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Cognitive and Behavioral Changes Related to Symptom Improvement Among Patients with a Mood Disorder Receiving Intensive Cognitive-behavioral Therapy

Christopher, Michael S., PhD*; Jacob, Karen L., PhD; Neuhaus, Edmund C., PhD; Neary, Timothy J., MA*; Fiola, Lauren A.

Journal of Psychiatric Practice®: March 2009 - Volume 15 - Issue 2 - p 95-102
doi: 10.1097/01.pra.0000348362.11548.5f

Objective To examine the relationship between cognitive and behavioral changes associated with cognitive-behavioral therapy (CBT) and treatment response in an intensive partial hospital (PH) setting.

Methods Study participants were 105 patients with mood disorders receiving treatment in a private psychiatric PH setting. The flexible treatment model used evidence-based CBT interventions adapted to the PH context, with emphases on psychoeducation and skills training. Participants completed self-report measures at admission and discharge to assess psychological distress, depression, negative automatic thoughts, and behavioral activation. Mean treatment duration was 9 days.

Results Decreased negative automatic thoughts and increased behavioral activation predicted reduction of depressive symptoms; however, only decreased negative automatic thoughts was predictive of patients' overall level of psychological distress.

Conclusions These results suggest that a CBT intervention adapted for use in a PH setting can be an effective treatment for severe mood disorders. Furthermore, although the design used in this study precludes causal inferences, depressive symptom improvement appears to be associated with decreased negative automatic thoughts and increased behavioral activation. Implications for the delivery of CBT in PH programs and future directions for research are discussed. (Journal of Psychiatric Practice 2009;15:95–102)

*Pacific University, Portland, OR

McLean Hospital and Harvard Medical School, Belmont, MA

The authors declare no conflict of interest.

Reprints: Michael Christopher, PhD, Assistant Professor and Director, Counseling Psychology Program, Pacific University, 511 SW 10th Ave, Suite 400, Portland, OR 97205 (e-mail:

Copyright © 2009 Wolters Kluwer Health, Inc. All rights reserved.