both depression measures and improvement in social adjustment. Furthermore, at termination in the combined-treatment group there were significantly more improvers and remitters on the Hamilton Depression Scale and on the Global Index of Improvement and more improvers on the target problems ratings. The overall attrition rate in this study was low at 5%. The population studied was more severely depressed and dysfunctional than populations previously included in cognitive therapy/pharmacotherapy trials. Despite utilizing a more severely depressed and dysfunctional sample than previous trials, combined treatment was found to produce more improvement than pharmacotherapy alone.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
Beck, A. T. (1976).Cognitive therapy and the emotional Disorders. Philadelphia: University of Pennsylvania Press.
Beck, A. T., Epstein, N., & Harrison, R. (1983). Cognition, attitudes and personality dimensions in depression.British Journal of Cognitive Psychotherapy, 1, 1–16.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979).Cognitive therapy of depression. New York: Guilford Press.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. K. (1961). An inventory for measuring depression.Archives of General Psychiatry, 4, 61–571.
Bowers, W. A. (1990). Treatment of depressed inpatients: Cognitive therapy plus medication, relaxation plus medication and medication alone.British Journal of Psychiatry, 156, 73–78.
Dobson, K. S. (1989). A meta analysis of the efficacy of cognitive therapy for depression.Journal of Consulting and Clinical Psychology, 57, 414–419.
Elkin, I., Shea, J., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D., Pilkonis, P. A., & Leber, W. R. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Programme: General effectiveness of treatments.Archives of General Psychiatry, 46, 971–982.
Ellis, A. (1991). Using RET effectively. In M. E. Bernard (Ed.),Using rational-emotive therapy effectively. New York: Plenum Press.
Fawcett, J., Epstein, P., Fiester, S. J., Elkin, I., & Autry, J. M. (1987). Clinical Management—Imipramine/Placebo Administration Manual: NIMH Treatment of Depression Collaborative Research Programme.Psychopharmacological Bulletin, 23, 309–324.
Guy, W. (1976). CGI, EDC EU Assessment Manual for PsychopharmacotherapyDHEW Review Number (ADM), 76–338.
Hamilton, M. (1960). A rating scale for depression.Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–61.
Kernberg, O. F. (1984).Severe personality disorders: Psychotherapeutic strategies. London: Yale University Press.
Kranz, S., & Hammen, C. (1979). The assessment of cognitive bias in depression.Journal of Abnormal Psychology, 88, 611–619.
Lancaster, S. G., & Gonzalez, J. P. (1989). Lofepramine: A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness.Drugs, 37, 123–140.
Marks, I. M., Stern, D. S., Mawson, D., Cobb, J., & McDonald, R. (1980). Clomipramine and exposure for obsessive-compulsive rituals.British Journal of Psychiatry, 136, 1–25.
Miller, I. W., Norman, W. H., & Keitner, G. I. (1989a). Cognitive-behavioral treatment of depressed inpatients.Behavioral Therapy, 20, 25–47.
Miller, I. W., Norman, W. H., & Keitner, G. I. (1989b). Cognitive-behavioral treatment of depressed inpatients: Six- and twelve-month follow-up.American Journal of Psychiatry, 146, 1274–1279.
Miller, I. W., Norman, W. H., & Keitner, G. I. (1990). Treatment response of high cognitive dysfunction depressed inpatients.Comprehensive Psychiatry, 30, 62–71.
Norman, W. H., Miller, I. W., & Dow, M. E. (1988). Characteristics of depressed patients with elevated levels of dysfunctional attitudes.Cognitive Therapy Research, 12, 39–52.
Persons, J. D., Burns, D. D., & Perloft, J. M. (1988). Predictors of drop out and outcome in cognitive therapy for depression in a private practice setting.Cognitive Therapy Research, 12, 557–575.
Roussel (1987).Depression—the condition and its treatment.
Shea, M. T., Pilkonis, P. A., Beckham, G., Collins, J. G., Elkin, I., Sotsky, S. M., & Docherty, J. P. (1990). Personality disorders and treatment outcome in the NIMH Treatment of Depression Collaborative Research Programme.American Journal of Psychiatry, 147, 711–718.
Spitzer, F. L., Williams, J. B. W., & Gibbon, M. (1987).Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) New York: New York State Psychiatric Institute Biometrics Research.
Stanway, A. (1987).Overcoming depression. London: Arrow Books.
Walen, S. R., Di Guiseppe, R., & Wessler, R. C. (1980).A practitioners guide to rational emotive therapy. Oxford, England: Oxford University Press.
Weissman, A. W., & Beck, A. T. (1978).Development and validation of the Dysfunctional Attitude Scale: A preliminary investigation. Paper presented at the Annual Meeting of the Educational Research Association, Toronto.
Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment by patient, self-report.Archives of General Psychiatry, 33, 1111–1115.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Macaskill, N.D., Macaskill, A. Rational-emotive therapy plus pharmacotherapy versus pharmacotherapy alone in the treatment of high cognitive dysfunction depression. Cogn Ther Res 20, 575–592 (1996). https://doi.org/10.1007/BF02227962
Issue Date:
DOI: https://doi.org/10.1007/BF02227962