My former student Tony Tang and I (Tang & DeRubeis, 1999) found that sudden, large reductions in symptoms occurred during the course of cognitive therapy in about 40% of cases, and in about 55% of those who improved overall. Patients that experienced “sudden gains” were less depressed than other patients at posttreatment.
My colleague Steve Hollon and I, along with our colleagues at Penn and Vanderbilt, completed a NIMH-funded, two-site, randomized controlled trial that compared the short- and long-term effects of cognitive therapy, pharmacotherapy, and placebo in the treatment of severely depressed outpatients. In this study, the short-term effects of brief (16-week) cognitive therapy and pharmacotherapy on depressive symptomatology were very similar, but the longer-term (relapse-prevention) effects of cognitive therapy were significantly greater than short-term pharmacotherapy treatment. The papers describing these findings have been published in the Archives of General Psychiatry. (DeRubeis et al., 2005; Hollon et al., 2005)
We conducted an NIMH-funded study to examine the longer-term effects of cognitive therapy. Our interest is in whether cognitive therapy can prevent recurrences (the onsets of new episodes). 450 patients were randomly assigned to medications alone, or medications plus cognitive therapy. Once a patient has remitted and recovered (i.e., minimal symptoms for 6 months), cognitive therapy is ended for those who had been assigned to the combined condition. All recovered patients are then assigned randomly to either: (a) a continuation condition (continuation of the medicines that were used in the treatment phase); or (b) discontinuation. All patients were followed for three years, or until a recurrence is observed.
Using data simulations, we showed that the expected correlation between an excellent measure of therapy quality and outcome would be small under conditions likely to be common in psychotherapy research (DeRubeis et al., 2014)
Antidepressant Medication vs. Placebo
Antidepressant medications have shown to be efficacious compared to pill placebo for patients with severe depression. However, we find that the benefit of antidepressant medication compared with placebo may be minimal on average for patients with mild or moderate symptoms (Fournier, DeRubeis, et al., 2010)