Robert J. DeRubeis, Ph.D.   

Cognitive Therapy More Effective than Medication

        for Moderate to Severely Depressed Patients

“The American Psychiatric Association has it wrong.  Cognitive Therapy without medication is a first line treatment for outpatients with moderate to severe depression,” asserted Rob DeRubeis at NJ-ACT’s January 6 workshop.  And Dr. DeRubeis had statistics to support his provocative claim.  Here are a few highlights from his research that he shared with NJ-ACT:

For moderately to severely depressed patients, CT works about as well as medication after 16 weeks.  But the percentages of patients who were undepressed (Hamilton <13) after 16 weeks of treatment and remained undepressed at one year follow-up were: 39.0% for CT patients, 29.8% for Paxil patients with maintenance Paxil during the follow-up period, and 15.6% for Paxil patients who received placebo maintenance.  The CT patients had 3 booster sessions during the follow-up period.

            Of course, the CT must be well-conducted, and Dr. DeRubeis offered a number of points to keep in mind:

            1. Patients must understand and accept the CT model:  their emotions result from automatic thoughts, and they can change their automatic thoughts.  Thought Records hammer this concept home, and all patients

should learn to use them.  

            2. Never accept a patient’s assertion that no image or thought preceded an emotion.  Use role-playing or guided imagery to help the patient remember, or ask “what do you guess you were thinking about?” or offer a smorgasbord of possibilities.

3. Treatment should not be formulaic, but should focus on issues from the patient’s life.

4. Working on CT between sessions is necessary, but unique homework assignments must be designed for each patient.  At the end of a session ask “in what small way can you improve before our next session?”  Let the patient choose the homework. 

            5. When patients don’t do homework, use CT help them understand their avoidance.  “When you considered doing the homework, what thoughts and images did you have?”  DeRubeis believes that working on obstacles to completing homework is often more productive than working on other problems.

            6.  If a patient is focused on medication, say to that  patient, “the medication has made your thinking more rational, but you can learn to do that yourself, without medication.”      

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