Dysfunctional attitudes in cognitive-behavioral therapy and antidepressant pharmacotherapy for adult depression: A systematic review and meta-analysis of individual participant data.
Frank J Don, Lynn Boschloo, Frederik J Wienicke, Erica S Weitz, Steven D Hollon, Zachary D Cohen, Zindel V Segal, Sidney H Kennedy, Robert J DeRubeis, R Michael Bagby, Lena C Quilty, Anne D Simons, Jos W R Twisk, Ioana A Cristea, Toshiaki A Furukawa, Pim Cuijpers, Ellen Driessen
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Abstract
Objectives: Dysfunctional attitudes (DA) constitute a vulnerability factor for depression that might be most effectively targeted with cognitive-behavioral therapy (CBT), but evidence is inconclusive. This individual participant data meta-analysis examined DA change during CBT and antidepressant medication, potential pathways of change by exploring how DA were related to depressive symptoms at posttreatment, and whether baseline DA moderated CBT versus antidepressants' efficacy on depression outcomes.
Method: We conducted systematic literature searches up to May 1, 2024. We included randomized comparisons of CBT and antidepressants in the acute-phase treatment of adult depression, assessing the Dysfunctional Attitude Scale at baseline and posttreatment. Individual participant data were requested and analyzed with mixed-effects models and network estimation techniques.
Results: Five studies totaling 734 participants met inclusion criteria. DA decreased significantly after CBT and antidepressants, with no significant difference between treatments. Regardless of treatment, posttreatment DA were positively associated with posttreatment depressive symptomatology, particularly with guilt and suicidal thoughts. Baseline DA moderated the efficacy of CBT versus antidepressants on observer-rated outcomes, with CBT more effective for participants with higher DA and antidepressants more effective for those with lower DA, but this was not replicated across individual studies nor with self-reported outcomes.
Conclusions: Change in DA and its associations with changes in depressive symptomatology do not appear specific to CBT. We found inconsistent evidence for the notion that CBT is more efficacious than antidepressants for individuals with high levels of DA. Repeated DA assessment during treatment would allow for more nuanced analysis in future studies. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
期刊介绍：
The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.
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