Can depression be de-medicalized in the 21st century: scientific revolutions, counter-revolutions and the magnetic field of normal science.

This article is about our scientific investigations of the change mechanisms in cognitive therapy (CT) for depression. In a previous clinical trial, we found that so-called 'cognitive' interventions were not necessary for the success of CT: the behavioral activation (BA) component, a treatment precluding attempts to change thinking, worked as well as the entire CT package, both in maximizing acute treatment response and in relapse prevention over a two year period. We tentatively suggested at the time of publication [Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E. T., & Prince, S. E. (1996). A component analysis of cognitive-behavioral treament for depression. Journal of Consulting and Clinical Psychology, 64, 295-304; Gortner, E. T., Gollan, J. K., Dobson, K. S., & Jacobson, N. S. (1998). Cognitive-behavioral treatment for depression: relapse prevention. Journal of Consulting and Clinical Psychology, 66, 377-384.] that the 'cognitive' components of CT may not only be unnecessary but potentially a liability, since they result in a less parsimonious treatment package that may be not be cost effective. In this article, we not only defend this contention, but counteract the skepticism expressed by some CT advocates that the quality of our CT was deficient. Finally, we describe a study designed to confirm our conclusions from the earlier trial and, in the process, reintroduce a contextual perspective on depression, one which counters the currently dominant defect models reflected in both Beck's cognitive model and in theories that emphasize biological causation.

Cognitive-behavioral treatment for depression: relapse prevention.

This study presents 2-year follow-up data of a comparison between complete cognitive-behavioral therapy for depression (CT) and its 2 major components: behavioral activation and behavioral activation with automatic thought modification. Data are reported on 137 participants who were randomly assigned to 1 of these 3 treatments for up to 20 sessions with experienced cognitive-behavioral therapists. Long-term effects of the therapy were evaluated through relapse rates, number of asymptomatic or minimally symptomatic weeks, and survival times at 6-, 12-, 18-, and 24-month follow-ups. CT was no more effective than its components in preventing relapse. Both clinical and theoretical implications of these findings are discussed.

Psychological aspects of perpetrators of domestic violence and their relationships with the victims.

Domestic violence is a serious public health concern in the United States. Despite the serious and often tragically fatal consequences of spousal abuse, we have very little understanding about the root causes of domestic violence. We know even less about providing effective treatments and prevention. In this article, we have discussed some of the more promising individual difference variables that discriminate between violent and nonviolent men. We also have addressed some of the growing research on how violent couples are different from nonviolent ones. Unfortunately, methodologic limitations hamper us from being able to discuss definitive risk factors or predictive variables, but we can speak of factors associated with domestic violence. We also have discussed the importance of attending to important differences among violent men and violent couples. The complexity of battering behavior and battering relationships necessarily points researchers and clinicians toward multifaceted research designs and treatment models. The tragedy of domestic violence demands that science continues to address these crucial unanswered questions.

A component analysis of cognitive-behavioral treatment for depression.

The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.

Psychological factors in the longitudinal course of battering: when do the couples split up? When does the abuse decrease?

The longitudinal course of battering was investigated over a 2-year time span. Forty-five batterers and their spouses were assessed with self-report, psychophysiological, and marital interaction measures. Both the stability of the relationship and of the battering were assessed. At the two-year follow-up, 62% of the couples were still married and living together, while 38% had separated or divorced. A combination of six variables, reflecting severity of husband emotional abuse, wife dissatisfaction, husband physiological arousal, and wife defending herself assertively, was 90.2% accurate in predicting separation or divorce 2 years later. Of the couples still living together at follow-up, 46% of the batterers did not reduce their levels of severe violence, while 54% did significantly decrease levels of violence. Husbands who continued to be severely violent at 2-year follow-up were more domineering, globally negative and emotionally abusive toward their wives at Time 1 than husbands who reduced their levels of violence. Even though 54% of the batterers decreased the frequency of violent acts over the 2-year period, only 7% achieved complete desistance. Moreover, husband emotional abuse did not decrease over the 2-year period, even when physical abuse did.