Unprimed DAS Predicts Depression Relapse

Unprimed, higher dysfunctional attitude scale scores in a group of depressive cognitive therapy responders predicted depression relapse and recurrence.

On the other hand, primed negative mood was not associated with cognitive reactivity or dysfunctional attitudes in responders.

The findings "challenge the idea that it is necessary to prime mood in order to maximize dysfunctional attitudes’ prediction of depressive relapse and/or recurrence," reported Robin B. Jarrett, Ph.D., and her associates. The report is in the May issue of Behaviour Research and Therapy.

Dr. Jarrett of the University of Texas Southwestern Medical Center, Dallas, and her colleagues looked at 207 patients aged 18-70 years with DSM-IV nonpsychotic, recurrent major depressive disorder.

All patients had previously responded to either 16 or 20 sessions of acute phase cognitive therapy but were considered to be at higher risk based on a Hamilton Rating Scale for Depression (HRSD₁₇) score greater than or equal to 7 over the previous seven acute phase evaluations (Behav. Res. Ther. 2012:50;280-6).

Upon completion of the acute phase of cognitive therapy, patients performed the Visual Analogue Scale (VAS) and the Dysfunctional Attitudes Scale (DAS) and then underwent a mood induction procedure. Overall, 80% of patients were successfully primed to have a worsened mood, while the remaining 20% reported unchanged or improved moods after priming.

Following the mood priming, patients completed a second VAS and an alternate DAS form.

The authors found, to their surprise, that there was no significant change in patients’ mean DAS scores pre- and post mood induction.

"Because we did not observe the hypothesized negative cognitive reactivity, we examined the extent to which ... unprimed DAS scores at the end of acute phase therapy predicted relapse and/or recurrence," wrote the authors.

In this case, the DAS scores did not predict relapse or recurrence in the initial 8 months of postacute, continuation therapy.

"However, these unprimed DAS scores following acute phase cognitive therapy were predictive of relapse and/or recurrence across both the first year (20 months postrandomization) and second year of follow-up (i.e., full 32 months postrandomization)," they found.

Indeed, after the researchers controlled for posttreatment depression severity, patients with higher DAS score were at greater risk of relapse/recurrence over 20 months (hazard ratio = 1.01) and 32 months post randomization (HR also 1.01) after completion of the acute phase of cognitive therapy, compared with patients with a 1-unit-lower DAS score.

That translated to a 1.33-fold greater risk for patients with DAS scores equal to one standard deviation (30.2) higher over 20 months, and a similar figure (HR = 1.32) over 32 months – "a large, clinically relevant difference" in relapse vulnerability.

"The fact that cognitive reactivity was not evident in the current study suggests that the cognitive therapy responders may have been activating a behavior or a yet to be identified skill, perhaps learned in cognitive therapy, that prevented an increase in dysfunctional thoughts even in the presence of a negative affect shift," postulated the researchers.

"Future research may examine the change in cognitive reactivity (both positive and negative) throughout the course of illness before, during, and following different modalities of treatment," they wrote.

Several study authors disclosed ties with multiple pharmaceutical companies. The study was supported by Eli Lilly and Company.

Unprimed, higher dysfunctional attitude scale scores in a group of depressive cognitive therapy responders predicted depression relapse and recurrence.

On the other hand, primed negative mood was not associated with cognitive reactivity or dysfunctional attitudes in responders.

The findings "challenge the idea that it is necessary to prime mood in order to maximize dysfunctional attitudes’ prediction of depressive relapse and/or recurrence," reported Robin B. Jarrett, Ph.D., and her associates. The report is in the May issue of Behaviour Research and Therapy.

Dr. Jarrett of the University of Texas Southwestern Medical Center, Dallas, and her colleagues looked at 207 patients aged 18-70 years with DSM-IV nonpsychotic, recurrent major depressive disorder.

All patients had previously responded to either 16 or 20 sessions of acute phase cognitive therapy but were considered to be at higher risk based on a Hamilton Rating Scale for Depression (HRSD₁₇) score greater than or equal to 7 over the previous seven acute phase evaluations (Behav. Res. Ther. 2012:50;280-6).

Upon completion of the acute phase of cognitive therapy, patients performed the Visual Analogue Scale (VAS) and the Dysfunctional Attitudes Scale (DAS) and then underwent a mood induction procedure. Overall, 80% of patients were successfully primed to have a worsened mood, while the remaining 20% reported unchanged or improved moods after priming.

Following the mood priming, patients completed a second VAS and an alternate DAS form.

The authors found, to their surprise, that there was no significant change in patients’ mean DAS scores pre- and post mood induction.

