Relapse after cognitive behavior therapy of depression: Potential implications for longer courses of treatment

Objective: The authors studied the risk of relapse among depressed patients after cognitive behavior therapy in order to document the need and potential indications for longer-term models oftreatment. Method: Forty-eight patients with major depression who responded dur-ing a 1 6-week course of cognitive behavior therapy entered a 1-year prospective follow-up study, as did two patients who received 20 weeks oftherapy. Standardized, independent clini-cal assessments were completed 1, 3, 6, 9, and 12 months after treatment. Relapse was defined as, at minimum, a 2-week period in which the subject met the DSM-III-R criteria for major depression and had a Hamilton depression scale score of 1 5 or more. Results: Sixteen patients (32%) relapsed during the 1-year follow-up. Correlates of relapse included a history of de-pressive episodes, higher levels of depressive symptoms and dysfunctional attitudes, slower response to therapy, and being unmarried. Patients who fully recovered during therapy (Ham-ilton depression score of 6 or less for 8 weeks or more) were at significantly lower risk for relapse than those who partially recovered (9 % and 52%, respectively). Slower response to therapy, unmarried status, and high residual scores on the Dysfunctional Attitudes Scale were independently and additively related to increased risk ofrelapse. Conclusions: These finding