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Attitudes Toward Cognitive and Behavioral Interventions: Prediction of Preference and Outcomes in the Treatment of Major Depression

Cooper, Andrew Astley

Abstract Details

2013, Doctor of Philosophy, Ohio State University, Psychology.
In their influential dismantling study, Jacobson and colleagues (1996) established a precedent for comparing the cognitive and behavioral interventions that comprise CBT for depression. Follow-up analyses of patients from that study suggested that certain patient characteristics might be associated with attitudes toward, and response to, these interventions. In particular, agreement with the treatment rationale and complexity of beliefs about the cause of one’s depression were identified as potential predictors, with subsequent research also suggesting a role for patient preferences. The present study investigates attitudes toward cognitive and behavioral interventions for depression, as well as complex beliefs about the cause of one’s depression, as predictors of preference and treatment outcomes. Dysphoric students (n=193) and depressed outpatients (n=38) completed ratings of written rationales and videotaped vignettes describing the two interventions. Patients also participated in a small trial comparing these interventions as separate treatments, with symptom change and dropout assessed across the first eight weeks of therapy. All participants completed ratings of intervention credibility (using the intervention credibility scale, ICS) and personal reactions to the treatment rationales (PRR) for both interventions. Participants also rated their preference between the interventions using a continuous scale. Beliefs about the cause of their depression were also assessed using the Reasons for Depression inventory (RFD), with higher scores reflecting a “reason-giving” tendency expected to predict less favorable reactions to the behavioral intervention. Results were generally more consistent with hypotheses in the patient sample. Both patients and students rated the interventions as equally credible. For the patients, higher RFD scores were associated with higher absolute and relative ICS scores for the cognitive intervention, while no such associations were observed with ICS ratings in the student sample. Higher RFD scores predicted preference for cognitive treatment in the patient sample. PRR ratings of the vignettes did not differ in the student sample, but patients rated the cognitive intervention higher than the behavioral treatment. Higher RFD scores predicted lower PRR ratings of the behavioral treatment in the student sample. Difference scores on the ICS and PRR were highly predictive of preference ratings, with the higher-rated vignette being strongly preferred. Patients tended to prefer the cognitive intervention, and thus more were “mismatched” in the behavioral treatment. Depressive symptoms generally improved across eight weeks in both treatment conditions, with a 24% dropout rate. RFD scores, ICS and PRR difference scores, preference ratings and treatment match status all failed to predict symptom change, as main effects or in interactions with treatment assignment. Higher RFD scores predicted increased odds of dropout, overall and especially in the cognitive intervention. Cognitive preference predicted higher odds of dropout overall, but the interaction of preference and treatment assignment was not significantly predictive of dropout. Finally, the interaction of PRR difference scores and treatment trended toward predicting lower dropout odds. Probability of dropout decreased as PRR ratings of a patient’s assigned treatment were lower relative to the other treatment. These results suggest a potentially meaningful role for PRR ratings and RFD scores as predictors of preference, as well as odds of dropout. These findings are considered relative to limitations of the present study, implications for patient care, and future research directions.
Daniel Strunk, PhD (Advisor)
Jennifer Cheavens, PhD (Committee Member)
Mary Fristad, PhD (Committee Member)
Alicia Bunger, PhD (Committee Member)
109 p.

Recommended Citations

Citations

  • Cooper, A. A. (2013). Attitudes Toward Cognitive and Behavioral Interventions: Prediction of Preference and Outcomes in the Treatment of Major Depression [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1371421827

    APA Style (7th edition)

  • Cooper, Andrew. Attitudes Toward Cognitive and Behavioral Interventions: Prediction of Preference and Outcomes in the Treatment of Major Depression. 2013. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1371421827.

    MLA Style (8th edition)

  • Cooper, Andrew. "Attitudes Toward Cognitive and Behavioral Interventions: Prediction of Preference and Outcomes in the Treatment of Major Depression." Doctoral dissertation, Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1371421827

    Chicago Manual of Style (17th edition)