"Because we did not observe the hypothesized negative cognitive reactivity, we examined the extent to which ... unprimed DAS scores at the end of acute phase therapy predicted relapse and/or recurrence," wrote the authors.

In this case, the DAS scores did not predict relapse or recurrence in the initial 8 months of postacute, continuation therapy.

"However, these unprimed DAS scores following acute phase cognitive therapy were predictive of relapse and/or recurrence across both the first year (20 months postrandomization) and second year of follow-up (i.e., full 32 months postrandomization)," they found.

Indeed, after the researchers controlled for posttreatment depression severity, patients with higher DAS score were at greater risk of relapse/recurrence over 20 months (hazard ratio = 1.01) and 32 months post randomization (HR also 1.01) after completion of the acute phase of cognitive therapy, compared with patients with a 1-unit-lower DAS score.

That translated to a 1.33-fold greater risk for patients with DAS scores equal to one standard deviation (30.2) higher over 20 months, and a similar figure (HR = 1.32) over 32 months – "a large, clinically relevant difference" in relapse vulnerability.

"The fact that cognitive reactivity was not evident in the current study suggests that the cognitive therapy responders may have been activating a behavior or a yet to be identified skill, perhaps learned in cognitive therapy, that prevented an increase in dysfunctional thoughts even in the presence of a negative affect shift," postulated the researchers.

"Future research may examine the change in cognitive reactivity (both positive and negative) throughout the course of illness before, during, and following different modalities of treatment," they wrote.

Several study authors disclosed ties with multiple pharmaceutical companies. The study was supported by Eli Lilly and Company.

Unprimed, higher dysfunctional attitude scale scores in a group of depressive cognitive therapy responders predicted depression relapse and recurrence.

On the other hand, primed negative mood was not associated with cognitive reactivity or dysfunctional attitudes in responders.

The findings "challenge the idea that it is necessary to prime mood in order to maximize dysfunctional attitudes’ prediction of depressive relapse and/or recurrence," reported Robin B. Jarrett, Ph.D., and her associates. The report is in the May issue of Behaviour Research and Therapy.

Dr. Jarrett of the University of Texas Southwestern Medical Center, Dallas, and her colleagues looked at 207 patients aged 18-70 years with DSM-IV nonpsychotic, recurrent major depressive disorder.

All patients had previously responded to either 16 or 20 sessions of acute phase cognitive therapy but were considered to be at higher risk based on a Hamilton Rating Scale for Depression (HRSD₁₇) score greater than or equal to 7 over the previous seven acute phase evaluations (Behav. Res. Ther. 2012:50;280-6).

Upon completion of the acute phase of cognitive therapy, patients performed the Visual Analogue Scale (VAS) and the Dysfunctional Attitudes Scale (DAS) and then underwent a mood induction procedure. Overall, 80% of patients were successfully primed to have a worsened mood, while the remaining 20% reported unchanged or improved moods after priming.

Following the mood priming, patients completed a second VAS and an alternate DAS form.

The authors found, to their surprise, that there was no significant change in patients’ mean DAS scores pre- and post mood induction.

"Because we did not observe the hypothesized negative cognitive reactivity, we examined the extent to which ... unprimed DAS scores at the end of acute phase therapy predicted relapse and/or recurrence," wrote the authors.

In this case, the DAS scores did not predict relapse or recurrence in the initial 8 months of postacute, continuation therapy.

"However, these unprimed DAS scores following acute phase cognitive therapy were predictive of relapse and/or recurrence across both the first year (20 months postrandomization) and second year of follow-up (i.e., full 32 months postrandomization)," they found.

Indeed, after the researchers controlled for posttreatment depression severity, patients with higher DAS score were at greater risk of relapse/recurrence over 20 months (hazard ratio = 1.01) and 32 months post randomization (HR also 1.01) after completion of the acute phase of cognitive therapy, compared with patients with a 1-unit-lower DAS score.

That translated to a 1.33-fold greater risk for patients with DAS scores equal to one standard deviation (30.2) higher over 20 months, and a similar figure (HR = 1.32) over 32 months – "a large, clinically relevant difference" in relapse vulnerability.

"The fact that cognitive reactivity was not evident in the current study suggests that the cognitive therapy responders may have been activating a behavior or a yet to be identified skill, perhaps learned in cognitive therapy, that prevented an increase in dysfunctional thoughts even in the presence of a negative affect shift," postulated the researchers.

"Future research may examine the change in cognitive reactivity (both positive and negative) throughout the course of illness before, during, and following different modalities of treatment," they wrote.

Several study authors disclosed ties with multiple pharmaceutical companies. The study was supported by Eli Lilly and Company.