In Review Advances in Cognitive-Behavioural Therapy for Unipolar Depression

BT has developed out of a creative and rigorous synergy between empirical evidence and clinical innovation. In the 1970s, a group of cognitive therapists in Philadelphia led by Aaron T Beck listened carefully to what their clients were saying and turned to learning theory and the cognitive revolu-tion to formulate a new theoretical account and therapeutic approach to depression.1 This first CBT therapy protocol was then subjected to efficacy research in the first RCT of CBT for depression,2 which has since been followed with many more trials unequivocally demonstrating that CBT is an effective therapy for unipolar depression.see 3 On the basis of this research, the original therapy protocol has been elaborated4 and, for particular populations, substantively reformulated.5 It is this commitment to evidence-based practice that has The Canadian Journal of Psychiatry, Vol 52, No 1, January 2007 5 Objective: To describe the main innovations in our theoretical understanding of depression and key clinical developments in cognitive-behavioural therapy (CBT). We outline the current status of CBT and discuss how it can respond to the public health problem of depression. Method: We undertook a narrative literature review. Results: CBT provides a sophisticated, empirically grounded account of depression and an evidence-based therapeutic approach for people who suffer from depression. Beyond its efficacy in treating acute depression, it has prophylactic effects and is acceptable to various populations in a range of settings. Good theoretical accounts of the emergence of depression in adolescence are forthcoming; to date, however, attempts at primary prevention are unconvincing. Our understanding of factors contributing to positive outcomes is growing, allowing CBT to be tailored to individual client needs. Conclusions: CBT is a mainstay approach to depression. Significant remaining challenges include tailoring it to different populations and settings and, most importantly, ensuring that it is more readily accessible. (Can J Psychiatry 2007;52:5–13) Information on funding and support and author affiliations appears at the end of the article